Virtual maternity care for health plans is one of the most direct levers available for closing HEDIS prenatal and postpartum care gaps. The Prenatal and Postpartum Care (PPC) measures reward two things: a timely prenatal visit early in pregnancy and a postpartum visit in the weeks after delivery. Both are visits that a meaningful share of members, particularly in Medicaid populations, simply never make. The gap is rarely about clinical need; it is about access, engagement, and follow-through. Virtual maternity care attacks exactly those barriers, reaching members where they are and documenting the care that closes the measure.
For plans, the stakes are both quality and cost. PPC performance feeds Medicaid quality ratings and Star Ratings, and the members who fall through the gaps are frequently the same members at highest risk for costly maternal complications. Closing the gap and improving outcomes are, in maternity care, the same project.
What are the HEDIS prenatal and postpartum care measures?
The HEDIS Prenatal and Postpartum Care measures, known as PPC, assess two components of maternity care. The prenatal component looks at whether members receive a prenatal care visit in the first trimester or within a set number of days of enrollment. The postpartum component looks at whether members receive a postpartum visit within a defined window after delivery, commonly framed as roughly one to twelve weeks postpartum.
These PPC measures matter because they are quality signals with real weight. For Medicaid managed care plans they influence quality ratings and state reporting, and they serve as proxies for whether members are actually engaged in maternity care at the two moments that most shape outcomes: the start of pregnancy and the postpartum transition. A plan can have adequate maternity providers on paper and still post weak PPC numbers if members are not reaching those visits.
Why do prenatal and postpartum gaps persist?
Understanding why the gaps exist is the key to closing them, because most failures are structural rather than clinical.
Access and logistics come first. Transportation, childcare, inflexible work schedules, and long travel distances all reduce the odds that a member makes a first-trimester or postpartum visit. In maternity care deserts, the nearest obstetric provider may be far away, and appointment availability may be limited.
Timing works against the measures. The first-trimester window is narrow, and members may not realize they are pregnant, may not be enrolled yet, or may face a wait for a first appointment. Postpartum, the challenge is different: a new parent recovering from birth and caring for a newborn often deprioritizes their own follow-up, and a single visit weeks after delivery is easy to miss.
Engagement and continuity are the connective tissue. Members who are hard to reach, who move, or who lack a consistent relationship with a provider are the ones who drop out of the care pathway, and they are disproportionately represented in Medicaid populations. These same members are frequently at elevated clinical risk, which is what makes the gap so costly.
How does virtual maternity care close HEDIS gaps?
Medicaid maternity telehealth addresses the gaps at their root because it targets access, timing, and engagement directly rather than assuming members will overcome those barriers on their own.
It removes the logistics barrier. A virtual prenatal or postpartum visit eliminates travel, reduces the childcare burden, and fits around work schedules, which raises the probability that a hard-to-reach member actually completes the visit that closes the measure. For members in provider-scarce areas, telehealth may be the only realistic path to a timely visit.
It reaches members earlier and keeps them engaged. Virtual care can connect a newly pregnant member to a first prenatal touchpoint faster than waiting for in-person availability, supporting the first-trimester component. Across the pregnancy, virtual check-ins maintain the continuity that keeps members in the care pathway rather than falling out of it.
It protects the postpartum visit. Because the postpartum window is where drop-off is worst, a virtual postpartum visit that a member can complete from home is often the difference between a closed and an open measure. It also extends the plan's reach into the postpartum period, when both PPC compliance and clinical risk are in play.
It generates documentation. Gap closure is not only about care delivered, it is about care captured. Virtual visits produce documented encounters that feed measure compliance, and a maternity partner focused on quality can align its workflows to what the PPC measures require. Ouma works directly with health plans to close these gaps at the population level.
What role does care navigation play in gap closure?
Reaching members is not only a technology problem; it is an outreach and coordination problem, which is where care navigation becomes decisive. Many members who miss visits are not refusing care, they are lost in the seams: unaware of their benefits, unsure how to schedule, or disengaged after an early barrier.
Nurse navigators change that math. Proactive outreach identifies pregnant and postpartum members, connects them to care, helps them schedule and attend visits, and follows up when they slip. Navigation also handles the coordination that keeps a pregnancy on track, linking members to the right level of care, addressing social barriers, and ensuring the postpartum visit actually happens. Ouma pairs virtual maternity care with nurse navigation precisely because outreach and coordination are what convert a member who would have missed a visit into a documented, closed gap.
The combination is what works: telehealth removes the barriers to attending, and navigation makes sure members are identified, engaged, and guided to the visits in the first place.
Why does gap closure connect to better outcomes and lower cost?
For health plans, the PPC measures are not an isolated scorecard item; they are a proxy for whether the highest-risk members are engaged in maternity care. The members who miss prenatal and postpartum visits overlap heavily with those at risk for hypertensive disorders, poorly managed gestational diabetes, and untreated perinatal mental health conditions, all of which drive avoidable maternal morbidity and significant downstream cost.
That means closing HEDIS prenatal and postpartum gaps is not a documentation exercise in isolation. When done through real clinical engagement, it means members are actually being seen, screened, and managed at the two moments that most influence maternal and infant outcomes. Improved PPC performance and reduced maternal complications move together when the underlying care is genuine.
This is also why the nature of the maternity partner matters. Closing gaps through a real medical practice, rather than a self-service app, means the visits that satisfy the measure are also delivering clinical value: screening for preeclampsia risk and depression, managing chronic conditions, and coordinating care. The measure closes because the care happened.
Ouma Health: a maternity practice built for plan performance
Ouma Health is the largest independent, physician-led maternity telehealth practice, founded by maternal-fetal medicine specialists. For health plans, Ouma pairs virtual maternity care with nurse-led navigation to reach the members who miss prenatal and postpartum visits, especially in Medicaid populations, and to convert those missed visits into documented, closed HEDIS gaps. Because Ouma is a real medical practice and not an app, gap closure comes with genuine clinical engagement: screening, chronic condition management, and coordination at the moments that shape outcomes. To improve PPC performance and member outcomes together, explore how Ouma works with health plans.
Frequently asked questions
What are the HEDIS PPC measures?
The Prenatal and Postpartum Care (PPC) measures assess whether members receive a timely prenatal visit early in pregnancy and a postpartum visit within a defined window after delivery. They are quality signals that influence Medicaid quality ratings and Star Ratings and reflect member engagement at two pivotal moments.
How does virtual maternity care help close these gaps?
It removes the access barriers that cause missed visits, such as transportation, childcare, and provider scarcity, by letting members complete prenatal and postpartum visits from home. That raises completion rates and produces documented encounters that feed measure compliance.
Why are Medicaid populations a particular focus?
Members in Medicaid populations disproportionately face access, transportation, and continuity barriers, so they are more likely to miss PPC visits and more likely to be at elevated clinical risk. Medicaid maternity telehealth targets those barriers directly.
Does closing HEDIS gaps actually improve outcomes?
When gap closure happens through real clinical care rather than documentation alone, yes. The members who miss visits overlap with those at risk for preeclampsia, gestational diabetes, and perinatal mental health conditions, so genuine engagement at these visits improves outcomes while it closes the measure.
