Maternal wellness takes a second look at mom

Program gives HMOs reduced NICU admissions

A program that makes early risk assessments and provides educational support to pregnant women within an HMO’s membership is reportedly saving its customer health plans millions of dollars each year.

Marietta, GA-based Matria Healthcare’s MaternaLink program also has produced first-year reductions in the days spent in neonatal intensive care units (NICU) per 1,000 births, ranging from 16% to 34% — depending on the number of health plan members participating in the program.

"A lot of data have been published that say if you can identify pregnancies early, if you can identify risk early, and if you can intervene appropriately and educate women about signs and symptoms of preterm labor and about proper prenatal care, pregnancy outcomes will improve," says Jim Murray, Matria’s vice president of marketing.

The program relies on risk assessment and education — two things that obstetricians routinely do, Murray says. But the MaternaLink program augments the services. "Managed care has reduced the amount of money paid to a physician for managing a pregnancy. The physicians then are encouraged to see more patients, and not as much time is spent with patients as before."

In addition, patients may be reluctant to pick up the phone and call the doctor to ask a question, he says. As a result, they may not be gaining an in-depth understanding about pregnancy and good health habits.

The program — voluntary to health plan participants — provides a second chance for assessing and educating the patient, beginning with an in-depth telephonic risk assessment.

The standard MaternaLink program involves an initial assessment with a follow-up contact. During this assessment, nurses go through a lengthy discussion with the participant covering a number of issues, says Cindy O’Leary, BSN, clinical manager with MaternaLink. These include:

Demographic information, such as the highest grade of school completed and the occupation of the participant.

"This is mainly so we can send out the appropriate level of educational materials and to determine if there might be anything associated with their work that we might be concerned about," she says.

Family history of the participant and the father of the baby.

This includes genetic or family history of any birth defects.

Gynecological or reproductive history.

"This includes everything from infertility to all of the participants’ previous pregnancies and any complications therein, either during the pregnancy, with the delivery, or in the early postpartum period." The history also includes asking about the participants’ reproductive system to find out if they have had any problems in the past that might put them at risk during the current pregnancy.

In questions about the current pregnancy, MaternaLink staff focus on these factors:

Any hospitalizations during the pregnancy.

Any symptoms, particularly focusing on either preterm labor or blood pressure problems.

The appropriate education is given depending on the participant’s experience and/or previous history, O’Leary says.

Nutritional status, with teaching given here, too.

MaternaLink offers a dietary analysis of the participants depending on whether the participant meets certain criteria, such as being a teenager, starting the pregnancy underweight, or having an eating disorder.

Lifestyle and environment.

"We look at the hours they spend commuting, if there are toddlers in the home, and what kind of family support system they have," she says.

At the end of the assessment, staff instruct the participants to call if they have concerns or if they have additional medical diagnoses so MaternaLink can notify their case managers.

With the follow-up assessment, staff then talk about bottle feeding, birth control options, and whether the participants have selected a pediatrician.

The assessment results in an opportunity to identify patients who are at increased risk of having a preterm delivery or another complication of pregnancy. "These will be patients who have complications such as diabetes, hypertension, hyperemesis, or coagulation disorders," says Murray.

Letting the physician know

When Matria nurses identify the risk, they contact the patient’s case manager at the health plan. "The case manager might then contact the physician and say, We’ve identified a patient who is an increased risk. We would like you to take another look at that patient and see if there is any additional care that might be appropriate.’

"In a sense, we participate in an increased level of prenatal care and the surveillance of those patients who are identified with a complication of pregnancy," Murray adds.

The telephonic interview also provides an excellent opportunity for patient education, he says. "Patients receive much of their education though conversations [with the nurses]." Additional educational materials can be sent to the patients, depending on their reading levels. Materials in other languages also are available.

Another benefit of the program is 24-hour telephone access to perinatal nurses. "[The 24-hour telephone hotline] gives patients access to a registered nurse with obstetrical experience who they can talk to about pregnancy. It’s another part of the clinical support of that patient," says Murray.

Women experiencing problems with their pregnancies, however, are encouraged to call their doctor’s office. "Our job is not to render medical care; it is simply to help observe the patient and to alert the physician and case manager if we identify something that is troublesome."

For one of its payers, the MaternaLink program has reduced the overall rate of NICU admissions by 5.2% from the previous year, which resulted in a savings of 667 NICU days. With the average NICU stay costing approximately $2,000 per day, by eliminating 667 NICU days, the program saved the health plan more than $1.3 million.

The program, though, is only successful if women in the health plan agree to participate in it. "I believe the good results is a direct relationship to the level of participation of the members," Murray says.

"We have an opportunity only to impact those patients who chose to participate," he says. "If we can become involved with 70% of the patients, you’re seeing NICU days per 1,000 births in the 600 to 800 range. If you have a low level of participation, maybe 20%, the NICU days are probably going to be in the 1,000 to 1,100 per 1,000 births range."