A Toolkit for Implementing Two-Generation Postpartum Care

Additional Considerations and Resources

In this section, we provide further information to support organizations who are considering changes to enhance postpartum care in their organizations.

Click below to download the organizational assessment tool for enhancing postpartum care in your organization:

Dyadic Care

Medical and psychiatric care delivered in UI Health Two-Gen are reimbursed through usual billable health care encounters, billed for each patient (mother, infant, family members). Providing dyadic care should not affect clinic reimbursement from Medicaid or private insurance, as two (or more) different patients are being scheduled and seen.

The Two-Gen care model has the potential to include billing insurance (including Medicaid) for wrap-around services such as care coordination, depending on patient’s insurance plan or the state’s Medicaid coverage for services.  

Collaborative Care

If the Two-Gen clinic offers collaborative care in which psychiatric services are 
offered in conjunction with primary care, many payers (including Medicaid) cover this service.11 Collaborative care billing requires specific documentation and care coordination activities. For more information, see this psychiatry.org resource.

Grant Funding

In some instances, organizations providing Two-Gen care may consider grant funding to hire additional providers such as community health workers or lactation consultants if the services provided by these individuals are not reimbursable by Medicaid or private insurance.   

In 2022 and 2023, a Patient Care Satisfaction Survey was administered via phone to UI Health Two-Gen patients.12 The survey had 33 respondents out of 85 patients 
approached. Key findings are noted below:

In May 2023, select patients were approached to share their experiences of being a part of the UI Health Two-Gen Clinic. Some of their responses are shown below.

How is the Two-Gen clinic different from your past healthcare experiences?

“The Two-Gen clinic focuses not just on the medical part but like the whole picture, so the health care, the mental, as well as the kids. So, it’s not just me, it’s all of us at the same time.”

“Ever since I came into the clinic, I have had more support, more understanding not just the physical checkup but more about the family and my stresses in life.”

What parts of your care or your child’s care are you most happy or satisfied with?

“I am satisfied with the calling and making sure that I am on track with my 
appointments, that’s something other clinics have never done for me, and the text messages.”

“I am happy with pretty much every service that we have gotten. Our primary care doctor is great, she is very attentive to all of us. You guys [the social workers] are great, you are very attentive as well and with resources. Whatever we need pretty much you guys are giving us whatever resources we need.”

What surprised you the most about the Two-Gen Clinic?

“Originally, I thought it was just for kids, but it is for us adults as well. So that’s actually good, so I don’t have to go a different clinic and we just all come here and do everything at once.”

  1. Wang S, Rexrode KM, Florio AA, Rich-Edwards JW, Chavarro JE. Maternal Mortality in the United States: Trends and Opportunities for Prevention. Annu Rev Med. 2023 Jan 27;74:199-216. 
  2. Trost SL, Beauregard JL, Smoots AN, et al. Preventing pregnancy-related mental health deaths: insights from 14 US Maternal Mortality Review Committees, 2008–2017: Health Affairs 2021;40:1551–1559.
  3. Illinois Department of Public Health. Illinois Maternal Morbidity and Mortality Report, 2016–2017. April 2021.
  4. National Committee for Quality Assurance (NCQA). Prenatal and Postpartum Care. NCQA. 2024. https://www.ncqa.org/hedis/measures/prenatal-and-postpartum-care-ppc/
  5. American College of Obstetricians and Gynecologists Committee Opinion No. 736: Optimizing Postpartum Care. Obstet. Gynecol. 2018 May;131(5):e140-e150
  6. Zephyrin L, Johnson K. Optimizing Medicaid Extended Postpartum Coverage to Drive Health Care System Change. Women’s Health Issues. 2022;32(6):536-539. doi:101016/jwhi.2022.08.008
  7. 2021-2022 National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau. https://mchb.hrsa.gov/data/national-surveys
  8. Handler, A., Bergo, C., Dominik, B., Bier, E., Caskey, R. A two‐generation approach to postpartum care: Building on the well‐baby visit. Birth. 10 March 2021. https://doi.org/10.1111/birt.12544
  9. Caskey, R., Olender, S., Zocchi, A. Bergo, C., Uesugi, K. and Handler, A. Addressing Women’s Health Care Needs during Pediatric Care.  Women’s Health Reports. 2021 Jul 9; 2(1):227-234. doi: 10.1089/whr.2021.0016. https://pubmed.ncbi.nlm.nih.gov/34318292/
  10. Glassgow, AE, Wagner-Schuman, M., Knepper, A., Holicky, A., Angulo, M., Handler, A, Harris, B., Hickey, E., Manrique, Y., Mauro, A., Rodriguez, A., Schulte, J., Scott, S., Wainright, S. and Caskey, R. Addressing Maternal Health Disparities: Building a Novel Two-Generation Approach to Comprehensive Postpartum Care.  Population Health Management; 2023; 26(5): 275-281.DOI: 10.1089/pop.2023.0059
  11. AIMS Center. Collaborative Care Implementation Guide. University of Washington Department of Psychiatry and Behavioral Sciences, Advancing Integrated Mental Health Solutions (AIMS) Center. 2023. https://aims.uw.edu.
  12. Miller, Whitney, and Abigail Holicky. UI Health Two-Generation Clinic Patient Care Satisfaction Survey Summary, 2023.


This project was supported by the National Institute of Child Health and Human Development of the National Institutes of Health as part of a financial assistance award totaling $409,971 with 60 percentage funded under award number R21HD112104.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This project also was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $9.5 million with 40 percentage funded under award number U7AMC33720. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA/HHS, or the U.S. Government.

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