Maternal health sits high on the priority list for most Medicaid and commercial health plans. The challenge is that they often rely on traditional outreach methods that can’t move the needle on prenatal and postpartum care alone.
Sending an automated text blast, mailing a brochure or placing a robocall doesn’t motivate an expectant or new mother if obstacles in her daily life prevent her from visiting the clinic. Transactional interactions such as these paint health plans poorly as they go through the motions of surface-level interactions — or engagement washing — instead of building connections. Health care outreach must go above and beyond. As the U.S. Centers for Medicare & Medicaid Services focuses more on clinical outcomes and standardizes mandatory reporting through the 2026 Maternity Core Set, health plans must establish authentic relationships with their members.
By tying resources to meaningful member action, health plans can improve critical maternal quality metrics, such as Healthcare Effectiveness Data and Information Set (HEDIS) performance and downstream utilization outcomes. Prenatal and postpartum visits serve as the vital early indicators of improved maternal quality performance.
Activating members improves health, closes gaps and delivers a measurable return to plans.
Expectant and postpartum mothers face complex nonmedical drivers of health (NMDOH) that derail care compliance. These hurdles include a lack of childcare for older siblings, unreliable transportation and maternal mental health struggles. For many vulnerable members, federal Supplemental Nutrition Assistance Program budget cuts paired with shifting work requirements have limited eligibility, worsening food insecurity.
A mother can’t prioritize a postpartum checkup or a glucose screening if she is stressed about stable nutrition or navigating newborn logistics alone. Gaps in care stay open because plans try to solve a clinical problem without addressing the daily household trade-offs. Trade-offs are made around the kitchen table every day, forcing members to choose between groceries, prescriptions or a doctor visit. Solving maternal anxieties requires a strategy that addresses these household realities.
Pyx Health drives measurable improvements in maternal quality metrics, such as HEDIS scores, by tying deep member activation and resource delivery directly to clinical actions. Strategically deployed in-home deliveries of nutritious food boxes and maternal essentials capture a mother's attention and build trust to encourage health care participation.
The Pyx Health platform tracks maternal needs in the moment, blending member screenings and human-first support with technology to identify risks. The platform offers real-time assistance with resource eligibility, such as assisting with local program enrollment, all while guiding toward appointment scheduling.
Empathetic coordinators provide a friendly, nonclinical voice to screen for maternal isolation, depression and access to care, escalating critical needs to the health plan’s care managers. Loneliness can feel like no one understands what you’re going through, and pregnant women and new moms are among those hit the hardest. Without necessary support, their mental health can decline even more, making it all the more difficult to ask for help.
Pyx Health empowers plans to meet quality and financial goals by building trust with members. We help you build rapport and support NMDOH needs through strategic services and food box delivery. Prioritizing activation helps you track quality-centric member milestones, such as completed prenatal appointments, and drive clinical results. Protect your revenue and improve member experience and maternal quality metrics.
As the National Committee for Quality Assurance (NCQA) transitions traditional HEDIS hybrid measures to digital formats, plans need accurate and actionable data.
The NCQA postpartum care measure tracks care throughout pregnancies. While data shows that approximately 83% of women completed a prenatal depression screening at opt in, the 7-84 day postpartum visit window looks much different. Over half of maternal deaths occur after birth, many of which could be prevented. Activating members to attend these visits allows clinicians to identify and address complications such as hemorrhage, hypertensive disorders, or mental health crises.
Pyx Health data shows that moving past surface-level outreach yields clear clinical results:
Proactive behaviors such as these drive healthier long-term actions, reduce avoidable emergency room utilization and establish trust between moms and their health plans.
Most moms want prenatal care to ensure their child’s health —they just don't have the access or understanding to do so. Filling this gap requires intentional activation. As health plans build the trust and connection to address NMDOH challenges mothers face at home, maternal quality metrics, such as HEDIS performance, improve.
Partner with Pyx Health to transform maternal care and drive clinical action. Contact us today to learn how our approach turns compassionate support into measurable quality outcomes and revenue protection.