‘This is a baseline year’
Ohio Medicaid estimates investing $5 million in the program by the end of its first year, reaching more than 14,000 pregnant and postpartum patients and enrolling 77 medical practices currently caring for pregnant and postpartum patients.
“This is a baseline year,” said Marisa Weisel, Ohio Medicaid’s deputy director of strategic initiatives. The program provides quarterly payments to practices based on the number of Medicaid patients those practices typically serve, according to Weisel.
The Comprehensive Maternal Care program creates a framework for providers and community partners to develop individualized plans to support women and families who’ve historically lacked ready access to high-quality, responsive care before and after pregnancy, according to the governor’s office.
“Ohio Medicaid and our vision for the ‘Next Generation’ of care commits to delivering a personal care experience to every Ohioan served,” Corcoran said, referencing Ohio Medicaid’s Next Generation managed care program. The next stage of implementation will launch on Feb. 1, which will include managed care plans.
“The (Comprehensive Maternal Care program) model builds on that commitment by encouraging providers and communities to partner on building a trustworthy and comprehensive system of care for members,” Corcoran said.
What that care looks like
The practices involved in the program may use the funds to help their patients achieve better health outcomes, as Ohio Medicaid will be monitoring them through measurements to allow those practices to track how they are doing.
“We could have a practice that decides they want to hire a community health worker with their extra resources,” Weisel said. The health worker could help patients sign up for benefits such as WIC, help them work on finding stable housing or help get women connected with the behavioral health system to deal with post-partum depression.
Weisel said post-partum depression can play a big role in the parent’s ability to care for their child. It also points to how mental health impacts maternal mortality rates. In an analysis on pregnancy-related deaths between 2017 and 2019, the Centers for Disease Control found four out of five pregnancy-related deaths could have been avoided, with 23% of those deaths being associated with mental health conditions, including deaths to suicide and overdose/poisoning related to substance use disorder.
The health practices involved in the program also must consider and link patients to resources that address broader factors of health, such as housing, food instability and transportation.
“We know that health care is not the only thing that matters,” Weisel said. “There are often other barriers to them accessing care.”
Gina McFarlane-El, CEO of Five Rivers Health Centers, said the Comprehensive Maternal Care program will help them continue to care for their pregnant patients. Five Rivers Health Centers is the 10th largest federally-qualified health center in Ohio, seeing more than 27,000 patients a year. Of their pregnant patients, approximately 22% of them are uninsured.
In addition to health visits, McFarlane-El said Five Rivers Health Centers also supports their pregnant patients through programs like their diaper and bra banks, as well as with group visits for pregnant individuals.
“Diapers are one of those things that are not supported through any of the various funds that our women receive, so we created Montgomery County’s first diaper bank within this area through our Healthy Start program,” McFarlane-El said. “We use those resources to help women not worry about diapers.”
Cost figures vary for diapers, but the National Diaper Bank Network estimates the average monthly supply of diapers costs approximately $80 in Ohio, costing parents approximately $960 a year.
Five Rivers Health Centers also offers group prenatal care visits through the program Centering Pregnancy. Toni Tipton, a certified nurse midwife at Five Rivers Health Centers, said pregnant women can take part in group prenatal visits to allow for them to learn more and connect with other individuals whose delivery dates are similar to theirs.
“We really highly recommend it for first time moms, and it also provides social support,” Tipton said. The program is also aimed at decreasing infant mortality, while also increasing breastfeeding and immunization rates.
McFarlane-El said they will use some of the funds they receive through Ohio Medicaid’s Comprehensive Maternal Care program to support those programs and expand other efforts.
Requirements for providers
Participation in the Comprehensive Maternal Care program requires obstetrical practices to receive feedback from patients and families, such as through advisory councils or other means, which can then be used to improve patient experiences and reduce disparities.
“One thing we’ve heard, sometimes (patients) don’t feel like they’re able to communicate effectively with their provider,” said Weisel. This program then encourages those practices to get regular feedback from patients.
Additionally, Weisel said practices must use the pregnancy risk assessment to identify women in need of a first prenatal appointment and ensure timely access to appointments and services. This assessment also helps Ohio Medicaid track pregnant individuals’ needs and maintain their Medicaid coverage while they’re pregnant and also after their pregnancy. In April of last year, Ohio Medicaid extended its coverage of benefits for new mothers from 60 days to 12 months after the birth of their child.
Additional criteria for participation includes engaging community supports, evaluating the mother’s and family’s experiences throughout the treatment, ensuring patient involvement and care continuity with their providers and assessing the practices’ operations to make sure they are achieving healthier outcomes.