Thinking outside-the-box to reach out to high-risk mothers has led to a 75 percent reduction in traumatic births in South Texas.

Summary:
  • Medicaid managed care provides more flexibility and creativity  which allows for more coordinated care and an increased focus on prevention in comparison to the old fee-for-service modelthat resulted in bad outcomes for children.
  • Dr. Peterson compiled research and ideas to better maternal births in South Texas which would not be possible without the model of Medicaid managed care.
  • A $10 million investment in fetal medicine specialists has reduced traumatic births by 75 percent, decreased premature births by 31 percent, and has saved Texas taxpayers $423 million.

DR. MARY DALE PETERSON | GUEST COLUMNIST

Dr. Mary Dale Peterson is president & CEO of Driscoll Health Plan.

As a pediatric anesthesiologist in South Texas, I have logged countless hours in operating rooms caring for babies who have undergone multiples surgeries — some in the moments after birth. These have been some of the most heartbreaking moments of my life. Sadly, many of these surgeries could have been prevented if someone had stepped in and provided support to the expectant mothers, taking their hand and walking them through the steps of a healthy pregnancy and delivery, as well as providing special help in complicated preg-nancies.

Much of what I witnessed was under the old way that Texas ran its Medicaid program — the fee-for-service model. Under this approach, the state paid doctors and other providers for the quantity of services they provided — not the quality of those services. Care was fragmented. Ultimately Texas moved to today’s model — the managed care approach — in which the state partners with private health insurers who have the tools and expertise to boost quality while keeping costs affordable. This modern approach lends itself to more flexibility and more creativity, which has led to coordinated care and a focus on prevention. Over the years, both as a physician and today as an administrator with our Medicaid plan, Driscoll Health Plan, I have seen a slow but steady transformation of the Medicaid program in Texas. A snapshot of that transformation is the incredible gains we have made for mothers and babies in South Texas.

During my days in the operating room at Driscoll Children’s Hospital, I began to realize I could have a bigger impact on a larger population for our health insurance partner, Driscoll Health Plan, which serves fami-lies in the Medicaid program in 24 counties in South Texas. In this new role, I began researching and pulling together data to back up what I had witnessed in the hospital.

I found that across South Texas, a whopping 30 percent of mothers were being induced when it was not medically necessary. This puts both the mother and the baby at risk for complications, including increased risk of cesarean section and bleeding, as well as the risk of babies being born too soon, which can lead to more intensive medical care and time spent in the NICU. To that end, I found that 20 percent of babies born in the region were being sent to the NICU after birth. I also discovered that none of our counties had access to a maternal fetal medicine specialist. These are highly skilled physicians with specialized training to manage high-risk pregnancies.

I took these findings to the obstetricians in the local community. These men and women went into their profession with a genuine desire to ensure healthier moms and babies, but they were not being supplied with the real-time data they needed to understand how many expectant mothers in their communities were slipping through the cracks of care. We began to meet regularly and brainstorm on how we could change these negative trends.

Little by little, we started putting ideas into practice. We began hosting Cadenas de Madres (Network of Mothers), a series of educational baby showers across South Texas. We invited expectant mothers and provided them with healthy snacks and helpful tips to ensure a healthy pregnancy. Many of these mothers went on to agree to have hospital and home visits by our team members to help them ensure a healthy pregnancy and delivery, and a safe home for their babies.

I also partnered with our health system to hire maternal fetal medicine specialists to travel around South Texas and hold clinics for high-risk mothers. These clinics have been extremely well received and our specialists are seeing hundreds of mothers every day. Today, we employ six of these specialists, and we are working toward bringing more into the area.

The results of these and other efforts have been truly remarkable. Investing in the fetal medicine specialists is expensive, but that $10 million investment — as well as the partnerships with our obstetricians — has turned into a 75 percent reduction in traumatic births in our service area, and $423 million in savings for Texas taxpayers. C-section rates are down, NICU stays are down, maternal immunizations for flu and whooping cough are up, and premature births have decreased by 31 percent. Texas Medicaid is working for these mothers and children in South Texas.

More work remains to be done, but the numbers are clear: We are on our way, one new life at a time, to a brighter future for moms and their children in South Texas.

Dr. Mary Dale Peterson is president & CEO of Driscoll Health Plan.

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