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Office of Medicaid Policy and Planning Birth Record and Outcome Data

Office of Medicaid Policy and Planning Birth Record and Outcome Data. Presented by: Dr. Caroline Carney Doebbeling, MD, MSc Director, Healthcare Evaluation, Research, Outcomes, and Quality. Distribution of Deliveries by Mother’s Age (CY05-07). Source: MedInsight, June 2008.

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Office of Medicaid Policy and Planning Birth Record and Outcome Data

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  1. Office of Medicaid Policy and Planning Birth Record and Outcome Data Presented by: Dr. Caroline Carney Doebbeling, MD, MSc Director, Healthcare Evaluation, Research, Outcomes, and Quality

  2. Distribution of Deliveries by Mother’s Age (CY05-07) Source: MedInsight, June 2008

  3. Distribution of Gestational AgeCY07 Birth Records for Medicaid Enrolled Women 40% births 38 wks or less 46% C-section 38 wk or less Source: ISDH/OMPP combined birth record data. Singleton births in CY07 only. Page 3

  4. Distribution of Preterm Births by RaceCY07 Birth Records for Medicaid Enrolled Women Source: ISDH/OMPP combined birth record data. Singleton births in CY07 only. Page 4

  5. First Trimester Prenatal Care:CY07 Birth Records for Medicaid Enrolled Women State of Indiana Average 80.6% (1996-2005) Healthy People 2010 Goal = 90% Source: ISDH/OMPP combined birth record data. Singleton births during CY07 only. OMPP claims data used to identify prenatal care visits during the first trimester. Note: 60 Counties have less than 60% of Medicaid enrolled pregnant women obtaining 1st Trimester Prenatal Care. Page 5

  6. Weeks of Pregnancy at Time of Enrollment in MCOCY08: Prior to PE • Fewer than 20% of women that deliver in a health plan are enrolled during the 1st trimester or prior to pregnancy • As many as 50% of women that deliver in a health plan are not enrolled until the 3rd trimester • 2nd and 3rd trimester enrollment leave women and newborns vulnerable • Action Taken: Presumptive Eligibility for Pregnant Women implemented July 1, 2009. Source: HEDIS 2009 Reports (CY08 Data)

  7. Prenatal Strategy: Address Modifiable Risk Factors Early and Systematically • Early Prenatal Care • Identification of Risk Factors • Interventions for Modifiable Risk Factors • Patient Centered Systems of Care

  8. Presumptive Eligibility (PE) for Pregnant Women Page 8 • Started July 1, 2009 • Over 180 locations trained as Qualified Providers (QPs) • Over 4,300 women enrolled in PE since July 1, 2009 • PE provides coverage of outpatient prenatal care services, including physician visits, labs, transportation, behavioral health services, and other outpatient services. • PE requires that women complete the Medicaid enrollment process • PE women are immediately enrolled in an MCO and must select a PMP

  9. Notification of Pregnancy (NOP)July 1, 2009 – Septemer 7, 2009 Page 9 • Began collecting July 1, 2009 • Comprehensive risk assessment • Maternal Medical and OB risk factors • Tobacco and Other Drug Use • Psychosocial risk factors • Weeks of current pregnancy, previous birth outcomes • Utilized by Medicaid-enrolled providers and supported by all MCOs • Electronic submission • $60 incentive paid to physician for timely and complete submission of data using Web interChange • Nearly 4,000 risk assessments have been received by OMPP and the MCOs since July 1, 2009

  10. Notification of Pregnancy July 1, 2009- November 15, 2009 Total NOPs submitted: 3,929 Women are entering care earlier in pregnancy, with 50% between 13-27 weeks of pregnancy at time of the Notification of Pregnancy (NOP)

  11. NOP DataJuly 1, 2009 - November 15, 2009 • Race • White 77% • Black 17% • Other 4% • Asian 1% • Ethnicity • Non-Hispanic 95% • Hispanic 5% • Diagnosis of Pregnancy Risk • Normal Pregnancy n= 2,784 (70%) • High Risk Pregnancy • n= 1,185 (30%) Approx. 20% <18 y/o

  12. NOP Data –Social Risk FactorsJuly 1, 2009- November 13, 2009 Of women screened with NOP, N=3,969

  13. NOP Data – Substance Abuse Status July 1, 2009- November 13, 2009 Of women screened with NOP, N=3,969

  14. NOP Data – Tobacco Use Status July 1, 2009-November 13, 2009 Of women screened with NOP, N=3,969

  15. Smoking During Pregnancy – CY07 2005 Statewide Average 17.9% Source: ISDH/OMPP combined birth record data. Singleton births during CY07 only. Statewide average for smoking during pregnancy (ISDH Maternal and Child Epidemiology Reports). Note: Race data pending. Preliminary reports from Marion County indicate a higher proportion of white women smoking. Data prepared by OMPP DMA Data prepared by OMPP DMA Page 15 February 2009

  16. Women Smoking During Pregnancy, CY07 Counties >1,000 Births: County Births % Smoking Marion 8,781 21% Lake 3,652 15% Allen 2,603 24% St. Joseph 1,934 21% Elkhart 1,724 23% Vanderburgh 1,259 33% Tippecanoe 1,001 24% Data Source: ISDH/OMPP combined birth record data. Singleton births during CY07. 2005 statewide average for smoking during pregnancy is 17.9% (ISDH Maternal and Child Epidemiology Reports) Important Note: The majority of counties (68) have 30% or more Medicaid women attesting to smoking during pregnancy. Page 16

  17. Tobacco Cessation During Pregnancy If women quit smoking during pregnancy Baby get more oxygen Baby’s lung function better Decreases chances of baby being born too early Mom experiences easier breathing and more energy The effects of maternal smoking • Nicotine withdrawal • Increased crying and irritability • Breathing problems (lungs poorly developed) • Increased health problems (colds, ear infections, asthma)

  18. Tobacco Cessation Efforts – Current Current Status • MCO Welcome Packet includes tobacco cessation materials directed to the general population • Materials in the form of Member Handbook • MCOs send pregnancy packets if they determine a woman is pregnant • NOP facilitates this process • Prior to NOP, the MCO only knew about tobacco use if the woman was assessed by the MCO • Very few formal notifications of pregnancy occurred • Collaborated with MCOs, ISDH, IPN, ITPC to develop tobacco cessation material for pregnant women on Medicaid

  19. Tobacco Cessation Efforts - Future Future Status • MCOs will continue to send pregnancy packets to members if pregnancy is identified • The pregnancy packet will include the recently developed flyer • Provider training regarding Quitline Referral process will be provided in 2010 • Some MCOs are distributing IPN’s Perinatal Substance Abuse DVD to providers

  20. Medicaid Flyer for Pregnant Women Nicotine Withdrawal Is Extremely Painful for Your Baby. Smoking while pregnant causes • Babies to suffer from nicotine withdrawals • Ear infections, asthma and increased colds • Hyperactivity, learning and behavioral problems Quitting is hard, but there is help. It’s free. It’s easy. It’s confidential. Call 1-800-QUIT-NOW (1-800-784-8669)

  21. Additional OMPP Activities • Sunny Start • Indiana Coordinating Council (ICC) • Participated in Teen/Unplanned Pregnancy Event at Black Expo in 2009 • OMPP staff regularly coordinates with ISDH MCH staff and Indiana Perinatal Network staff • OMPP Quality Committees and Subcommittees • Quality Strategy Committee • Neonatal Quality Subcommittee

  22. Tune In • Data systems being built to link to week of enrollment, HEDIS scores, and outcomes • Earliest outcomes from PE not expected until July 2010 (gestation + claims run-out) • Sample size likely too small to be meaningful until end 2010 • Modification of NOP to meet clinician needs

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