Improving high-risk pregnancy outcomes

The opportunity

When it comes to health outcomes for expectant mothers and newborns, Tennessee consistently ranks among the most challenged states in the country. According to the 2018 America’s Health Rankings report by the United Health Foundation, Tennessee is 39th among the 50 states for infant mortality, with 7.2 deaths per 1,000 live births. The state also ranks 45th for preterm births and 44th for the prevalence of low birth weight babies – an issue frequently associated with poor prenatal care that puts babies at increased risk for serious immediate and long-term health problems. In addition, between 2000 and 2010, Tennessee experienced a tenfold increase in the number of babies with Neonatal Abstinence Syndrome (NAS), a condition caused by withdrawal from addictive drugs consumed by the mother during pregnancy. These issues put a significant strain on the health and well-being of mothers and infants, as well as a financial strain on the broader health system due to the costs associated with extended hospital stays, neonatal intensive care, and treatment of ongoing health problems. For example, the average cost of a NICU stay for a Tennessee Medicaid beneficiary is approximately $2,000 per day (or $27,750 per NICU admission) – with many babies requiring multiple days or even weeks in the NICU – compared with an average total cost of $4,500 for a routine delivery. Unfortunately, a variety of barriers can prevent expectant mothers from accessing the prenatal care that can help them avoid health problems for themselves and their babies. To help expectant mothers overcome barriers and get the care and support they need to have healthy pregnancies and healthy babies, UnitedHealthcare Community Plan of Tennessee launched the Maternity Medical Home program.

Tennessee is ranked 39th among the 50 states in
infant mortality, with 7.2 per 1,000 live births.

The innovation

The Maternity Medical Home program seeks to improve maternal and birth outcomes by providing personalized support to expectant mothers who are enrolled in Tennessee’s Medicaid program (TennCare) and are at high risk for health problems. The program is designed to improve the health of Tennessee mothers and babies, and lower the overall associated costs of care, by ensuring that mothers get the appropriate prenatal and postnatal care. Through the Maternity Medical Home program, obstetrical nurses work with high-volume obstetrical (OB) and fetal maternal specialty providers to identify and engage members who are pregnant and at increased risk for health problems, based on a questionnaire about risk factors such as a history of preterm births or miscarriages, whether the member has a health condition such as hypertension or HIV, and many other factors. After high-risk members are identified, the nurses offer care management services throughout the members’ pregnancies and into the post-partum period. They meet with members face-to-face and telephonically, ensuring that each member is following her provider’s care plan, attends her scheduled appointments, and understands how to manage her health. If there are barriers to the member receiving care, the nurse care managers will help the member overcome them. For example, the nurse care manager may help arrange transportation to prenatal appointments.

Maternity Medical Home program accounted
for 1,300 births during 2018.

The outcomes

The Maternity Medical Home program currently supports 16 provider offices that include general OB practices, Maternal Fetal Medicine groups, and Regional Perinatal Center practices. The supported provider offices accounted for more than 1,300 births during 2018. By helping members adhere to their physicians’ care plans, the program supports participating practices in their efforts to better manage patients’ health. This is particularly important to Tennessee maternity providers who, under the state’s health care payment reform initiative, are at risk for a percentage of reimbursement based on their cost and quality performance related to live births. The Maternity Medical Home program would not be possible without the participation of high-volume OB and fetal maternal practices across the state of Tennessee.

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