Opportunities and Challenges to Improve Postpartum Care: Payors’ and Purchasers’ Perspectives in California
Open accessAbstract
Introduction: U.S. maternal mortality rates are two to three times higher than other high-income countries, with most deaths occurring postpartum. Fragmented care, exacerbated by health insurance gaps and workforce shortages, underscores systemic deficiencies. Although patients’ and clinicians’ perspectives are well-documented, little is known about payors’ and purchasers’ perspectives. Given their influence in coverage decisions, payment rates, and service reimbursement, the objective was to explore their perspectives and identify challenges and opportunities in improving postpartum care in California, currently engaged in reshaping maternal health pathways. Methods: We conducted a qualitative study using semi-structured interviews with high-level administrators from major California health insurance providers and purchasers between June and October 2023. Participants, recruited through professional connections, were selected through purposive sampling based on their involvement in maternal and child health coverage decisions. A hybrid inductive–deductive approach was employed to identify major themes. Results: Participants ( n = 11) identified barriers including limited insurance coverage, lack of clinical provider incentives, reimbursement concerns, and misaligned measures and metrics. Opportunities to improve postpartum care focused on visit timing and frequency, alternative payment models, and improving continuity of care between birth and the transition to primary care. Conclusions: Insurance payors and purchasers identified postpartum care barriers and suggested solutions well-supported by the literature. These solutions—including reimagining global bundle payment models, updating Healthcare Effectiveness Data and Information Set measures, and promoting dyadic models—could address barriers, improve outcomes, and inform California’s ongoing maternal health transformation and those happening around the United States.
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Workforce shortages, funding mechanisms, and organizational culture all play significant roles in the scalability and success of continuity models.
“Workforce shortages, funding mechanisms, and organizational culture all play significant roles in the scalability and success of continuity models (Parham et al., 2025).”
From Extending the continuum: Mapping post-6-week nurse/midwife-led interventions for postnatal women – A scoping review (2026) · cites this paper as Parham et al., 2025
The Results (Barriers and Opportunities; page unavailable) identify obstetric workforce shortages and reimbursement arrangements as obstacles to postpartum care. The Discussion links workforce capacity and payment changes to models intended to increase continuity. Our copy does not identify organizational culture as a factor or establish that these factors determine the scalability and success of continuity models generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPublicly organised maternity and community health services, insurance-based systems, federally qualified health centres, and hospital-based programs create different workforce roles, referral pathways, reimbursement incentives, and barriers to continuity.
“Publicly organised maternity and community health services, insurance-based systems, federally qualified health centres, and hospital-based programs create different workforce roles, referral pathways, reimbursement incentives, and barriers to continuity (Habib et al., 2023; Parham et al., 2025).”
From Extending the continuum: Mapping post-6-week nurse/midwife-led interventions for postnatal women – A scoping review (2026) · cites this paper as Parham et al., 2025
The Results (Barriers; page not provided) describe different reimbursement arrangements for Medicaid, private insurance, and FQHCs, as well as fee-for-service barriers to care coordination. The Discussion (page not provided) addresses clinician roles, referrals, and continuity. The paper does not establish the claimed comparison across publicly organised services and hospital-based programs. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMany healthcare systems limit postpartum care to a single visit at six weeks, leaving a gap in support as women adjust to the physiological, psychological, and social changes of motherhood.
“Many healthcare systems limit postpartum care to a single visit at six weeks, leaving a gap in support as women adjust to the physiological, psychological, and social changes of motherhood (Parham et al., 2025; Dol et al., 2022).”
From Extending the continuum: Mapping post-6-week nurse/midwife-led interventions for postnatal women – A scoping review (2026) · cites this paper as Parham et al., 2025
The feasibility of nurse- and midwife-led models differs among countries.
“The feasibility of such models also differs among countries.”
From Extending the continuum: Mapping post-6-week nurse/midwife-led interventions for postnatal women – A scoping review (2026) · cites this paper as Parham et al., 2025
The Results > Opportunities passages discuss nurse-practitioner home visits and community midwives in California, but do not compare the feasibility of nurse- or midwife-led models across countries. The Discussion likewise addresses California’s postpartum-care system. Searches for cross-country feasibility and international nurse- or midwife-led models found no passage making the attributed point; page numbers were not available in our copy. (LLM, conf=0.74)
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- Authors
- Parham, L., Clarke, R., Ornelas, M. D., Li, S., & Guendelman, S.
- Affiliations
- University of California, Berkeley (US)
- Corresponding author
- Parham, Lindsay
- Clarke, Renee
- Venue
- Women's Health Reports
- Publisher
- SAGE Publications
- Published
- 2025-01
- Volume
- 6
- Issue
- 1
- Pages
- 464-475
- ISSN
- 2688-4844 (ISSN-L)
- PMC
- PMC12177326
- OpenAlex
- W4409646936
- Cited by
- 4
- References
- 25
- Citations by year
- 2026: 3 · 2025: 1
- FWCI
- 3.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Women s Health Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- postpartum care, maternal health, insurance coverage gaps, reimbursement, continuity of care, transition to primary care, maternal mortality
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