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Performance-Based Maternity Payments

Value-based initiatives seek to reward better health outcomes, enhance beneficiaries’ experience of care, and reduce health care costs over time. In 2018, TRICARE introduced its Performance-Based Maternity Payment Pilot, a value-based initiative that sought to improve health outcomes for mothers and babies through an increased emphasis on maternity care quality in the TRICARE networks. 

The Leapfrog Group, a national nonprofit organization established to drive improvements in health care quality and safety, conducts an annual hospital survey and compares reported hospital performance against nationally-recognized benchmarks for five maternity care measures (early elective deliveries, C-sections, episiotomies, maternity care processes, and high-risk deliveries). Applicable providers were awarded a rating based upon the most current survey data posted by The Leapfrog Group and were eligible for annual incentive payments. 

TRICARE’s Performance-Based Maternity Payments Pilot Program ended Sept. 1, 2021.

Survey Time Frames

The Leapfrog Group survey opens every year on April 1. Surveys that are completed by June 30 are published on July 25; however, the latest submission deadline is November 30 to be considered for the Spring Leapfrog Hospital Safety Grade. Visit The Leapfrog Group’s Deadline page to learn more. 

To learn more about The Leapfrog Group and survey participation, scoring and results, please visit www.leapfroggroup.org.

Incentive Payments

Hospitals who participated in The Leapfrog Group’s survey were eligible for annual incentive payments under TRICARE’s Performance-Based Maternity Payment Pilot.

  • High Value = 2 percent
  • Value = 1 percent
  • High-Risk Delivery = an additional 1 percent

The Defense Health Agency calculated incentive payments for the following incentive cycles:

  • Incentive Cycle 1: Calculated based on The Leapfrog Group rating as of Aug. 1, 2019 (for dates of service between Sept 1, 2018 and Dec. 31, 2018)
  • Incentive Cycle 2: Calculated based on The Leapfrog Group rating as of Feb. 1, 2021 (originally Aug. 1, 2020) (for dates of service between Jan. 1, 2019 and Dec. 31, 2019)
  • Incentive Cycle 3: Calculated based on The Leapfrog Group rating as of Feb. 1, 2022 (originally Aug. 1, 2021) (for dates of service between Jan. 1, 2020 and Dec. 31, 2020)

Participation in The Leapfrog Group’s survey is voluntary; however, only hospitals that participated in the survey were eligible for incentives. 

Directory Ratings

HNFS’ Network Provider Directory identifies those providers awarded with a rating of High Value, Value or High-Risk Delivery with a corresponding icon (gold stork, green stork, pregnant woman), based upon the most current survey data posted by The Leapfrog Group on its public website. Ratings are through Sept. 1, 2021, at which point the Performance-Based Maternity Payments Pilot Program ended, although a final ratings update will occur in February 2022 to correspond with the final Incentive Cycle 3.

Maternity Care Measure Resources

Early Elective Deliveries

Cesarean Sections 

Episiotomies

Maternity Care Processes

High-Risk Deliveries

  • High-risk delivery data by hospital on nationally standardized metrics collaboration between Castlight Health and The Leapfrog Group.

Visit The Leapfrog Group's Maternity Care page to learn more about these measures and their latest hospital performance report.