With health care transitioning from provider focused to a consumer-centric approach, it is expected that the Medicaid population — particularly mothers — will experience significant benefits. This would be welcome news as pregnant women within the Medicaid system are at a higher risk of adverse newborn outcomes than expectant mothers in the commercial population.
When you consider that the Medicaid population as a whole is less healthy, it’s no surprise that risk carries over to pregnancies and births. There is a higher percentage of preterm or low birth weight infants in the Medicaid population, and expectant mothers are more likely to be admitted to a neonatal intensive care unit (NICU).
These adverse outcomes also translate to substantially higher health care costs. According to a study conducted by the March of Dimes, medical costs for both a mother and preterm infant are four times higher than for a mother and a healthy infant.
Putting mother and baby at the center of care
A consumer-centric approach to care focuses on the whole person — the physical, mental and social elements that are interconnected to maintain health. For the high-risk Medicaid mother, this is critical. Expectant mothers often encounter barriers to care, from a lack of transportation and financial resources, to limited education.
Improving birth outcomes starts with leveraging data and analytics (such as medical claims, biometric data, health risk assessments) to drive total population monitoring, create holistic member profiles and identify gaps in care. This data integration and identification enables local care coordinators to effectively work together to engage the member and create meaningful, individualized care plans.
From preconception to the first year of life, there are key opportunities to make a difference in the health of a mother and her child, but local, face-to-face care coordination must drive that engagement.
Improved outcomes at more affordable costs
This type of care coordination is more affordable than it may sound. Programs can be standardized through integration and coordination of existing community resources, with only a minimal portion requiring customization.
A consumer-centric approach to care is critical to helping pregnant women on Medicaid experience healthy pregnancies. Learn more by downloading our white paper, “Improving birth outcomes: The value of a consumer-centric approach in the Medicaid population.”
About the author
Kevin U. Stephens, Sr., MD, JD, FACOG, Senior National Medical Director, Community and State, Optum
In his current role as Senior National Medical Director of Optum, Dr. Stephens oversees Medicaid operations and led the launch of Optum’s community health worker intervention, which brings care to Medicaid members where they live and work.