Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program

Abstract

Maternal and infant health is critical to our nation's health. Disparities remain unacceptably high, particularly in the areas of prematurity and infant mortality. In 2012, traditionally distant partners such as federal and state governments, Medicaid and commercial payers, patients, public health and private clinicians, and multiple advocacy groups collaborated to focus on improving birth outcomes. To catalyze the alignment, the Centers for Medicare and Medicaid Services convened an Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program. Over a year's time, the Expert Panel assimilated the best available evidence in clinical science and policy from content leaders and patients. These recommendations culminated in the present report, which challenges us as a nation to implement strategies to help all children have the best chance to survive and thrive comparable to that of other westernized nations.

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

“…Several of these recommendations are consistent with action areas identified by a recent Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program (Applegate, Gee, & Martin, 2014). The Centers for Medicare and Medicaid Services Innovation Center also recently funded a model designed to support “clinical-community collaborations” that decrease low-value utilization by addressing “upstream social and environmental determinants of health” and tracking utilization across time to identify high-risk groups (Alley, Asomugha, Conway, & Sanghavi, 2016).…”

Infant Growth following Maternal Participation in a Gestational Weight Management Intervention

“…4,32 Reversing these inequities requires specific attention to the population served by NIP. Based on race, income, and geographical residence, NIP participants represent a population that has experienced significant barriers to healthcare access, 33,34 yet NIP has been feasible for both patients and clinical staff. The NIP model is of particular interest because it is funded exclusively through reimbursement from local Medicaid payors.…”

On the same page: a novel interprofessional model of patient-centered perinatal consultation visits

“…This model of care is consistent with recommendations from the U.S. Centers for Medicare and Medicaid Services Expert Panel on Improving Maternal and Infant Health Outcomes, which called for the creation of patient-centered models of interdisciplinary prenatal care for at-risk women that include MFM specialist input. 31 …”

“…4, 32, 33 Interprofessional and collaborative model of practice and provision of perinatal health services have the potential to decrease unnecessary interventions while increasing patient safety and engagement in care. 31, 34 However, there are few published studies on collaborative, interprofessional models beyond a few case reports. This small-scale feasibility study contributes valuable information that simultaneous collaborative visits involving a nurse-midwife from the woman's chosen practice and an MFM specialist are logically feasible and improve communication among providers and pregnant women.…”