By Darnell Dent FirstCare Health Plans, Published 5:07 pm, Tuesday, May 15, 2018
Early identification and intervention of high-risk pregnancies increases the chances of delivering full-term, healthy babies. Unfortunately, at-risk expectant mothers often seek care later in their pregnancies, missing the window for vital prenatal care.
This is especially true in Texas. The most recent Premature Birth Report Card from the March of Dimes gave Texas a grade of “D,” reporting that more than 10 percent of births in the state are pre-term. Babies born prematurely run the risk of prolonged hospitalization and severe health problems. There is much to be done to ensure healthier mothers and babies in Texas.
One thing, in particular, that has and can make a big difference in the health of Texas mothers and their children is health insurers. In Texas, health plans like the one I run—FirstCare — have been tasked by the state to manage the Medicaid program. Medicaid serves more than 4 million individuals in Texas — many of whom represent the state’s most vulnerable individuals, including children, mothers, the elderly and those with disabilities.
Today, these insurers — also called Medicaid managed care plans — have the private sector tools, innovations, technology, and access to real-time data to identify high-risk pregnancies early and connect mothers-to-be with necessary education, social support, and clinical care.
Created by FirstCare in 2008, Expecting the Best is a maternity program that uses early identification and intervention, ongoing patient education, social support, and proactive prenatal care to support expectant mothers from the first days of their pregnancy through the birth of their babies with coordinated, effective, patient-centered care.
Through the Expecting the Best program in 2015, we analyzed layers of data and demographics in West Texas, identified at-risk mothers, and invited these women, who may already be pregnant or soon become pregnant, to join our program. After assessing their health and risk factors, we immediately connected those mothers with high-risk pregnancies with experienced nurses to serve as their case managers, which includes regular coaching calls, arrangement and coordination of critical doctor’s appointments, and more. These nurses stay in close contact with the mothers assigned to them, ensuring they have access to the medications they need to prevent premature delivery, as well as access to a 24-hour BabyLine hotline staffed by experienced nurses.
One FirstCare member, a 42-year-old expectant mom from Midland, enrolled in the Expecting the Bestprogram in week 12 of her pregnancy. Our team examined her health history and determined that her age, history of high blood pressure and gestational diabetes from a previous pregnancy, previous 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. Her nurse case manager closely monitored her health — managing her blood pressure and weight, looking for danger signs, and encouraging her to take her medications consistently, drink more water, and maintain her regular doctor’s appointments. As a result, this Texas mom avoided complications during her pregnancy and delivered a full-term, healthy baby girl.
Through the innovative Expecting the Best program, we have seen remarkable results for the mothers and babies we serve, as well as considerable savings for Texas taxpayers. We’ve seen significant improvements in the number of expectant mothers who seek prenatal care early in their pregnancy, resulting in a rate of neonatal intensive care unit (NICU) admissions that was 38 percent below that of the national Medicaid population. Our rates for babies born with very low birthweight is nearly 75 percent below national benchmarks. Our program has a 96 percent satisfaction rating among expectant mothers, saving the state of Texas roughly $1,000 per infant — totaling $1 million in taxpayer dollars, per 1,000 live births. Most importantly though, it has delivered healthier babies to healthier mothers.
Today, FirstCare’s Expecting the BestMedicaid-managed care program actively manages cases for 300 to 400 high-risk expectant mothers every month. By developing a patient-centered partnership with OB/GYN doctors and nurses, using a robust and proactive process to identify, screen and enroll high-risk mothers into case management services, and removing barriers to medications to prevent pre-term births, we are creating a coordinated system of care, and giving mothers and their babies in West Texas their best chance for healthy lives.
Darnell Dent is president & CEO of FirstCare Health Plans, which is owned by Covenant Health and Hendrick Health System.
Ninety-five percent of Texans believe it is important to have a strong, sustainable Medicaid program.