Delivering Maternity Support Services to Women at High Risk for Poor Birth Outcomes

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Delivering Maternity Support Services to Women at
High Risk for Poor Birth Outcomes

• June 9, 2008

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Program History RCW 74.09.760 through 910

• The goal of the Maternity Care Access Act of 1989
  is to
• Improve access to prenatal care
• Reduce barriers to health care and other
  preventative
• services on the premise that preventative care
  leads to
• Healthier families
• Reduction in infant illness and death
• Premature and low birth weight births have been
  directly linked to infant illness and deat
• Contain health care costs.

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Problem

• Overall, Medicaid women have disproportionately
  higher rates of poor birth outcomes than
  Non-Medicaid women. Subgroups within Medicaid
  women demonstrate the highest rates of maternal
  risk factors associated with low birth weight
  (LBW) and the poorest birth outcomes.
• Since 2003, entry into first trimester prenatal
  care for Medicaid women has been declining and
  the disparity in prenatal care access between
  Medicaid and non-Medicaid women has increased

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Process

• Review First Step Provider input
• Review First Steps Data
• Review Literature
• Review other State Models

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Provider Input- Barriers

• Lack of prenatal providers, providers require
  medical coupon before they will serve clients
• Lack of understanding /education
• Transportation
• Clients overwhelmed by current life
  circumstances

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Provider Input- Strategies

• Outreach/marketing (Media, community groups,
  providers)
• Increase Care Coordination
• Client incentives
• Simplified Medicaid access
• Reduce program documentation requirements
• and number of risk factors
• Reimbursement- Allow fiscal flexibility, let
  agencies decide when to use more resources for
  higher risk do not limit units, reimburse for
  care coordination/outreach/groups

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Literature Review

• What risk factors are used when defining high
  risk pregnancy
• Birth Outcomes-75 of poor birth outcomes are
  associated with preterm birth
• Researched risk factors and interventions most
  highly correlated with preterm birth
• IOM/Botsko/others- Regardless of Risk factors
  used
• Early access to prenatal care
• Health education/risk assessment with appropriate
  intervention
• Care coordination

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Other State Models

• Several state programs were reviewed and
  contacted based on their program goals
• States were then reviewed to identify the
  following
• Use of evidence based risking and intervention
• Reimbursement models
• Model of service delivery
• Outcomes achieved
• Michigan, Colorado and Florida were identified as
  states with components that were most aligned
  with our project goals.

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Recommendations

• Use of Framework
• Health Promotion Activities
• Increased Outreach
• Tailor MSS (Pilot)
• Promote Care Coordination/Case Management
• Address Systems Issues

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Recommendations

• Implementation of Specific Projects
• Work groups with DSHS
• Media campaign
• Community stakeholder meetings

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Recommendations

• Development of a Pilot
• Standardized screening tool
• Risk factor refinement
• Interventions based on risk factor acuity levels
• Explorations of reimbursement models

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Next Steps