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Population Health Approach to Prenatal Care Cuts Payer Costs

Taking a population health approach to prenatal care and high-risk pregnancies can cut costs for payers and improve outcomes, AHIP says.

prenatal care programs focus on patients

Source: Thinkstock

By Jesse Migneault

- Health insurance payers can improve patient outcomes and reduce spending by expanding the use of population health management models for expectant mothers.  Early intervention and preventive care can lower costs in high-risk birth situations, said AHIP in a recent blog post, helping babies get off to a healthier start in life. 

“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,” AHIP said.

Health outlooks for high-risk and premature births in the US are at their lowest levels in eight years, according to a 2016 March of Dimes Premature Birth Report Card.  The study showed a disturbing downward trend across the nation.  The United States as a whole earned a ‘C’ grade for high-risk pregnancy care.  Three states in the study, Louisiana, Mississippi, and Alabama, received an ‘F’.   

Taking a population health management approach to identifying high-risk cases and delivering preventive care can improve outcomes and reduce spending, the blog post asserted.

For example, in 2008, Austin, Texas based, FirstCare Health Plans (FirstCare) launched Expecting the BestThe prenatal maternity program focused on a whole-patient approach to care. Key components of the program included early identification of possible complications and a cohesive intervention strategy for the pregnant mother. 

READ MORE: Why Population Health Data is Integral for Value-based Care

In 2015, FirstCare partnered with Optum (division of UnitedHealth Care) to expand the program.

"Expecting the Best Maternity Program helps us better serve our expectant members by giving them the tools they need to manage their pregnancies in concert with the care they receive from their physicians,” said Dr.Adolfo Valadez, Chief Medical Officer for FirstCare.

“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.” 

After expectant mothers are invited into the program, an initial assessment is completed.  If any high-risk cases are identified, the program connects patients with case managers who coordinate treatment and services.  

A key component of Expecting The Best is the all-encompassing mission for patient education and social support.  This includes medication access and even a 24-hour “BabyLine” staffed with experienced maternity nurses   The program also features online access to education tools and articles through a patient health portal.

READ MORE: Hospitals Lagging Behind in Population Health Management

Case managers followed participants throughout the entire pregnancy and post-partum checkup, coordinating care with the mother’s providers and FirstCare.

The results were significant.  Out of 703 mothers participating in the program, 88 percent enrolled in prenatal care.  The national average for prenatal care is 70.8 percent.  This early intervention resulted in a 38 percent reduction in neonatal intensive care unit (NICU) admission rates.

In its first year, Expecting the Best is estimated to have saved $1,000 per infant, or $1.7 million in total costs.

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. “Early intervention programs are not simple, but they are instrumental to delivering healthier outcomes for healthier babies.”

READ MORE: ‘The Future is Accountable Care,’ Population Health Management

Medicaid beneficiaries can also benefit from preventive care during pregnancy.  In a recent study, researchers from Anthem, BlueChoice Health Plan of South Carolina, and Greenville South Carolina Health System found that group prenatal appointments reduced Medicaid costs, particularly those associated with preterm births.

Costs for preterm births were over $6 billion per year in 2016, and made up half of all birth costs.  This amount did not factor in additional health complications experienced by the premature babies.

The Centering Pregnancy program enrolled 85 pregnant women to track throughout their pregnancies.  The women in the program were compared with a control group of expectant mothers who were receiving individual medical treatment.

In the Centering Pregnancy model, groups of eight to twelve pregnant women due to give birth at similar times attended individual medical assessments followed by a 90-minute group discussion on topics including stress management, labor and nutrition.

“The value of the group model is that it engages patients in their own health, enhances the care experience for both patient and provider, and creates a community of support,” says Angie Truesdale, CEO of Centering Healthcare Institute. “All of these components contribute to cost savings and healthier moms and babies.”

The study showed that children of women participating in CenteringPregnancy had a 3.5 percent NICU admission rate, compared to 12 percent of babies in the control group needing NICU care.   That reduced NICU admission rate led to savings of over $67,000 for Medicaid managed care organizations.

Both Expecting the Best and Centering Pregnancy illustrated how a population health approach to prenatal care led to quantifiably lower costs, and better patient outcomes.   The net result of early detection, provider involvement, enhanced patient care combined with education was a verified decrease of NICU rates and overall birth costs.   

Karen Shea, Anthem’s vice president of maternal child health, said these programs indicate a strong potential for future expansion.  “They are a potentially sound investment for payers to reduce inpatient costs and help more babies get a healthy start in life.”


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