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NJ Family Care

NJ FamilyCare’s perinatal episode of care is a three-year pilot to test a new alternative payment model for prenatal, labor, and postpartum services statewide. Clinicians who choose to participate in the pilot are financially incentivized to take on comprehensive responsibility for the quality and cost of their patients’ care. The episode pilot will tie incentives to improvements in quality and cost of maternity-related care, from the prenatal period to 60 days postpartum. In addition to eligibility for additional financial incentives, providers who participate in the pilot will receive detailed personalized feedback on their performance and will undertake specific quality improvement activities.

The pilot’s goal is to improve the quality and equity of perinatal care delivered within NJ’s Medicaid and CHIP programs, while supporting the financial sustainability of the program.

The perinatal episode of care pilot is part of the maternal health reforms of NurtureNJ, a statewide campaign led by First Lady Tammy Murphy to make New Jersey the safest and most equitable place in the nation to deliver and raise a baby.

Information for Providers Interested in Participating in the Episode of Care

Practices must provide obstetrical care for members enrolled in at least one of our NJ FamilyCare managed care organizations (MCOs) to be eligible to participate.

Participation in the pilot by providers is voluntary. To participate in the episode pilot, providers must tell DMAHS (NJ’s State Medicaid Agency) in advance of their interest—first through submitting a Letter of Intent, and later submitting a Participation Agreement. The pilot begins on April 1, 2022. Providers can choose to participate in any of the following three Performance Periods of the pilot (see Key dates):

Performance Period 1 (15 months): April 1, 2022-June 30, 2023

Performance Period 2 (12 months): July 1, 2023-June 30, 2024

Performance Period 3 (12 months): July 1, 2024-June 30, 2025

For Performance Period 1, the Letter of Intent from any provider interested in participating is due Friday, January 21, 2022. The submission form for the Letter of Intent must be completed via the HIPAA-Compliant online form here.

For more information:

  • Watch the introductory webinar (Webinar #1: Introduction to the NJ FamilyCare perinatal episode of care pilot). A recorded version of the webinar is available here: Video recording, Slide deck.
  • Read our Guide for Participating Providers. For Guide Appendices, see “Performance Period 1 Guide for Participating Providers: Appendix Material” below.
  • Review your personalized Pilot Launch Report (see Sample Report for the information that is contained). This report, sharing the quality and cost of your patients’ care from 2020, has been sent to most providers eligible to participate in the pilot via the PRA/SPECT portal. To get guidance on how to interpret your Pilot Launch Report, watch the Pilot Launch Report webinar (Webinar #2: NJ FamilyCare’s perinatal episode of care pilot: Pilot Launch Report). A recorded version of the webinar is available here: Video recording, Slide deck). Even if you do not see a Pilot Launch Report in your account, you may still be eligible to participate. If you have any questions about why your practice did not receive a report, please attend our webinar or email us at mahs.maternityepisode@dhs.nj.gov.

Email mahs.maternityepisode@dhs.nj.gov with questions about the episode pilot.

 
 
Information for Members

If your provider chooses to participate in this pilot program, it does not in any way restrict your rights or ability to access care as a Medicaid or CHIP member. You can choose any NJ FamilyCare provider in your managed care organization’s network for your obstetrical care, including a provider who has not chosen to participate in this pilot.

If your obstetrical provider(s) participates in this pilot, they have made a commitment to drive improvements in the quality of maternity care that you receive. Your provider will receive information about the care you and their other NJ FamilyCare patients have received during the perinatal period, which is intended to make them aware of the quality of care they are providing, and identify opportunities for improvement in the care you receive.

Once participation in Performance Period 1 has been finalized, a list of participating providers will be posted on this website.

 
 
Episode of Care Steering Committee

The design of NJ FamilyCare’s perinatal episode of care has benefited from the ongoing input of the Episode of Care Steering Committee. This group includes providers, hospital systems, managed care organizations, and state agencies. For more information about the work of the Steering Committee, please see Episode of Care Steering Committee.

 
 
Episode of Care North Star Principles

The Episode North Star Principles describes the overall goals of the pilot and guides our implementation of the perinatal episode of care.

 
 
Performance Period 1 Guide for Participating Providers: Appendix

Appendices for the Guide for Participating Providers:

 
 
Episode of Care Recorded Webinars

Webinar #1: Introduction to the NJ FamilyCare perinatal episode of care pilot (Original Session Date: 12/7/2021)

  • Webinar 1 is a 45 minute presentation that covers the background on the pilot and describes key features of the perinatal episode of care for Performance Period 1.
  • Presentation (video recording)
  • Slide deck (PDF)

Webinar #2: NJ FamilyCare’s perinatal episode of care pilot: Pilot Launch Report (Original Session Date: 1/7/2022)

  • Webinar 2 is a 45 minute presentation that covers how to read and interpret the data shared in the Episode Pilot Launch Report released to providers in December 2021. The information included in the Pilot Launch Report reflects what providers who choose to participate in the pilot will receive in Interim/Final Performance Period reports.
  • Sample Pilot Launch Report
  • Presentation (video recording)
  • Slide deck (PDF)
 
 
 
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