High-risk women receive prenatal support
Collaboration is key to preventing preemies
Select Health of South Carolina is collaborating with community partners to ensure that pregnant women in their First Choice health plan's Medicaid population have full-term, healthy babies.
"The Medicaid population has a lot of health disparities based on social and economic factors, and many of them have barriers to receiving care. Our Bright Start program is open to all pregnant members and provides additional support for those at highest risk of a premature birth," says Angela Glyder, RN, CCM, director of integrated case management for the Charleston-based health plan.
Case managers help at-risk pregnant women develop care plans that will work for them, share information with the patients' prenatal care providers and collaborate with community agencies to make sure the women get the psychosocial support they need.
When members are identified as being pregnant, the health plan reviews historical claims and pharmacy data to determine if they have already had problems with a pregnancy or are taking medication for conditions like hypertension and diabetes that can affect a pregnancy.
Since the usual point of entry to the Bright Start program is the physician's office, the plan asks providers to fill out a risk assessment to help identify women at risk for premature deliveries. Using claims data and information from the physicians, the health plan stratifies women into low-risk and high-risk categories.
Members who are identified as low risk receive a welcome letter with information on having a healthy pregnancy, how to access care, when in their pregnancy they need to see their provider, and offering assistance in making appointments and helping the women access transportation to physician visits. The health plan sends all pregnant members a magnet with a phone number they can use to reach the program and be connected with a nurse.
High-risk members are assigned to a nurse case manager with experience in prenatal care who follows them throughout the pregnancy. Since the health plan covers the entire state of South Carolina, case managers are assigned to particular geographical regions. "They get to know the providers and the staff in their offices and are familiar with resources in the area so if members need help with clothes, electricity, housing, food, and other needs, they can connect them to community resources," she says.
One of the biggest barriers is getting in touch with the members, Glyder says. The case manager works with pharmacies and providers for assistance in getting phone numbers. If that doesn't work, she sends the member a letter describing the program and asking her to call. If pregnant members are hospitalized, the nurse contacts them while they're in the hospital and gets their phone numbers.
The case managers call the member, explain the program, and complete an in-depth physical and behavioral health assessment. "We know if there are behavioral issues or substance abuse, it can be a barrier to receiving early and consistent prenatal care," she says.
When the case manager finishes the assessment, she develops a care plan and shares it with the member's provider. The case managers call members after their physician appointments and help them understand what the doctor told them and make sure the members understand their treatment plan and any medication they are supposed to take. They clarify with the provider if there are any questions.
They call the women at intervals throughout the program, educate them about what they should be doing to have a healthy pregnancy, and about any signs and symptoms that indicate they need to see their provider. "Over time, the case managers build a close relationship with the members. Many members find the telephonic outreach less threatening than face-to-face contact and share information with the case managers they may never reveal in person," Glyder says.
Recognizing that the majority of young women today are tech-savvy, the health plan offers pregnant women the opportunity to sign up with text4baby, a national program that sends them text messages three times a week with the content geared to their stage of pregnancy. After delivery, the organization sends out regular text messages on caring for infants for a year.
"We think outside the box when it comes to engaging members. Young women are more apt to look at a text message than to listen to a voice mail. This offers a great way to stay in touch with them and keep them informed during their pregnancy," Glyder says.
The health plan has a contract with a vendor to provide face-to-face case management for members who have intensive case management needs. The vendor's nurses visit the members in their homes, providing education, support, and injections of 17 alpha-hydroxy progesterone (17P), a hormone that keeps the uterus from contracting during pregnancy.
Case managers with experience in the neonatal intensive care unit (NICU) work with parents of premature babies as they transition home from the hospital and follow the infants through the first year of life. "The nurses are experienced in care for preemies and understand the issues these babies have and can guide parents as they care for the infants themselves," Glyder says. The case managers guide the parents through feeding, monitoring the baby, and help them navigate the healthcare system to ensure that the babies get the care and follow-up they need.
"Our main goal is to empower our members to advocate for healthcare for themselves and their children and to help them take control of their health and their healthcare decisions," she says.