One project improves infant mortality rate
One project improves infant mortality rate
Project tracks pregnant Medicare patients
Concerned by low birth weights and high infant mortality rates in the Philadelphia area, four competing HMOs have collaborated on a project designed to improve birth outcomes in the Medicaid population.
The Healthier Babies project identifies and tracks behaviors and health status of pregnant Medicare women in a five-county region of Southeastern Pennsylvania. 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, says Richard J. Baron, MD, president and chief executive officer of Healthier Babies, Inc.
The project was developed by Health Partners, a leading Medicaid HMO in Philadelphia. Other participating health plans include Keystone/ Mercy, Health Management Alternatives, and Health Resources Management.
The data collected during the prenatal visits is put into the Healthier Babies database, giving insurance company case managers the information they need to determine which pregnant women need interventions to improve their health and that of the babies.
For instance, the case managers are using the information to enroll the women in smoking cessation and diabetes management programs, 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 in May 1998, the four HMOs participating had four different methods of collecting clinical data on its Medicaid patients, Baron says. These included reports by telephone, fax, and paper documents. Many times, 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, he 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. Healthier Babies finished collecting a year of data on May 1.
"It’s not our expectation that we will be able to demonstrate a specific impact now. The major thing it has done is make information about the patients available to their HMO so that the HMO case managers are doing more outreach and women who have certain needs are being offered certain services," Baron says.
For instance, one HMO reports that it now is identifying 40% more pregnancies with the Healthier Babies database. In the past, the only way it identified a pregnancy was when it got a claim from an obstetrician.
The average physician’s office does not have the ability, knowledge, or resources to solve the problems that cause low-birth-weight babies, Baron points out.
"The managed care providers have the ability to follow women longitudinally across sites. No individual physician can do that," he says.
When the project began, 11.5% of the mothers in the five-county area gave birth to low-birth-weight babies, almost 2.5 times the national health goal, Baron says. The Philadelphia area has a 60% Medicaid population.
In suburban counties, where there is a smaller Medicaid population, the low-birth-weight rate is 6% to 8%, Baron says.
"It’s a public health problem of major proportions. Every obstetrician taking care of Medicare patients cares about it, and every one would do what they could to make it better," Baron says.
The goal is to reduce greater Philadelphia’s infant mortality rate from eight to 12 deaths per thousand to five deaths per thousand.
The program tracks about 15,000 pregnancies each year across five counties. The pregnant women see a doctor an average of seven times, for a total of 105,000 encounters in a year. Nearly 800 providers see patients at 250 to 300 sites. The sites include city health centers, residency clinics, and private doctors’ offices.
"We have a very heterogeneous provider environment. It was a challenge to come up with a new standard of care and get it implemented across such a wide variety of venues," Baron says.
When the project was proposed, some physicians complained about the extra time they would spend filling out the form.
"We suggested that the physicians regard providing the information the same way they would regard sending a diabetic with a complicated pregnancy to an expert. It is a process of providing the information they need to improve their health," he adds.
The providers and managed care organizations expressed concerns about patient confidentiality, Baron says. "We were collecting a lot of sensitive data. They questioned whether we had the authority to do that," he says.
The ultimate answer was that Healthier Babies acts as an agent of the insurance company, has access to the same information as the insurance company, and faces the same confidentiality issues as an insurance company, Baron adds.
The database was designed so it cannot be widely accessed. For instance, if a patient is a member of HMO "A" for the first half of her pregnancy and HMO "B" for the remainder, HMO "B" cannot get access to the records from the first half of the pregnancy.
In the future, the HMOs and county health departments will team up to coordinate a smoking cessation program for pregnant smokers identified by the database. A grant from the Robert Wood Johnson Center for Health Care Strategies, Princeton, NJ, provided money to capitalize the project. User fees from the Medicaid HMOs are used to support the day-to-day operations.
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