UnitedHealthcare recently won the 2020 Centers for Medicare & Medicaid Services (CMS) Health Equity Award. The award recognizes the organization’s commitment to health equity by reducing disparities among vulnerable populations. Leading a team in Ohio, Doctor Srinivas Merugu MD, Chief Medical Officer for UnitedHealthcare Community Plan of Ohio, drove a pilot study to address postpartum mortality in members who are covered by our Medicaid plan.
As COVID-19 sweeps the nation, we can see how the virus adversely impacts communities that have historically had disparate health outcomes. This observation aligns with a trend I’ve been watching for years, with the significant difference in maternal and infant mortality rates depending on where a member lives in the United States. Specifically, mothers and infants who are challenged by social inequities in their communities — even apart from a pandemic — are more likely to have poor or serious health outcomes.
This trend was on full display as we worked on a study with postpartum mothers in three states (Michigan, Ohio, and Hawaii). We gave special focus to Mahoning County, Ohio, which we knew had a high rate of substance use disorder, poor health outcomes, and poverty. Beginning in 2018, we focused on members in these areas with the goal of using locally based care coordinators to identify risks and connect mothers with resources.
For the purposes of our study, we looked at health disparities related to race, ethnicity, geography, language, gender identity, and sexual preferences. It’s common for Medicaid enrollees facing these disparities to not have the resources they need because of systematic issues, including the fact that providers do not routinely screen for non-medical conditions. Or if they do, the provider is unable to address the member’s SDOH. Because of this reality, our study utilized culturally and regionally tailored interventions.
While prenatal and post-partum visits and connections with pediatricians for well-checks were already part of our protocol for these Medicaid enrollees, members did not complete these on a consistent basis, which made it challenging to intervene and change outcomes. As an alternative, we promoted early and comprehensive postpartum care though community health workers. These workers collected information during local primary care, obstetric nurse partnerships, home visits, and care coordination. We then used that information to connect our members with existing community and faith-based organizations, and governmental public health agencies that were involved in efforts aimed at addressing infant mortality.
Through these partnerships, UnitedHealthcare was able to improve maternal and infant outcomes in the targeted communities. During 2018 and 2019, the team reduced disparities in timely postpartum care for Black women by 42.4% in Michigan (from 15.1% to 8.7%) and by 83.2% in Mahoning County, Ohio (from 19.6% to 3.3%), and by 40.3% for rural women in Hawaii (from 12.9% to 7.7%).
Not surprisingly, continuing this course of action will be a labor-intensive process. While we have built relationships with organizations and case managers, not all members will benefit from the same approach. As UnitedHealthcare maintains a focus on improving the lives of mothers and infants across the nation, we must continue to take on health disparities one member and one community at a time. Through this approach, we can change lives by addressing specific needs with person-centered plans.