Maintaining contact improves health of Medicaid moms

Key Points

FOR MEDICAID MANAGED CARE plans, improving clinical care for pregnant women is critical to reduce preterm delivery, increase newborn birth weight, decrease the likelihood that newborns will spend time in the neonatal intensive care unit (NICU), and, for those infants who do end up in the NICU, minimize the number of days of care they require.

Improving performance on any of these metrics can reduce the overall cost of caring for the mothers and their newborns significantly.

"Medicaid managed care programs could focus on these measures and set the bar high for performance," she says. "Other levers for improvement are supporting implementation of shared decision-making programs and testing models of care coordination including woman- and family-centered maternity care homes."

Health plans that are trying to improve outcomes for pregnant Medicaid patients might also get some help from the federal government. The Centers for Medicare & Medicaid Services (CMS) recently launched funding for two initiatives to reduce elective deliveries before 39 weeks and to test new approaches to prenatal care.

SOCIOECONOMIC ISSUES

Obviously, the issues the Medicaid population faces go well beyond clinical care. Pregnant enrollees tend to have significant socioeconomic challenges that make it difficult to keep medical appointments, for example, and to manage their health. For that reason, managed care plans are focusing establishing and maintaining contact with pregnant patients, ensuring compliance with required prenatal care, and identifying and removing barriers to that care.

A pilot program in Milwaukee sponsored by the state of Wisconsin and WellPoint is focused on addressing such issues through an enhanced medical-home approach. Because some of these issues involve basic needs that prevent patients from focusing on their care, such as obtaining adequate housing, utility disconnections and inadequate nutrition and transportation, WellPoint has partnered with a community-based organization with a long history of working with this population to provide additional non-medical services.