HMOs cooperate to reduce infant mortality rate
HMOs cooperate to reduce infant mortality rate
Project tracks pregnant Medicaid patients
Concerned by low birthweights and high infant mortality rates in the Philadelphia area, four HMOs have collaborated on a project to improve birth outcomes in the Medicaid population. The Healthier Babies project identifies and tracks the behaviors and health status of pregnant Medicaid women in a five-county region of southeastern Pennsylvania.
The data collected in the Healthier Babies database will give insurance company case managers the information they need to determine which pregnant women need interventions to improve their health and that of the babies, says Richard J. Baron, MD, president and CEO of Healthier Babies Inc. in Philadelphia.
The average physician’s office does not have the ability, knowledge, or resources to solve the problems that cause low-birthweight babies, Baron points out. "The managed care providers have the ability to follow women longitudinally across sites," he says. "No individual physician can do that."
Since May 1998, the Healthier Babies project has collected data on close to 300,000 encounters and some 40,000 patients. "We are an active regional coalition of Medicaid managed care organizations," says Baron. "The approach we are taking is to standardize clinical data collection and to work together to standardize the data, to understand what it means to the population, and to offer interventions to women when we think we can make a difference."
For example, through data analysis, the coalition has been able to identify the relative risk of cocaine use, a history of domestic abuse, or illness as a predictor of poor birth outcomes in the Medicaid population. "It’s not that what we’ve learned has been surprising, but we know that we are getting good information," says Baron.
The project gives HMO case managers a wealth of data they can use to design interventions for their Medicaid population. For example, in about seven seconds, a case manager can get a list of all of the HMO’s pregnant women who say they use cocaine. "The technology is impressive," notes Baron. "It finds the needle in the haystack."
The data give the plan the ability to use the information on the population they cover to decide which interventions might work. "The plans have built their own risk assessment scoring system based on the data to produce reports of high-risk pregnant women," explains Baron. "It can drive their prenatal case management system." For example, one plan may design an intervention for pregnant women who smoke. Others may use the data to design a diabetes management program, to institute nutritional programs, to find shelter and food for homeless pregnant women, and to schedule cesarean sections for HIV-positive patients or drug users.
Before the project was implemented, the four participating HMOs had four different methods for collecting clinical data on their Medicaid patients. Many times the data collection and reporting fell between the cracks because the various types of paperwork and ways of reporting made it impossible for physicians to comply, Baron adds. "There was no way that the doctors could comply with four different procedures for these patients," Baron says. Now, there is a standard form for collecting data for all HMOs, which operate across five counties.
One significant achievement has been that health plans are able to significantly increase their HEDIS scores when they add the data from the Healthier Babies project. "What is interesting is that people assume that the best data are going to be claims information, because if there is money on the table, someone will figure out a way to bill for it," Baron says.
One HMO was paying a $225 incentive to providers for reporting the first visit of a pregnant woman on Medicaid within 48 hours. Their HEDIS scores still improved when they added Healthier Babies information. All providers who see pregnant women covered by the four Medicaid HMO plans use a universal prenatal encounter form to identify and track the health behaviors of their patients.
The reporting system is voluntary. The HMOs involved made it an administrative requirement but did not set up sanctions for providers who don’t comply. The fact that there is good compliance points out that a common reporting system is a superior way to collect data and analyze claims, Baron says. "We’ve validated the hypothesis that you can change the culture if you are all on the same page," he adds.
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