Program helps to reduce preterm deliveries
Members receive individual CM
As a result of a low-tech, high-touch case management program for women at risk for preterm delivery, preterm deliveries for ConnectiCare, a small, regional HMO based in Farmington, CT, consistently run 10% to 20% below national and regional averages.
The insurer’s Birth Expectations program concentrates on the members who are at highest risk for preterm deliveries and provides intensive case management from identification of risk until delivery.
The program includes risk assessment for all pregnant members, education, and intensive case management for members who are at risk for preterm deliveries.
ConnectiCare’s preterm delivery rate is about 6.8%, compared with a national average of about 12%, according to Maggie Perracchio, RN, program coordinator and nurse case manager for the Birth Expectations Program.
"Our population is commercially insured, and we know that when we compare our statistics to national and regional averages, we’re not completely comparing apples to apples because our population is different, but we do know that our program makes a difference," she points out.
Risk assessment
ConnectiCare mails a risk assessment form to members when the health plan receives their precertification for maternity services. In recent years, many obstreticians have completed a risk assessment for the members as part of the precertification process. As the health plan receives the precertifications, information on the members’ pregnancy is entered into the health plan’s database. The members risk status, as identified by the obstetrical precertification form or the member risk assessment, is tracked in the database. Perracchio initiates case management as the members are identified.
The risk assessment tool asks for past medical history, particularly chronic medical conditions such as chronic hypertension and insulin-dependent diabetes that may put the women at risk for preterm delivery. Multiple gestations, a history of preterm labor, past cervical surgery, or being younger than age 21 are other risk factors included on the form.
If the form has not been returned by the time the women are 23 weeks pregnant, the health plan sends them another. If they don’t return that, Perracchio makes an attempt to contact them by telephone and do outreach.
About 3,000 ConnectiCare members deliver babies every year. The plan is notified of about 80% prior to delivery and does a risk assessment for about 2,500 members. Between 5% and 15% are at high risk for premature deliveries.
Perracchio typically manages about 450 members each year.
"I can’t prevent anyone from going into preterm labor. The only thing I can do is to educate women with potential risks as to the early signs of preterm labor and encourage them to seek medical care," she says.
As the surveys come in, Perracchio studies them and makes an assessment as to whether each woman is at high risk for a premature delivery. If the assessment form contains any information that may be an indication that the member is at risk, Perracchio calls them and does a verbal assessment. She ends up case managing about 80% of those she calls.
She also follows up with any women who are hospitalized during pregnancy, whether or not the risk assessment shows she is at risk for a preterm birth.
"While the majority of premature babies are born after 32 weeks, we do have a few that occur earlier, as early as 23 or 24 weeks. Education regarding preterm labor begins early," she says.
After the initial contact, Perracchio determines how often she should be in touch with the woman. For instance, she might call a woman who is having twins every few weeks in the beginning and step up the frequency of the calls as the pregnancy progresses.
She sends the members in the program a letter with her phone number and encourages them to call her if they have questions or concerns.
Most of the interventions are by telephone, although Perracchio does send out educational materials to some women, such as those who are at risk for gestational diabetes. She sends a book on multiple births to members who are having more than one infant and special information about the unique needs of younger women during pregnancy to those who are younger than 21.
When Perracchio talks to the women, she educates them on how their pregnancy should progress, stresses the importance of good nutrition and healthful habits, and helps them identify questions they should ask on their next visit to the obstetrician.
Perracchio notifies the doctor’s office that the woman has been enrolled in the program.
She encourages her diabetic members to follow their diet and take their medications to avoid being hospitalized with complications of pregnancy. "I help them recognize symptoms and encourage them not to be afraid to call their physicians if they experience any of the subtle symptoms of pregnancy-induced hypertension, like headaches or swelling in their hands or face."
Many pregnant women feel as though they will bother their physician if they call to report symptoms, Perracchio says. "I encourage them to go in if they have any problems. I tell them it’s better to find out they’re OK than to wait until they have to be hospitalized."
She keeps up with each woman’s scheduled office visits and calls them to discuss what they should ask the physician a few days in advance.
If a member tells her of symptoms that indicate that she might be having problems, Perracchio calls the physician’s office to alert them.
When ConnectiCare started its Birth Expectations program, the health plan was involved in a program in conjunction with local OB/GYN groups that called for women who were at risk for preterm delivery to go more frequently to the obstetrician and receive more ultrasounds and more education than women who were not at risk.
"It was a very expensive for the physician offices to run the program. Because not all the offices were able to provide the educational component, we started Birth Expectations to educate our own members," Perracchio says.
As a result of a low-tech, high-touch case management program for women at risk for preterm delivery, preterm deliveries for ConnectiCare, a small, regional HMO based in Farmington, CT, consistently run 10% to 20% below national and regional averages.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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