Redesigned prenatal program takes off
New marketing boosts enrollment 400%
The prenatal program had been limping along and moved between departments for more than three years. It wasn’t until First Priority Health, a subsidiary of Blue Cross of Northeastern Pennsylvania in Wilkes-Barre, moved its prenatal program to the care management department and gave it a whole new look that enrollment soared from 100 women for all of 1996 to nearly 400 women in the first eight months since the program’s redesign.
"First Priority had a prenatal program, but it wasn’t impacting the prenatal population," says Anne Sehne, RN, BSN, CCM, manager of care management at First Priority. "It was redesigned to take the holistic approach of care management. We set a goal to revamp the program and reintroduced it in April 1997 with a new marketing strategy. The formula is working."
The first change First Priority implemented was a fresh approach to marketing the program to both members and physicians. "The difficulty with the prenatal program is that it’s voluntary. Now, the first communication pregnant members receive from us is a letter welcoming them to the program," Sehne says. "The program is voluntary, but we don’t tell them that initially. We welcome them to the program, outline all the benefits available at no cost to the member, and by the time they finish reading the letter, they want to take advantage of those benefits."
First Priority also made a stronger pitch for the prenatal program to the plan’s primary care physicians. "We reintroduced the program to many of the physicians’ offices and presented the program to them in person. We had one physician who was still a little resistant until his nurse got pregnant and entered the program," says Joy Hack, RN, BSN, CCE, prenatal coordinator for First Priority.
Like many prenatal programs, First Priority begins by identifying pregnant members and evaluating them for risks that could cause complications, such as preterm labor. "We receive a list of every member who has had a global referral for pregnancy in the previous month. We contact the physician’s office by mail to confirm each pregnancy," Sehne says. "Once we confirm the pregnancy, the member is sent a risk assessment, the welcome letter, and a brochure explaining the program."
Completed assessments are returned to Hack, who identifies risk factors and places members in one of three categories: low risk, potential risk, or high risk. "Any member considered potential or high risk has a summary report sent to them and to their physician. We just state that we’ve identified the following concerns from the returned questionnaire. Of course, we also cover those risks during telephone contact with the member," she says.
All enrolled members receive the same educational resources targeted to their gestational age, she notes. (See box, at left.) Also, Hack contacts high-risk members as soon as their risk factors are identified. "I go over the risks with them and touch base with them at least once a month. Other members receive a call at 28 weeks to discuss topics relevant to their gestational age."
To make each telephone contact more uniform, she developed teaching guides which she uses during each member contact. "I used to touch on different prenatal health issues without any specific guidelines. Now we have specific tools that outline the material to be covered during each call. It reminds me what to cover, and if I’m out and a member calls in, another staff member can pick up the teaching guides and fill-in for me."
In addition to the literature, the risk assessment, and the telephone counseling, the program offers members discounts for childbirth, prenatal exercise, and breast-feeding and parenting classes. "Offering discounts on the classes is another subtle way to nudge members into taking more responsibility for their own health. It tells them what they should be doing to take care of themselves and their baby," Sehne says. "For example, many women don’t know that they could be exercising. By offering discounted rates on prenatal exercise classes, we’re encouraging moms to participate."
The program also includes a post-partum home health visit for mom and baby. "We had always provided a post-partum visit but we had used whatever home health agency was available with no specific criteria or documentation to tell us what these agencies were doing for our members," Sehne explains. "When we revamped the program, we first developed credentialing criteria for the home health agencies. Then we developed specific criteria and guidelines for the agencies to follow including post-partum teaching guides."
In addition, First Priority requires agencies to fill out a sheet listing any concerns women raise during their post-partum home health visit. "One week after the home health visit, the agencies follow up with a telephone call to each of our moms to go over the guidelines again and find out if any new concerns need to be addressed."
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