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 Pregnancy Medical Homes

By Carolyn McCoy, MPH
Senior Policy Manager, AMCHP

North Carolina, one of the leading states in implementation of pregnancy medical home defines services provided in a pregnancy medical home as managed care services to provide obstetric care to pregnant Medicaid beneficiaries with the goal of improving the quality of maternity care, improving birth outcomes, and providing continuity of care. The pregnancy medical home is kept abreast of missed appointments, specialist visits and emergency department visits. This model of care is not yet widespread in the United States but there are efforts underway to implement and test the effectiveness this model of care.

As highlighted in the AMCHP Forging a Comprehensive Initiative to Improve Birth Outcomes and Reduce Infant Mortality: Policy and Program Options for State Planning, the North Carolina pregnancy medical home model aims to improve birth outcomes among the Medicaid population. The pregnancy medical home provides evidence-based, high-quality maternity care to Medicaid patients and focuses care management resources on those women at highest risk. In the medical home model, quality-improvement goals are aligned with cost-savings goals, keeping more babies out of neonatal intensive care using and avoiding associated expenses. Pregnancy care management is a key intervention of the medical home model. Pregnancy care managers, trained social workers and nurses, provide care management services for pregnant and postpartum women with specific risk criteria. The services are provided based on need and risk stratification. The pregnancy medical home incentives to providers include increased rate of reimbursement for the global fee for vaginal deliveries to equal that of a c-section global fee, incentive payment for risk screening, incentive payment for a postpartum visit, and no prior authorization required for OB ultrasounds. In turn, providers have a set of requirements as well, including appropriate use of 17P with their patients, completion of screenings, and attention to c-section rates and induction of labor before 39 weeks. This new model is based on the Community Care of North Carolina system of regional networks of providers, clinics and partners across the state.

In addition to state-led initiatives, a new effort by the Centers for Medicare and Medicaid Services (CMS), Strong Start for Mothers and seeks to test enhanced prenatal care interventions. The four-year initiative is for women enrolled in Medicaid or Children’s Health Insurance Program (CHIP) coverage who are at risk for having a preterm birth, improve the health outcomes of pregnant women and newborns, and decrease the anticipated total cost of medical care during pregnancy, delivery and over the first year of life for children born to mothers in Medicaid or CHIP. There are 27 sites that received funding for this initiative.

Title V MCH programs can offer a range of leadership and support through outreach and education to women, through an advisory role, contributions of data or quality metrics, coordination between stakeholders and others.