Sunday, January 30, 2011

Addressing High-Risk Pregnancies

Four BadgerCare Plus contracted health plans are working together on a medical home pilot program beginning 2011 and continuing to 2013, to improve care for high-risk pregnant women in Southeast Wisconsin. This initiative is now set to connect pregnant women with a medical home, according the Wisconsin Hospital Association (WHA) newsletter “The Valued Voice”.

The four BadgerCare Plus-contracted health plans in Southeast Wisconsin are Abri Health Plan, Children’s Community Health Plan, Community Connect Health Plan, and United Healthcare. Each plan emphasizes an obstetric care provider will be the primary point of contact for the women and will be responsible for coordinating all needed care among multi-disciplinary teams.

These plans were selected through a Request for Proposals to serve BadgerCare Plus members enrolled in the Standard and Benchmark plans in Milwaukee County and the five surrounding counties. The sites serve predominately low-income, minority populations and provide comprehensive prenatal and postpartum care for high risk women.

The healthcare organizations involved in the project have demonstrated success with their prenatal and postpartum programs. Many have established some of the capabilities required for a medical home and have demonstrated an interest and readiness towards becoming a fully-developed medical home, according to the plan submitted by Community Connect Health Plan.

The health plans will use the medical home model and a whole range of incentives designed to help ensure that women remain enrolled in the medical home throughout their pregnancy and throughout the postpartum period. The plan will ensure that women keep their appointments and will provide for follow-up for missed appointments and include home visits, personal phone calls, and the use of collateral contacts.

The medical home sites will use an Electronic Health Records (EHR) system or registry to manage medical home member data, organize clinical information including the presence of chronic conditions, track test results and make referrals if needed. The EHR system for each practice will vary based upon their investment in technology. There are a number of different vendors in the market all offering multiple variations from prescribing modules to patient portals.

In looking at EHRs, the higher certification from NCQA generally means that a practice will have an advanced EHR capable of providing the full spectrum of information on each patient. If a practice has not yet invested in an EHR system, it can still achieve a Level I from NCQA. For this practice to achieve a Level III, it would be difficult until they invest in a top tier EHR system.

Throughout the medical home initiative, the HMOs will monitor and report on a number of performance measures, including three Healthcare Effectiveness Data and Information Set (HEDIS) measures, early prenatal care, frequency of prenatal care and postpartum care, as well as patient satisfaction. Performance information will be shared regularly with practices, providers, and patients.

For more information, email, Jason Helgerson, Medicaid Director and Administrator, at or call (608) 267-9466.