Improving Timeliness of Prenatal Care & Well-Child Visits in First 15 Months: Findings & Best Practices

1. PIP Check-In #3 Follow-UpImproving Timeliness of Prenatal Care & Well-Child Visits in First 15 months (6+ visits) Summary of Findings: Best Practices and Recommendations Janicka D. Harris, MPH Government Analyst II Bureau of Medicaid Quality Clinical Quality Review and Initiatives Unit Agency for Health Care Administration

2. Best Practice Categories • Pay for Performance Programs • Provider incentive/bonus • Member Rewards • Community Engagement • Clinic Days • Baby Showers • Data Enrichment Programs • Update member contact information • Collaborate with United States Postal Service (USPS) • Utilization of Text4Baby • Evidence-based texting to moms 3x per week • Interim HEDIS measure tracking • Employ Motivational Interviewing Approach • Community Connector & Home Doctor Programs • Certified Community Health Workers • Home Visits • High-risk members • OB Educational Webinars • Utilization of Provider Network Verification (PNV) Portal • SMMC Panel Roster • Includes “pregnancy indicator” • Medical Record Reviews • Identify/capture missing records from providers • Reduce care gaps • Care Management for Homeless members • Social Determinants of Health • Health Literacy Programs • Apply CLAS Standards • Implement Cultural Competency Plan Cutting Edge Practice Best Practice Emerging Practice Promising Practice Best Practices model adapted from the Association of Maternal and Child Health Programs (AMCHP)

3. Cutting Edge Initiatives Include social determinants of health questions to identify member needs to link them community and social services. Assess disparities in various programs (e.g., prenatal care, child vaccinations). Members with limited housing and poor living conditions. Care is provided for moms and their babies to get the needed services. Apply CLAS Standards in programs or interventions; and implement Cultural Competency Plan into practice; and effectively promote the importance of preventive and medical programs.

4. Emerging Practices Trainings on billing/coding, referral process, the benefits of family planning waiver, and Healthy Behaviors Programs. Offer CEU/CME credits to encourage provider participation. Data file includes the “pregnancy indicator” and daily PCP and member information for early identification of enrollees. Identify/capture missing records from health care providers to help with reducing care gaps and providing needed services to members.

5. Promising Practices Ex. Receive $100 when you perform the first prenatal visit in the 1st trimester and use the appropriate billing codes. Ex. Earn up to $50 for attending 6 or more prenatal care visits. Maintain updated member contact information and ability to apply GIS mapping/geo-coding. Contract with external vendors (e.g., USPS, Optum, Silverlink, Voxiva, Text4Baby). Ex. Host regional or community baby showers, clinic days, health and fitness fairs.

6. Best Practices Track HEDIS/HEDIS-like measures on a frequent basis for evaluation purposes and to identify gaps in care to prioritize members for outreach. Evidence-based counseling style where providers become a helper in the change process and express acceptance of your member. Ex., for lifestyle change, substance using members, and other therapeutic approaches. Use certified Community Health Workers to conduct EPSDT and Prenatal Care outreach & home visiting for non-compliant or hard to reach members (e.g., children, high-risk pregnant women). Application sends evidence-based text messages to moms 3x/week timed to throughout the course of their pregnancy.

7. Recommendations • Educate your providers on proper coding and billing for family planning, prenatal, postpartum/inter-conception, and well-child care. • Engage fathers or significant others in PRE, postpartum, and W15 care. • Apply GIS mapping/geo-coding to locate members with gaps in care and implement home visiting interventions. • Have providers integrate the plan’s Health Risk Assessment and Healthy Behaviors Program forms into their EHR systems. • One Key Question™ Pregnancy Intention Screening Questionnaire • Improve care coordination with local Healthy Start Coalitions. • Encourage providers to screen for perinatal anxiety, depression, BMI, substance use, and tobacco use. • Have at least five data points to show an improvement in the comprehensive maternal and infant health (MIH) measures and indicators for internal program evaluation • Program Participation • Low Birth Weight • C-section • Pre-term Birth • Family Planning (e.g., contraceptive use, service availability by provider type) • Inform pregnant members about the 1115 Family Planning Waiver Program during 1st and 2nd trimester.

8. PIP Check-In #4! WHAT’S NEXT? • Continue our focus on Improving Timeliness of Prenatal Care and W15 • Identify what plans have considered/incorporated from the PIP Check-In Team Recommendations • Assess the progress of interventions post PIP Check-In #3, given any modifications or enhancements • Think about innovative strategies to integrate behavioral health in MIH. • Address other evidence-based approaches to the improvement of comprehensive maternal and infant health outcomes.

9. Resources ONE KEY QUESTION™ Pregnancy Intention (adapted from Oregon Foundation for Reproductive Health) – Download PDF WHO Medical Eligibility Criteria Wheel, 2015 http://srhr.org/mecwheel/ Screening Forms/ Tools LARC and the Office of Population Affairs Contraceptive Care Measures Hosted by the American College of Obstetricians and Gynecologists March 16, 3-4 p.m. ET Register Here Upcoming Webinars • Expanding Contraceptive Access: Developing and Implementing State-based Approaches • Hosted by the American College of Obstetricians and Gynecologists • March 16, 1-2:30 p.m. ET • Hear presentations from both Mississippi and Oregon • Register Here

10. Questions/Comments? Janicka D. Harris, MPH Government Analyst II Bureau of Medicaid Quality Clinical Quality Review and Initiatives Unit Agency for Health Care Administration Janicka.Harris@ahca.myflorida.com