PREVENTIVE OBSTETRICS: New Managed Care Approaches
This week's American Medical News profiles several programs designed by managed care companies to lower premature birth rates by providing better prenatal care. The programs are described in a new report from the American Association of Health Plans as models for managed care companies nationwide.
- Virginia Chartered Health Plan's "Ready, Set, Grow" program cut premature births among Medicaid enrollees in half during its first two years. Under the program, case workers make home visits and phone calls to link expectant mothers with services and educational programs. If patients miss appointments, case workers call to reschedule them. The program also is pioneering a physician incentives component: doctors are reimbursed on an adjusted fee-for-service basis under which they get paid more if their patients are seen early and regularly.
- Blue Cross and Blue Shield of Florida increased the "average gestational age of high-risk newborns by almost two weeks and cut average lengths of stay by almost 8%" by offering high-risk mothers an intensive prenatal education program.
- Keystone Mercy Health Plan of Philadelphia reduced the number of newborns requiring hospital stays from 16% to 13% by providing social service support and free childbirth education.
- Blue Cross and Blue Shield of Massachusetts convened an "obstetrical collaborative," allowing staff teams to brainstorm ways to reduce the number of C-sections. The plan also paid doctors for taking the time to educate patients about the "pros and cons of vaginal births after C-sections." Together, the two initiatives reduced the C-section rate from nearly 24% to just over 20%.
Incentives are Key
AMN reports that payment approaches that reflect the extra time required to provide better care, patients' improved attendance and lower prematurity rates helped convince doctors to support the programs (Prager, 1/25 issue).