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North Carolina Uses Pregnancy Medical Homes to Improve Birth Outcomes
Physical Health, Quality Improvement
Source Of Information:
ZERO TO THREE Policy Center state updates
Community Care of North Carolina
North Carolina is working to improve birth outcomes by getting doctors and other providers of maternity care to screen pregnant women for risk factors and to use evidence-based practices for prenatal care. The Pregnancy Medical Home program is a partnership among Community Care of North Carolina and the state Divisions of Medical Assistance (Medicaid) and Public Health. The program began in April 2011 as an effort to address North Carolina’s high prevalence of low birth weight, preterm birth, and infant mortality rates.
Participating health care providers agree to screen every Medicaid-eligible pregnant woman to determine whether she is at risk for preterm birth using a list of ten priority risk factors that can impact pregnancy outcomes. When a woman is determined to be at risk, the doctor refers her to a pregnancy care manager from the local public health department to develop an individualized care plan and coordinate care throughout the pregnancy. In addition, the pregnancy medical home agrees to not perform elective deliveries before 39 weeks of gestation, aim for a primary cesarean delivery rate below 20 percent, and provide progesterone injections for women with a history of spontaneous preterm birth. About 85 percent of all prenatal care providers serving Medicaid patients are enrolled in the Pregnancy Medical Home program.
Doctors receive financial incentives to participate in the program. Incentives paid by Medicaid include $50 per patient for performing the initial risk screen, enhanced reimbursement for vaginal deliveries, and $150 for a postpartum visit that includes depression screening, reproductive life planning, and referral for ongoing health care. In addition, 14 local Community Care networks of health care providers, which cover the whole state, have teams that support the pregnancy medical home practices in their area.
The Pregnancy Medical Home program aims to demonstrate not only improved quality of care and improved outcomes, but also cost savings. Approval of a Medicaid state plan amendment was required to change the reimbursement structure, but no additional funding was allocated. Funding will come from Medicaid money saved by the new techniques through reductions in low birth weight, preterm birth, and cesarean delivery. North Carolina expects to save close to $1 million in the first year and up to $9 million in the second year.
In FY 12, over 75 percent of all pregnant women in the Medicaid program were screened. Of these, 70 percent were determined to have high-risk pregnancies and were referred to a pregnancy care manager. Preliminary results from the Pregnancy Medical Home program indicate downward trends in the rates of low birth weight and primary cesarean delivery among pregnant women receiving Medicaid.
For more information about the Pregnancy Medical Home program, see https://www.communitycarenc.org/emerging-initiatives/pregnancy-home/ .