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CM program keeps preterm delivery rate low
Doulas pitch in when moms-to-be need extra help
A program that targets women at risk for premature deliveries for case management has paid off for ConnectiCare, a regional HMO based in Farmington, CT.
ConnectiCare's preterm delivery rate (babies born before 37 weeks) ranges from 7.8% to 6.5% compared to national rates of 11.3% to 12.7%.
In 2006, ConnectiCare's low-birth-weight rate (less than 5.5 pounds) was 6.8% compared to a national average of 8.2%.
"It's hard to compare our statistics year by year because every nine months, there's a whole new set of people with a whole new set of risk factors. One year, we may have a preponderance of women with preterm deliveries and the next year, a large number of multiple births," Maggie Perracchio, RN, program manager and nurse case manager for the ConnectiCare's Birth Expectations program.
The program was developed in 1995 to help women identify signs and symptoms of preterm labor, the primary cause of preterm births.
Women identified in risk assessment
Women are identified through a risk assessment form that asks for medical history, including chronic conditions, such as hypertension and diabetes that may put them at risk for a preterm delivery. Other risk factors include an incompetent cervix, a history of preterm births, or multiple births.
When physician offices precertify pregnant women with ConnectiCare, the health plan mails the members a risk assessment to fill out and return.
"Many of the physicians fill out the risk assessment and they alert us when there are risk factors so we don't have to wait for the member to return the assessment," Maggie Perracchio says.
If a woman hasn't returned the survey by the time she's 23 weeks pregnant, ConnectiCare sends another survey. And the health plans sends another survey to pregnant members at 23 weeks to find out if anything has changed.
"Sometimes someone might find out later in the pregnancy they are carrying twins or that they are having issues with their cervix that could put them at risk for a preterm delivery," she says.
In 2006, the health pan completed a risk assessment on 91% of all women precertified for maternity benefits.
Once a member is identified as having a risk factor for a preterm delivery, Perracchio makes an outreach call.
"My goal is to educate them regarding what to expect, what to watch for, and what to report to their physician. I can't prevent anyone from going into preterm labor but I can educate women with potential risks about the early signs and encourage them to seek medical care," she says.
When a physician determines that a woman needs to be on complete bed rest in order to have a full-term delivery, the health plan may offer the services of a doula if the woman has small children at home or otherwise needs extra help.
Doulas provide physical and emotional support to women before and after childbirth. ConnectiCare contracts with a doula service to provide doulas for a certain number of hours a day, depending on the needs of the mother.
"If a woman is the primary caregiver of a toddler, there's no way she can stay in bed. We live such fragmented lives that we don't have support from mothers or sisters who live nearby like we used to. That's where the doulas come into play," Perracchio says.
"We want to make sure our pregnant members have the physical and emotional support they need to have a healthy pregnancy with a good outcome," Perracchio adds.
The frequency with which Perracchio calls the members depends on what the women need. Some members in the program don't need much reinforcement. Others need to be called frequently, she adds.
She advises them on the importance of nutrition and healthful habits and encourages the diabetic members to follow their diet and take their medications in order to avoid being hospitalized for complications of pregnancy.
"My job is to make sure they know what symptoms to look for that may be a sign of problems and when they should call their physician. Women are sometimes reluctant to bother their doctor but I tell them it's better to find out they're OK than to wait until they have to be hospitalized," she says.
At 22 weeks
When the women in the program are 22 weeks along in their pregnancy, Perracchio may increase the frequency of contact, depending on what is happening with the member and the pregnancy.
"Sometimes I follow up to talk about the results of their last appointment. Sometimes when we are talking they'll bring up something that happened and I may tell them to ask the doctor or at the next visit or to call right away," she says.
The plan also covers post-partum doulas as part of its early-discharge program. If members opt to stay in the hospital for a shorter period of time than their coverage will pay for, ConnectiCare will provide a doula to help out with the children, prepare meals, do grocery shopping, or take care of other household tasks so that the mom can rest and take care of the baby.
"Some women like to leave the hospital early when they can have additional support at home," she says.
The post-partum doula program is available to all pregnant members, not just those at risk for complications of pregnancy. Members call ConnectiCare to sign up for the benefit.
"We don't do outreach for this program. All pregnant members get mailings during the course of the pregnancy with information about all the services available to them. This program is not limited to members in case management," Perracchio says.