Improving perinatal outcomes

Learn more about the work being done to improve perinatal outcomes and get project updates.


In 2022, the Washington Health Care Authority (HCA) set out to explore and design a maternal episode of care to incentivize high-quality, high-value care. The goal was to improve perinatal health outcomes and address racial and ethnic inequities by leveraging a value-based purchasing (VBP) strategy.

After analyzing existing maternity episode of care models from other states (focused on the Medicaid context), limited evidence of improved outcomes, and engagement with stakeholders and partners, HCA has decided not to pursue implementation of a maternity episode of care at this time. HCA remains open to the possibility of an episode of care in the future.


HCA continues to work toward improving perinatal outcomes, defined as initiation of prenatal care through 12 months postpartum. We aim to decrease inequities for birth parents and infants and incentivize higher value care. This work aligns with HCA’s mission, vision, and strategic plan.

In July 2023, HCA began work on two projects:

  • Creating and supporting a doula benefit for Apple Health, PEBB, and SEBB
  • Increasing access to midwives and midwifery models of care

These projects aim to:

  • Improve perinatal outcomes, including reducing maternal morbidity and mortality.
  • Address inequities in the Apple Health population.
  • Increase utilization and improve quality of prenatal and postpartum care.
  • Utilize data-informed and data-driven approaches.
  • Increase care coordination between health care providers and broader care teams across the perinatal period for both birth parent and infant.


HCA is pursuing two projects to improve perinatal outcomes. Read more about birth doulas and midwives below.


Birth doulas are trained nonclinical professionals who provide emotional, physical, psychosocial, and informational support to pregnant, birthing, post-pregnancy people, and their families.

Evidence supports doulas improving outcomes across a range of metrics for this population, including infants, and a larger positive impact for Black, Indigenous, and people of color populations. There has long been support in Washington for increasing access to doulas, especially for people on Apple Health.

The goals of this project are to:

  • Implement Apple Health, PEBB, and SEBB doula benefits.
  • Support this benefit and related services post-implementation.
  • Address barriers or unintended consequences that arise.

To stay informed on this project, sign up for doula notifications from HCA.

Doula resources


Midwives are trained, clinical, licensed health professionals who primarily care for pregnant, birthing, and postpartum people.

There are different types of midwives in Washington:

  • Licensed midwives
  • Certified nurse midwives

Evidence supports that midwives and midwifery models of care have positive impacts on various outcomes, including:

  • Natural and physiologic birth.
  • Less interventions.
  • Decreased preterm birth.
  • Improved mental health.
  • Increased breastfeeding.
  • Other clinical outcomes for low risk pregnancies, such as those expected to have a natural (vaginal) birth.

The goal of this project is to increase access to midwives and midwifery models of care for Apple Health.



For input on design and implementation
 HCA improving perinatal outcomes