Aligning with the state’s ongoing efforts to improve maternal health and reduce maternal morbidity and mortality, Episcopal Health Foundationhas chosen maternal health as a Priority for Change. In support of this strategic priority, EHF commissioned an evaluation of an alternative payment model (APM) between Cook Children’s Health Plan (CCHP) and My Health My Resources of Tarrant County (MHMR) for the Family Connects program. This evaluation identifies key findings and opportunities to expand and sustain maternal health APMs across the state.1
Family Connects APM
CCHP and MHMR express a shared commitment to improving the health and outcomes of mothers and children in the community through the delivery of proven services. The Family Connects APM, which began in December 2019 and continues today, is an example of these efforts.2
Family Connects is an evidence-based, universal postpartum nurse home visiting program. During the home visit that typically occurs within three weeks of delivery, nurses conduct health assessments of the mother and newborn, provide education, connect families with needed medical and community resources, and follow-up as needed.
According to FamilyConnects International, findings from 2009 and 2014 studies reveal significant benefits of the model, including, but not limited to, 50% fewer emergency room visits and overnight hospital stays in the first year, 30% lower likelihood of postpartum depression or anxiety, and more mothers attending their 6-week postpartum health check.
APM Performance
MHMR served from 264 to 332 CCHP members annually from 2023 to 2025, including about 22% of referrals to the program from CCHP.3 CCHP reports daily hospital deliveries to MHMR, which makes three attempts to contact the members via phone or text. MHMR assigns nurses to women who agree to participate and closes cases when members cannot be reached or decline services.
Overall, MHMR was successful in achieving APM performance goals, and significantly exceeded them for most performance measures. However, the 90% goal for postpartum home visits was not met for one APM payment, with MHMR completing 85% of postpartum home visits. For other APM payments, MHMR’s performance on postpartum home visits was at or above the goal.
Limited comparisons can be made between MHMR’s performance and other benchmarks, because the APM measures are not standardized, except for postpartum OB visits. For postpartum care, the state’s overall Medicaid rate was 80.70% for 2024 for the STAR Medicaid program.4 MHMR exceeded this rate for all but one of the payment periods.
Key Findings
Goal alignment and the trusting, collaborative relationship of CCHP and MHMR of Tarrant County have been important factors for the development and continued operation of the APM. They effectively worked together to jointly develop the Family Connects APM and address any initial operational issues (e.g., reporting and validating data, service coordination). Currently, they are discussing evolving the APM to potentially include services across the full perinatal period (from pregnancy through 12 months postpartum). Separate work is also occurring on financing models for the North Texas Maternal Health Accelerator which will need to consider existing APMs, like this agreement between MHMR and CCHP.6
Provider participation in APMs also requires capacity and infrastructure. Negotiating APMs takes significant time, and APM payments can be made retroactively and periodically, requiring providers to cover upfront costs for service delivery and administration. MHMR of Tarrant County has sufficient funding to cover these costs temporarily, but other MHMRs and safety net providers may not have this ability and would need other sources of seed funding.
In addition to having the necessary capacity and infrastructure, MHMR of Tarrant County provides integrated services – physical health, mental health, and non-medical drivers of health – that are connected to local systems of care. For maternal health specifically, MHMR of Tarrant County administers a system of care collaboration with community partners through Help Me Grow North Texas (HMGNTX), of which Family Connects and Perinatal Connections are sub-systems.7 The scope of services and local integration were identified as valuable and effective for driving quality improvement.
Opportunities for Scaling and Sustainability
The evaluation of the Family Connects APM identified opportunities for scaling and sustaining APMs to improve maternal health and address other state priorities. These include:
- Implementing Evidence-based Models: Family Connects is an evidence-based model, increasing confidence for providers and managed care organizations (MCOs) that outcomes and payments will be achieved. Despite the use of an evidence-based model, CCHP and MHMR still experienced barriers to reaching and engaging members, with about 22% of individuals referred by CCHP to MHMR participating in Family Connects. Increasing member education about available programs and services and providing members with additional incentives could help identify pregnant members earlier and increase member response and participation rates.
- Scaling APMs based on Members Served: The Family Connects APM provides a periodic, fixed payment amount, which does not change based on the number of members served. Providing payments based on members served would better support program growth and improve sustainability.
- Moving to Outcome Measures: CCHP and MHMR are working to transition to performance measures that are more focused on outcomes and better aligned with HEDIS (Healthcare Effectiveness Data and Information Set) and other standardized quality measures. While the current APM’s performance measures are consistent with maternal and child health priorities – like postpartum visits, postpartum depression screening, and well child visits – they do not all follow standardized measure definitions, reducing comparability across populations and programs. Adding outcome measures may also help to better demonstrate the APM’s impact and estimate return-on-investment (ROI). ROI estimates could support development of an APM that is more advanced (e.g., shared savings), sustainable long-term, and applicable across MCOs.
- Aligning across MCOs: MHMR also has an APM with another MCO in the Tarrant Service Area for perinatal services. To the extent feasible, aligning APMs across MCOs could improve sustainability by reducing administrative burden and providing consistent payment methodologies for providers.
- Leveraging Medicaid Flexibilities: The Texas Health and Human Services Commission’s guidance on Quality Improvement Costs and implementation of the APM-Performance Framework provide MCOs flexibility and incentives to pursue APMs like the Family Connects APM.
Conclusion
The Family Connects APM shows how MCOs and providers can collaborate to address state priorities, like maternal health, and improve the health and outcomes for the people they serve. As MCOs and providers gain experience in an APM together, they can evolve into more advanced and sustainable value-based arrangements that achieve better outcomes and reduce unnecessary costs.
Note: This summary was completed by Stephens Consulting Group. This work was completed prior to August 2026.
More from Digging Deeper
What it Takes to Use AI Responsibly: Guardrails for Safety-Net, Rural, and Underserved Care
Artificial intelligence (AI) is rapidly entering health care including safety-net, rural, and underserved settings, where access, capacity, and workforce constraints are most acute. Across the literature, AI is described as a tool that can support clinical decision-making, improve outcomes, and expand access. But those same systems also raise concerns about
How AI Deepens Inequity: Where the Risks Show Up in Practice
Artificial intelligence (AI) is rapidly entering health care including safety-net, rural, and underserved settings, where access, capacity, and workforce constraints are most acute. Across the literature, AI is described as a tool that can support clinical decision-making, improve outcomes, and expand access. But those same systems also raise concerns about
Where AI Could Help: Filling the Gaps that Safety-Net, Rural, and Underserved Systems Face Every Day
Artificial intelligence (AI) is rapidly entering health care including safety-net, rural, and underserved settings, where access, capacity, and workforce constraints are most acute. Across the literature, AI is described as a tool that can support clinical decision-making, improve outcomes, and expand access. But those same systems also raise concerns about