State program reduces infant mortality 27%
CMs coordinate care for Medicaid moms
More than 40% of all births in the state of North Carolina are Medicaid births. That represents 44,000 plus births each year and gives the state a strong incentive to provide care coordination services that help Medicaid mothers improve birth outcomes by reducing the high costs associated with premature births.
The Baby Love Program has been providing care coordination services to Medicaid mothers in North Carolina since 1987. By helping with housing problems, transportation, nutrition, education, employment, and other basic needs, care coordinators have helped reduce the state’s infant mortality rate from 12.6% in 1988 to 9.2% in 1995, but those aren’t the only data that confirm the program has an impact, says Lynda C. Dixon, BSN, RN, state Baby Love program coordinator with the North Carolina Division of Medical Assistance in Raleigh.
"Our care coordinators assist our Medicaid moms in obtaining resources they need to help them have a healthy pregnancy. Instead of a gatekeeper model, our maternity care coordinators are professional advocates, or brokers of resources, out to open the floodgates and connect clients with needed resources."
Here are some of the data that demonstrate this "floodgate" approach is working:
• 93% of Medicaid mothers in the Baby Love program had live births in 1995, compared with 69.7% of Medicaid mothers without care coordination.
• More than 77% of Medicaid mothers in the Baby Love program had nine or more prenatal visits, compared with 64% of Medicaid mothers without care coordination.
• More than 80% of children of Medicaid mothers in the Baby Love program received routine well-child visits, compared with only 27.1% of children whose mothers did not receive care coordination.
• More than 76% of Medicaid mothers in the Baby Love program received a postpartum visit that included family planning, compared with 32.1% of Medicaid mothers without care coordination.
• Health clinics report significant decreases in "no shows" for clinic appointments and increases in patient compliance for Baby Love program participants.
Blanketing the state
Baby Love care coordinators are located in all 100 North Carolina counties within the local health departments. In addition, there are Baby Love coordinators located in every rural and community migrant health center that provides prenatal care, including one located on the Cherokee Indian reservation. To complete the Medicaid application for Medicaid for Pregnant Women benefits, verification of pregnancy is required. Women are given information about Baby Love when they apply for benefits. In most cases, the women can see a Baby Love coordinator for an assessment the same day.
The state also is piloting a new approach that outposts a Baby Love coordinator to a private physician’s office, says Dixon. For example, one physician schedules Medicaid patients for Tuesday mornings and Thursday afternoons. The care coordinator goes to the physician’s office at those times and sees patients there. "So far, physicians seem to like this approach. The care coordination service costs the physician nothing because the coordinator is a local employee. It helps ensure there are fewer no shows’ for office prenatal appointments, alleviates staff time normally spent on follow-up, and addresses patients’ psychosocial needs."
The first step to program enrollment is a 30-item psychosocial assessment, says Dixon. "We want to identify any concerns that are causing stress in the mother, and eliminate any barriers to care," she says. Services Baby Love coordinators provide include:
• arranging transportation to physician appointments;
• assistance in securing adequate housing;
• providing child care information;
• providing job training information;
• assistance with high school equivalency examinations;
• referrals to food stamps and other nutritional support programs.
"We try to point the women in the direction they want to go. We help them prioritize their concerns and needs as we develop a plan of care. We encourage the client to take responsibility for much of the plan, rather than allowing them to sit back and have someone do everything for them," adds Dixon.
"Instead of arranging a job interview for a woman who is out of work, the Baby Love coordinator might suggest the woman bring in the newspaper and help the woman identify jobs she is qualified for in the want ads. Instead of finding new housing for the woman, the Baby Love coordinator might sit down and go through the rental ads and circle all the trailers for rent in the woman’s price range. We want them to become more secure about doing things for themselves," says Dixon.
Phone call to senator works wonders
Many Medicaid recipients are so downtrodden, they don’t realize that they have the right to basic services, says Dixon. "I remember a young woman who came into the office in tears because she had been waiting for the results of a laboratory test and the clinic had not called her. She didn’t know that she could call the clinic and ask for the results herself."
Baby Love coordinators are very successful in empowering their clients, notes Dixon. "There was a woman who consistently had problems receiving her food stamps. They were late every month. She got so angry she picked up the phone and called one of the state senators. She had gained the confidence to know she was correct and felt comfortable following through for herself. Her food stamps were on time after that." Baby Love coordinators follow their clients and their newborns until the last day of the month in which their 60th postpartum day falls. The 60th postpartum day designation is a federal regulation. It means that if a woman delivers on March 1 she receives care coordination services through May 31.
Suggested reading
Buescher PA, Roth MS, Williams D, Goforth CM. An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. Am J Public Health 1991; 81:1,625-1,629.
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