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Why are healthy pregnancies important?

Having a healthy pregnancy is one of the best ways to have a healthy birth. Things like getting early and regular prenatal care and getting support from ancillary services such as care coordinators or doulas can play a role in helping women have a healthy birth outcome. Women on Medicaid and women of color are less likely to get early prenatal care and other supports and are more likely to have a worse outcome for themselves or their baby. HealthPartners is working to improve access to prenatal care and supports for pregnant women, especially women of color to reduce these disparities.

What did we do to improve pregnancy care among our members?

The Healthy Pregnancy program is a HealthPartners program for our members who are pregnant and have a higher risk for problems in their pregnancy. Members who enroll in this program get extra support from a nurse throughout their pregnancy.

  • We updated how we identify women who are higher risk by using all the data that we have available to us.
  • We offer a Healthy Pregnancy assessment where women can answer questions about their current health and questions related to their pregnancy, including support services they may benefit from.
  • We offer an incentive for women to take the Healthy Pregnancy assessment, and an incentive to complete at least three calls with a Healthy Pregnancy nurse.

We created the MyPregnancy experience which offers on-line education and support during the pregnancy.

  • Members are sent information on a regular basis that is relevant to them based on the healthy pregnancy assessment and their due date.
  • We created content that covers the topics that are important to people on Medicaid such as the benefits for pregnant women like car seats, doulas, breastfeeding support, insurance coverage for newborns and postpartum health issues.
  • Resources are personalized based on the members race and ethnicity, preferences identified in the assessment and their location in Minnesota.
  • We connect members to online educational materials and videos about pregnancy, including information about nutrition, chest feeding, caring for your newborn, mental health and well-being, and pregnancy complications like preeclampsia and gestational diabetes.

Doulas are a covered benefit for women on state health insurance in Minnesota, but a lot of people do not know that. We wanted to make doulas more available to anyone who would like to work with one.

  • HealthPartners worked with our primary doula agency to certify several more doulas to serve women on Medicaid, focused on training doulas who are Black, Indigenous, and other women of color.
  • We gave the doula agency a grant to cover the costs for the training and the registration on the state website. One training was help in the twin cities metro and the other was held in the St. Cloud area.
  • We educated our staff about the availability of doulas and our provider network about the value that doulas can bring to women, especially women of color.
  • We increased the amount we pay for doulas who work with our Medicaid members.

How do we collaborate with providers?

We sent information to our provider network about the importance disparities that women of color face and the availability of the Healthy Pregnancy program and the value that doulas could offer to pregnant women.

We collaborated with the other Minnesota Medicaid health plans to offer webinars to providers about racism in health care and how to achieve health equity. These webinars were well attended and people who attended felt they learned new information and skills.

What challenges did we face?

It can be hard to identify and reach out to women early in their pregnancy to tell them about the services available to them. Sometimes women can't get scheduled for their first prenatal appointment early and we don’t receive claims until much later, so we don't know they are pregnant.

We often don’t have a current mailing address, email address, or phone number for members. The Healthy Pregnancy program is phone based so people may not want to use their limited minutes to talk to the Healthy Pregnancy nurse.

The amount of payment by Medicaid for doula services is much lower than for doulas who are privately paid. This discourages doulas from agreeing to serve women on Medicaid.

Results

In 2021, a total of 2947 Medicaid members visited the My Pregnancy web experience.

  • The most common page visited was the benefits page, followed by the find a pediatric provider page.
  • The average time spent on the site per visit was 23.61 minutes.
  • Most members accessed the site from a mobile phone (77.67%) followed by another device such as a computer (21.17%) and a tablet (1.15%).
  • American Indian (27.53 minutes) and Hispanic members (31.84%) spent longer on the site than other groups.

In 2021, 1,422 Medicaid members were identified as eligible for the Healthy Pregnancy program. Of those, 413 worked with a nurse, for a 29% engagement rate. In addition, 357 received the incentive for completing the program.

More women used doula services in 2021 than had in the year before the pandemic.
 

  Baseline (12 months ending 10/8/19) 2021
  White Non-white Unknown Total members White Non-white Unknown Total
L&D Session 16 21  37  15  32  55 
Non- L&D 19  25  44  32  48  85 
Unique Members 69 Unique Members 96

Ongoing work

This worked was started in 2021 and will be ongoing. We will monitor prenatal and postpartum care rates and other measures of birth outcomes to see how effective these programs are. We will continue to work with our provider network, our Healthy Pregnancy program and the community to improve pregnancy care and reduce disparities in birth outcomes for all women.

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