PRENATAL CARE: RI Program Shows Strong Results
Rhode Island's Medicaid managed care program, RIte Care, has significantly increased prenatal care participation for enrollees, according to a study published in the April issue of the American Journal of Public Health. Since its inception in 1994, RIte Care has prompted more women to receive prenatal care in private doctors' offices by "requiring private doctors to take RIte Care patients" and providing patients with the support to receive such care. The authors found prior to the inception of RIte Care, 57.1% of Medicaid recipients received adequate prenatal care -- defined as seeing a doctor within four months of becoming pregnant and keeping 80% of their appointments throughout the pregnancy program -- compared to 62.1% just 15 months after the program began. And program officials said that by the end of 1997, that figure climbed to 70.7%. The improvement was greatest for black women and teens.
The idea behind RIte Care was not only to extend eligibility to families earning up to 250% of the federal poverty level, but also to remove delivery barriers, said Tricia Leddy, RIte Care director and lead author of the study. Leddy attributes much of the success of the program to its targeted interventions that streamlined the application form, provided women with lists of available obstetricians, allowed women to see out-of-network providers, conducted a widespread outreach campaign and provided bus pass and cab vouchers to ensure that patients made their appointments, the Providence Journal-Bulletin reports. Leddy also notes that the program changed the delivery system by steering many women to private providers. Prior to the inception of RIte Care, just one in five enrollees saw a private doctor; today, it is one in three. According to the study, this has also lessened the pressure on public health and hospital clinics, improving care there.
However, OB/GYNs in the state complain that they are in effect subsidizing the program by accepting lower rates for RIte Care patients. Dr. Michael Fine, chair of the Primary Care Advisory Committee to the state Health Department, said, "I'm taking 20 or 30% less to do 40 to 50% more work," noting that many RIte Care patients tend to have more medical needs. "It put us in an absurd bind," he said, "On the one hand, RIte Care wants us to treat everyone the same. On the other hand, they don't want to pay us the same." The problem is exacerbated, he said, by specialists who refuse to accept referrals for RIte Care members in part because "no one is enforcing the rule." Despite its frustration for providers, Marti Rosenberg, chair of the RIte Care Consumer Advisory Committee, praises the program for improving access to primary care providers and opening the door for low-income women to participate in child-birth classes and smoking cessation programs. While the program has made important strides, Rosenberg said there is still room for improvement, saying that the program is "still working on what access really means -- having a doctor that speaks your language, having a doctor that understands your culture, having a doctors whose office is really open and welcoming to RIte Care patients" (Freyer, 3/31).