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Partners in Pregnancy: Managed Care and Community-based Home Visiting Improve Birth Outcomes

Judith A. Cash, MA, MEd President & CEO CHIP of Virginia. Nancy Jallo, RNC, MSN CS FNP Program Coordinator Partners in Pregnancy Optima Health Plan. AMCHP 2005 Conference. Partners in Pregnancy: Managed Care and Community-based Home Visiting Improve Birth Outcomes. February 21, 2005.

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Partners in Pregnancy: Managed Care and Community-based Home Visiting Improve Birth Outcomes

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  1. Judith A. Cash, MA, MEd President & CEO CHIP of Virginia Nancy Jallo, RNC, MSN CS FNP Program Coordinator Partners in Pregnancy Optima Health Plan AMCHP 2005 Conference Partners in Pregnancy: Managed Care and Community-based Home Visiting Improve Birth Outcomes February 21, 2005

  2. Page 2 PresentationOverview • Introduce partner organizations • Describe history and rationale • Describe model and program features • Share evaluation data • Share lessons learned

  3. Page 3 Partner Organizations Sentara Healthcare/Optima Health Plan • Integrated healthcare delivery system • Largest Medicaid Managed care provider in Virginia CHIP of Virginia • Network of local public/private partnerships • Home-based health supervision and family support services by registered nurses and outreach workers.

  4. Page 4 History and Rationale Why we thought this would work. . . . .

  5. Page 5 Program Aim To reduce the number of days and the dollars spent in the newborn intensive care unit by infants born to high-risk pregnant women

  6. Page 6 Program Model • Home-based case management by teams of registered nurses and community outreach workers • Case management efforts focus on prenatal health and reduction of high risk behaviors • Data tracking for both process and outcomes • Attendance at prenatal appointments • Stress reduction and use of stress management • Cessation or reduction of alcohol and other drug use • Smoking cessation or reduction • NICU days and dollars

  7. Page 7 Unique Program Features • Women referred prior to 26th week of pregnancy • Prenatal risk assessment identified major risk factors • “Risk” includes medical, psychosocial, and environmental factors • Home visits at least once every three weeks • Regular contact between field-based staff (nurses and outreach workers) and health plan case management staff

  8. Average maternal age Under age 19 Race Chronic Medical condition Previous pre-term delivery Previous low birth weight baby Average number of children Married Completed high school/GED 22.2 years 42% 83% African American 35% 24.3% 17.8% 2.4 12% 35% Page 8 Enrollment profiles of Population served

  9. Page 9 Enrollment profiles of Population served • In the last year • Moved two or more times 27% • Needed transportation, but could not get it 44% • Needed food, but could not afford it 30%

  10. Page 10 Evaluation data – NICU days/dollars • 15.2% of infants in intervention group were admitted to NICU, compared with 12% of control group • NICU admissions for intervention group represented cost increase of $3172 • Infants admitted to NICU from intervention group had a length of stay 1.06 days longer

  11. Evaluation data – Birth Outcomes Page 11

  12. Page 12 Evaluation Data – Process Measures • 81% reported using stress management techniques • 27% reported decreasing or stopping smoking during pregnancy • 88.5% increase in attendance at scheduled prenatal appointments

  13. Page 13 Lessons Learned • Greatest risk factors often unrelated to medical history or pregnancy • Substance abuse • Violence • Mental illness • Difficult population to engage and retain • Creative outreach, frequent contacts, incentives are necessary for success • Infants born preterm, but often healthier than counterparts

  14. Partners in Pregnancy Optima Health Plan 4417 Corporation Lane Virginia Beach, VA 23462 (757) 687-6244 www.sentara.com CHIP of Virginia 701 E. Franklin Street, Ste 502 Richmond, VA 23219 (804) 783-2667 www.chipofvirginia.org Contact Information

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