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National Efforts to Reduce Disparities in Birth Outcomes

National Efforts to Reduce Disparities in Birth Outcomes. Stephen A. Somers, President January Angeles, Program Officer Center for Health Care Strategies Grantmakers in Health Audioconference May 1, 2007. National Forces. = a challenge for Medicaid. Why Focus on Medicaid?. Medicaid/SCHIP

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National Efforts to Reduce Disparities in Birth Outcomes

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  1. National Efforts to Reduce Disparities in Birth Outcomes Stephen A. Somers, President January Angeles, Program Officer Center for Health Care Strategies Grantmakers in Health Audioconference May 1, 2007

  2. National Forces = a challenge for Medicaid

  3. Why Focus on Medicaid? Medicaid/SCHIP • 55 million opportunities to improve quality • 15.5 million opportunities to reduce racial and ethnic disparities • 60 percent in Medicaid managed care • Leverage point for quality

  4. Medicaid Population = Opportunity to Address Birth Outcomes Medicaid/SCHIP • Covers more than 1/3 of all births in United States • Normal-birth $ = $5,800 vs. high-risk $ = up to $1M • African-American LBW (13.1 %) more than double whites (6.4%) • High prevalence of complicating co-conditions, e.g., obesity, depression, substance abuse, etc.

  5. Disparities Initiatives • Medicaid Managed Care Disparities Collaborative • State Purchasing Institute • Health Plan QI Workgroup • National Health Plan Collaborative • Practice Site Exploratory Project Funding Sources: Robert Wood Johnson Foundation (RWJF) and The Commonwealth Fund; NHPC is sponsored by RWJF and the Agency for Healthcare Research and Quality.

  6. Challenge: Target High-Risk Opportunities • Identify race/ethnicity of members • Match data to utilization, outcome, HEDIS scores • Stratify opportunities for outreach and interventions • Do it: e.g. outreach workers for high risk members; cultural competency training; language lines; provider and consumer education; etc.

  7. What works to improve birth outcomes? • Health plan approaches • Monroe Plan for Medical Care • UPMC for You • Neighborhood Health Plan of Rhode Island • Collaborative approaches • New Jersey Collaborative to Improve Birth Outcomes and Health Status of Children

  8. Monroe Plan for Medical Care • Goals • Reduce neonatal intensive care unit (NICU) utilization of African American babies • Increase prenatal care rates of African American pregnant teens • Intervention • Provide outreach – hired peer staff to manage pregnancies and post-partum period • Education and support on family planning and preventive health

  9. Monroe Plan for Medical Care • Results • High retention of program participants • Decreased NICU admissions for African American babies from 18.1% to 13.5% • Demonstrated positive financial return on investment of $2.86 for each dollar invested

  10. UPMC for You • Goal • Decrease low birth weight rates among African American members • Intervention • Maternity program that provides family case management • Program addresses prenatal care, domestic violence, and postpartum care

  11. UPMC for You • Results • Increase in first-trimester identification from 20% to 40% • Decrease in low birth weight deliveries for African American women from 20% to 0%

  12. Neighborhood Health Plan ofRhode Island • Goal • Increase prenatal care rates of pregnant Hispanic women • Intervention • Provide prenatal education using “Teach with Stories” model

  13. Neighborhood Health Plan of Rhode Island • Results • 90.5% of women who received the intervention received optimal prenatal care compared to 64.7% of control group • Intervention group had slightly higher rates (4.4 percentage points) of kept post partum appointments

  14. NJ Collaborative to Improve Birth Outcomes and Health Status of Children • Goal • Improve birth outcomes in urban NJ areas • Connect infants and children ages 0-3 to preventive care services • Intervention • Adopt standardized Prenatal Risk Assessment form • Conduct academic detailing sessions on the importance of oral health treatment during pregnancy, and teaching good oral health care to new moms.

  15. NJ Collaborative to Improve Birth Outcomes and Health Status of Children • Preliminary Results • Providers more attuned to oral health care needs of pregnant women • Adoption of universal Prenatal Risk Assessment (PRA) form in three major urban centers • Increased provider satisfaction with simplified/standardized PRA form

  16. Funding Opportunities to Support Healthier Births & Reduce Disparities • Support efforts to obtain accurate and complete race, ethnicity, and language data • Support providers in small practices in conducting quality improvement • Increase access to culturally and linguistically competent providers

  17. Learn More at www.chcs.org • Download practical resources to help address disparities in care, including the Reducing Racial and Ethnic Disparities: Quality Improvement in Medicaid Managed Care Toolkit   • Subscribe to CHCS e-Alerts for regular updates on CHCS programs and resources to address disparities • Learn about current state/health plan efforts to identify and address disparities across the nation www.chcs.org

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