Tuesday, March 6, 2012

Addressing the Need for PMHs

HHS launched the “Strong Start Initiative” to increase healthy deliveries and to reduce preterm births. According to statistics, there are about 50,000 annual premature births costing $20,000 to care for each of these births while according to HHS, the average cost for a birth for full-term infants is $2,000.

As part of the “Strong Start Initiative”, CMS released a Strong Start funding opportunity announcement to help reduce the frequency of premature births particularly among pregnant women covered by Medicaid. Under this initiative, the CMS Innovation Center is going to award up to $43 million through a competitive process to providers, states, and managed care plans.

So far, just a few states have incorporated some research methods to improve prenatal care especially with Medicaid patients, but North Carolina is one of the first states to use multiple ideas in a statewide program to reduce risks for high-risk pregnant women.

North Carolina happens to have a higher than average rate of infant deaths and premature births. The state’s goal is to provide the right information, medical care, and be able to identify Medicaid beneficiaries considered to have high risk pregnancies. The state is working to achieve this goal through their Pregnancy Medical Home (PMH) program.

The North Carolina Division of Medical Assistance, the North Carolina Division of Public Health, and Community Care of North Carolina (CCNC) are working together to develop the program to provide comprehensive, coordinated maternity care to pregnant Medicaid patients. The plan is to model the PMH after the Enhanced Primary Care Case Management (PCCM) program developed by CCNC.

In 2011, the PMH program was implemented and today Community Care of North Carolina (CCNC) has 14 local networks each with each network having an OB physician champion and an OB nurse coordinator responsible for recruiting and supporting practices.

By participating in the PMH program, maternity care providers receive an additional $200 per patient from Medicaid for financial incentives for risk screenings and evaluations as well as ongoing support from a pregnancy care manager and the local CCNC network.

In turn, practices agree to work toward quality improvement goals to reduce elective deliveries prior to 39 weeks of gestation, complete a standardized initial high risk screening on each pregnant recipient along with a plan of care management, engage fully in the 17P project in each pregnancy medical home to prevent recurrent preterm births, and reduce the cesarean section rate.

The PMH will receive exemptions from prior approval on the Medicaid preauthorization required for ultrasounds, $50 for completing a high risk screening tool at the initial visit, $150 incentive for the postpartum visit per Medicaid recipient, and an increased rate for a vaginal delivery.

Close to 800 obstetricians in the state have signed up and so far results show that there are less visits to emergency rooms by pregnant women and also less use of neonatal intensive care units. By using the PMH program concept, it looks like the state will realize sizable financial gains and in the first year is expected to save $1 million and by mid-year 2013 save close to $9 million.