North Carolina Pregnancy Medical Homes
North Carolina is working to reduce infant mortality rates and improve birth outcomes through its innovative Pregnancy Medical Home program.
North Carolina’s program gets 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 program is a partnership among Community Care of North Carolina and the state Division of Medical Assistance (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.
Participating health care providers agree to screen every Medicaid-eligible pregnant woman to determine whether she is at risk for preterm birth using a list of ten priority risk factors that can impact pregnancy outcomes. When a woman is determined to be at risk, the doctor refers her to a pregnancy care manager from the local public health department to develop an individualized care plan and coordinate care throughout the pregnancy. 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. About 85% of all prenatal care providers serving Medicaid patients were enrolled in the program.
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. In addition, 14 local Community Care networks of health care providers, which cover the whole state, have teams that support the pregnancy medical home practices in their area.
The Pregnancy Medical Home 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 FY2012, over 75% of all pregnant women in the Medicaid program were screened. Of these, 70%were determined to have high-risk pregnancies and were referred to a pregnancy care manager. Preliminary results from the Pregnancy Medical Home program indicate downward trends in the rates of low birth weight and primary cesarean delivery among pregnant women receiving Medicaid.
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