Healthy Babies & Moms: Sr. Corporate Medical Director - PowerPoint PPT Presentation

Maria Samerson, MD, FAAP Healthy Babies & Moms: Sr. Corporate Medical Director Addressing Disparities and Identifying Change Alison Dorsey, MPH Sr. Director, Government Affairs November 18, 2019

ROADMAP  Introductions  Framing the Issue  Addressing the Issue  Q&A 2

WELLCARE FOOTPRINT 6.3M MEMBERS 607K 68K HEALTHCARE PHARMACIES PROVIDERS #155 14K Medicare Prescription Drug Medicaid Plans (50 U.S. states & D.C.) FORTUNE 500 ASSOCIATES Medicare Advantage Health Insurance Marketplace Medicaid (Pending) & Medicaid & Medicare Advantage* Medicare Advantage † *Includes states where the company receives Medicaid and Medicare revenues associated with Dual Eligible Special Needs Plans (D-SNPs) 3 † Anticipated beginning Nov. 1, 2019, WellCare of North Carolina will administer the state’s Medicaid Prepaid All numbers are as of June 30, 2019 Health Plans (PHPs).

FRAMING THE ISSUE 4

SOME STARTLING STATISTICS  10% National Pre-term Birth Rate BLACK 13.6 In the United States, the AMERICAN INDIAN/ALASKA NATIVE 11.3 preterm birth rate among HISPANIC 9.4 black women is 49% higher WHITE 9 than the rate among all other women. ASIAN/PACIFIC ISLANDER 8.7 0 2 4 6 8 10 12 14 16 Percentage of live births in 2015-2017 (average) born preterm 5

RACIAL DISPARITIES Infant mortality rates by race and ethnicity (CDC) 6

A NATIONAL CRISIS 34,000 Number of #1 Care for child- 32.9% US cesarean 49 Countries that women each year who bearing women and rate in 2009 – an all- have lower maternal nearly die from newborns is #1 reason time high following a mortality rates than pregnancy-related for hospitalization in 13 consecutive year complications – one every the US the US rise 15 minutes 2x The risk of 3-4 Black women are 2-3 Black infants in maternal death in 3-4 times more likely to the US are 2-3 times high-poverty areas is die from pregnancy- more likely to die as 2x that in low- related causes than white infants white women poverty areas 7

PUTTING IT INTO CONTEXT Economic Stability Social Health Education Determinants Care of Health Environment 8

ADDRESSING THE ISSUE: ONE STATE’S POLICY SOLUTIONS 9

NEW JERSEY LEGISLATIVE EFFORTS Maternal Mortality Review Committee Perinatal Risk Medicaid Assessment coverage for enhanced doula care requirements Non-coverage non-medically Perinatal episode indicated early of care pilot elective deliveries 10

FIRST LADY OF NEW JERSEY’S EFFORTS 11

ADDRESSING THE ISSUE: WELLCARE SOLUTIONS 12

COMMUNITY CONNECTIONS: SDOH Peer-based social service access Community and coordination Connections Help Line (CCHL) Data-informed community investing Integrated social service and grassroots innovation management platform Community Tools & Engagement Technology MEMBER Iterative pilot-based innovation Web-based data platform with and evaluation approach automated tools to enable data Innovation, Data & collection, analysis and evaluation Integration & Evaluation Development 13

STATE PROGRAMS ILLINOIS GEORGIA NEBRASKA The Harmony Hugs program Our prenatal outreach program supports and educates pregnant Our Baby’s First Program is a focuses on communication with women. 15-month postpartum text members and coordination with their OB/GYN to ensure message program offered to appointments are maintained any resident to provide Nurse case managers educate information on breastfeeding, throughout pregnancy. pregnant members on fetal wellness visits, birth spacing, development, breastfeeding, and postpartum depression substance abuse and education/screening. pregnancy, child development In addition to regular and nutrition. communication with NCMs, we hold monthly prenatal education events to educate pregnant NCMs also arrange members on how to maintain a transportation and make healthy pregnancy. appointments for prenatal visits . 14

MCM PROGRAM AT-A-GLANCE Member Incentives to Promote Early Access Phone Programs to • Safe Link / Assurion & additional minutes promote engagement • Text4Baby and education • Choice of a stroller, portable playpen, car seat or diaper supply • Annual Wellness Visit $25; Healthy Rewards to • Up to $60 for Well-Child Visits –Birth through 15 months improve outcomes • Lead Screening- $25 • Pre-natal visit $25 • Postpartum visit- $25 Over The Counter • Cough and cold medicines • Toothbrushes, toothpaste and floss (OTC) Rewards to • First aid items • Sunblock promote wellness • Vitamins 15

MATERNITY CARE MANAGEMENT  Members who are pregnant and eligible for Medicaid, regardless of risk level Emphasis on  Care management services, education, and supports linkage with community - Minimum 60 days postpartum resources, - Up to 90 days postpartum timely prenatal and  Assistance with appointment scheduling postpartum  Provider coordination care, and  Care planning interventions that prevent  Pregnancy education adverse birth  In-home maternity services outcomes  Community-based resource engagement

INTRODUCING BABY STEPS Key Elements and Services Baby Steps  Member Engagement  Provider Engagement  Measurement & Evaluation 17

BABY STEPS – GOALS & OBJECTIVES Goals and Objectives Goal #1: Improve Birth Outcomes Goal #2: Increase appropriate use of maternity-related services Goal #3: Improve maternal health outcomes 18

BABY STEPS – PROGRAM DELIVERY Program Delivery  Member Identification  Members Engagement, Outreach and Assessment  Communications 19

BABY STEPS – KPIs Key Performance Indicators Population Cost Quality Health Measures Measures Measures • Pre-Term • Timeliness of • C-Section Birth Rate % Prenatal Care Delivery Rate • NICU Birth • Postpartum Rate % Care 20

FUTURE INNOVATIONS Maternal Substance Strategic Abuse Partnerships Program Pre- Technology Pregnancy Planning 21

NEW LEGISLATION California Dignity in Pregnancy and Childbirth Act (SB 464) Signed into law 10/07/19  Primary provisions: - Requires hospitals & clinics to implement implicit bias training for all healthcare providers working in perinatal services. - Requires state health dept to track/publish add’l data re pregnancy-related deaths 22

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