North Carolina is working to reduce infant mortality rates and improve birth outcomes through its innovative Pregnancy Medical Home program.
North Carolina’s program encourages doctors and other providers of maternity care to screen pregnant women for risk factors and to use evidence-based practices for prenatal care. The Pregnancy Medical Home (PMH) program is a partnership between Community Care of North Carolina (CCNC) and the state Division of Health Benefits (Medicaid), in conjunction with the North Carolina Division of Public Health. The program began in April 2011 as an effort to address North Carolina’s high prevalence of low birth weight, preterm birth, and infant mortality rates. It now includes most maternity care providers across North Carolina, more than 450 practices and 2,500 individual providers.
Participating health care providers agree to complete a standardized risk screen on every Medicaid-eligible pregnant woman and provide it to the local public health department. In 2017, CCNC operationalized the Maternal-Infant Impactability Score™ (MIIS) stratification model. A score is assigned to every pregnant woman based on her specific characteristics and risk factors, reflecting the relative ability of a care manager to reduce the risk of low birth weight through intense care management. When a woman is determined to be at risk, a Care Manager for High Risk Pregnancies develops an individualized care plan and coordinates care throughout the pregnancy. Initial results from SFY2019 suggest a significant decrease in low birth weight rate overall, with the most significant reduction among the highest-impactable women.
In addition, the pregnancy medical home agrees to not perform elective deliveries before 39 weeks of gestation, aims for a primary cesarean delivery rate below 20%, and provides progesterone injections for women with a history of spontaneous preterm birth. Doctors receive financial incentives to participate in the program. Incentives paid by Medicaid include $50 per patient for performing the initial risk screen, enhanced reimbursement for vaginal deliveries, and $150 for a postpartum visit that includes depression screening, reproductive life planning, and referral for ongoing health care. A statewide OB physician and nurse team support the pregnancy medical home practices in their area.
The PMH program aims to demonstrate not only improved quality of care and improved outcomes, but also cost savings. Approval of a Medicaid state plan amendment was required to change the reimbursement structure, but no additional funding was allocated. Funding will come from Medicaid money saved by the new techniques through reductions in low birth weight, preterm birth, and cesarean delivery. North Carolina expects to save close to $1 million in the first year and up to $9 million in the second year.
In AFY2017 approximately 80% of pregnant women in the PMH program underwent a comprehensive risk screening while there was also a decline in the rate of elective deliveries before 39 weeks gestation. In FY2019, the PMH program continued to screen almost 80% of pregnant women in the North Carolina Medicaid population. Since 2015, women receiving care from a PMH had a 3% increase in the timeliness to prenatal care (before 14 completed weeks of gestation) and there has been a 10% increase in the postpartum visit rate. The 52.4% unintended pregnancy rate in 2012 was reduced to 44.5% by 2019.
North Carolina is currently moving toward managed care and at that time the Pregnancy Medical Home program will transition to the Pregnancy Management Program.
Updated March 2020