by Darnell Dent
April 18, 2017
Early identification and intervention of high-risk pregnancies increase the chances of delivering full-term, healthy babies. Unfortunately, at-risk expectant women often seek care later in their pregnancies, missing the window for vital prenatal care and treatment.
In fact, the 2016 March of Dimes Premature Birth Report Card reported the rate of pre-term pregnancies in the United States is on the rise again for the first time in eight years. Babies born prematurely run the risk of prolonged hospitalization and severe health problems.
With a wealth of data at our fingertips, health insurers are uniquely positioned to identify high-risk pregnancies early on and connect mothers-to-be with necessary education, social support, and clinical care.
Created by FirstCare Health Plans (FirstCare) in 2008, the Expecting the Best® maternity program leverages early identification and intervention, ongoing patient education, social support, and proactive prenatal care to improve birth outcomes. In 2015, FirstCare partnered with Optum, a global health services company, to expand the reach of the program.
As part of the 2015 pilot project, FirstCare analyzed claims data to invite women who may be pregnant to enroll in the program. After an initial assessment, participants identified with high-risk pregnancies were immediately connected with nurse case managers who conducted regular coaching calls and arranged treatments and services – such as access to medication to prevent premature delivery and a 24-hour BabyLine® staffed with experienced maternity nurses. Case management followed participants throughout the entire pregnancy and post-partum checkup, coordinating care with the mother’s providers and FirstCare.
FirstCare member, “L.M.,” a 42-year-old expectant mom from Midland, Texas, enrolled in the Expecting The Best® program in week 12 of her pregnancy. Her age, history of high blood pressure and gestational diabetes from a previous pregnancy, prior abdominal surgeries, exposure to second-hand smoke, and severe nausea in the first trimester placed her at high risk of delivering a pre-term baby. L.M. worked with her FirstCare nurse to help monitor and manage her blood pressure and weight, know which danger signs to watch for, increase fluid consumption, take medications and maintain regular doctor’s appointments. As a result, L.M. was able to avoid gestational hypertension during her pregnancy and delivered a full-term, healthy baby girl.
FirstCare achieved a strong case management enrollment rate of 71 percent of referred participants, or 703 mothers. Eighty-eight percent of participants initiated prenatal care in their first trimester of pregnancy, exceeding both the national rate of 70.8 percent and the Healthy People 2020 goal of 77.9 percent – resulting in a 38 percent reduction in neonatal intensive care unit (NICU) admissions. Rates for low and very low birthweight babies were 33 and 73 percent below national benchmarks, respectively. In its first year, FirstCare’s Expecting the Best program received a 96 percent satisfaction rate among participants and saved an estimated $1,000 per infant, or $1.7 million.
“Using a proactive and robust identification process and an evidenced-based approach to early intervention and case management, together with Optum, OB/GYN providers, and our expectant mothers earlier during pregnancy, we can give babies their best chance for healthy lives,” said Dr. Adolfo Valadez, Chief Medical Officer for FirstCare.
Today, FirstCare’s Expecting the Best program actively manages cases for 300-400 high-risk expectant mothers every month.
“Delivering positive health outcomes means proactively reaching out to communities, expanding access to education, and connecting expectant mothers with the care they need,” concluded Darnell Dent, President & CEO of FirstCare. “No time is this more important than when helping the tiniest members of our West Texas communities get a healthy start in life. Early intervention programs are not simple, but they are instrumental to delivering healthier outcomes for healthier babies.”
Darnell Dent is President & CEO of FirstCare Health Plans. FirstCare is owned by two Texas hospitals – Covenant Health and Hendrick Health System – and serves 143 counties throughout Texas. You can hear Dent discuss innovations in the Medicaid program at the Health Care CEO Forum 2017 in Austin, immediately preceding Institute & Expo.