Maternal health is a strong predictor of child health outcomes at delivery and as they age into adulthood. Engaging individuals in care at notification of pregnancy has proven to reduce pregnancy-related complications, premature deliveries, low birth weight, and infant disease. According to data from the Centers for Disease Control and Prevention (CDC),1 in 10 babies in the United States is born preterm. Additionally, CMS reports that Medicaid covers 42% of births in the United States. Not only do preterm and low-weight births contribute to the increased possibility of severe physical health and developmental difficulties, they also can impose significant avoidable medical costs. Also, while the health of the child is of utmost importance, so is the health and life of the pregnant individual. Although most deaths are preventable, maternal mortality has steadily increased in the United States, per the CDC. These facts demonstrate that effective maternal care is a public health issue that must be addressed.
Ensuring physical, mental, and societal needs of individuals are met at the onset of pregnancy through postpartum has the potential to significantly – and positively – impact health disparities, lower healthcare costs, and aid healthier children. Payers have a unique opportunity to harness the power of data to drive critical decisions, support comprehensive care, and attain cost savings. Through the use of risk stratification models, payers are enabled to identify impactable factors and behaviors early in the care journey to control unfavorable outcomes and prevent death or disability among the pregnant parent and their child. As part of a predictive data capture model, social indicators that correlate with poor health outcomes and health care utilization should be incorporated.
Analytical findings should be leveraged in creating an engaging member-centric experience that meets individuals’ unique needs, improves quality of care, and manages whole health. By incorporating the concepts of care management, integrated care, and disease management in program development, the health of parents and their newborns can be improved. A multi-faceted approach that includes member outreach, wellness education, provider collaboration, and the appropriate use of medical resources can extend the gestational period and reduce risks for both the child and member. Empowering individuals through prenatal, postpartum, and newborn care education also encourages long-term healthy lifestyle habits. Solving for barriers such as access to prenatal vitamins, transportation to appointments, social determinant factors, and preexisting or emerging mental health concerns also contribute to positive outcomes.
Pregnant individuals affected by substance use and substance use disorders (SUD) require individualized support delivered with dignity and without shame. Cultivating an integrated, whole health approach to prenatal care to address SUD helps ensure new or existing physical side effects and mental health concerns are monitored. Enhanced education and care coordination facilitates access to resources and support these individuals need to experience a healthy pregnancy and delivery.
States continue to adopt policies that extend Medicaid coverage after birth for up to 12 months, providing opportunity for increased mental and physical healthcare coverage for new parents. This extended access to postpartum care is an important step toward addressing maternal health disparities and provides opportunity to save lives and facilitate better long-term health outcomes for parents and their children. Additionally, it can help in achieving HEDIS measurements of care including timeliness of prenatal care, timeliness of postpartum care, and perinatal mood and anxiety measures.
Engaging pregnant individuals early is essential to supporting the appropriate use of medical and mental health resources to encourage a healthy pregnancy, delivery, and recovery. By constructing an integrated, whole-health experience, payers can improve birth outcomes, reduce neonatal admissions, help ensure all children meet their wellness goals, and coordinate care for pregnant individuals and their littlest members.