2018 Mommy Steps. Program Description. Our mission is to improve the health and quality of life of our members

Transcription

1 2018 Mommy Steps Program Description Our mission is to improve the health and quality of life of our members

2 Mommy Steps Program Description I. Purpose Passport Health Plan (Passport) has developed approaches to the management of members high risk obstetrical condition(s) in order in improve birth outcomes such as prematurity and low (LBW), and very low, birth weight (VLBW). The emphasis of the Mommy Steps Program is education and support for targeted members and clinicians to improve the overall health, wellness, and quality of the member s life. The Mommy Steps Program will facilitate member understanding and responsibility of the high-risk pregnancy process as well as coordination of care between the member and/or caregiver and the clinician. The Mommy Steps Program focus is on emphasizing prevention of complications by providing support and care coordination to increase compliance with Passport s Perinatal Care Clinical Practice Guidelines which are based on the American College of Obstetricians and Gynecologists (ACOG) Guidelines 1 utilizing patient empowerment strategies. II. Program Goals Increase percentage of members who receive prenatal care within 42 days of enrollment or within the first trimester. Increase average number of prenatal visits to 80% or greater of the expected visits per member to encourage regular prenatal care. Increase percentage of members who receive a postpartum clinician visit between 21 and 56 days after delivery. Decrease the number of preterm deliveries ( 37 weeks). Decrease the number of LBW (1,501 grams to < 2,500 grams) babies. Decrease the number of VLBW (< 1,500 grams) babies. III. Rationale 1. National According to the 2016 March of Dimes PeriStats, 9.8% of all live births in the United States were preterm, or 1 in In addition. According to the 2014 March of Dimes PeriStats, 8.8% were LBW and 1.4% was VLBW. 3 Major risk factors for preterm and VLBW include a history of preterm birth, current multiple gestation pregnancy, stress, infection, smoking, and illicit drug use. 3 VLBW babies who survive may suffer lifelong consequences, including cerebral palsy, blindness, and other chronic conditions /9/18 FINAL Page 1 of 7

3 2. Kentucky According to the 2016 March of Dimes PeriStats, 11.4% of live births in Kentucky were preterm, or 1 in 9. 1 According to the 2014 March of Dimes PeriStats, 8.8% were LBW and 1.5% was VLBW 3. Risk factors for LBW and VLBW include smoking, alcohol, street drugs, and abusing prescription drugs, exposure to air pollution or lead, little education, low income, being unemployed, age, race and/or ethnicity and domestic violence. 2 In 2013, major risk factors for preterm birth include a history of preterm birth, current multiple gestation pregnancy, some uterine/cervical abnormalities, infection (especially genito-urinary), diabetes mellitus, hypertension, late or no prenatal care, smoking, alcohol, and illicit drug use Passport In 2017, Passport had an average of 4,097 members per quarter enrolled in the Mommy Steps Program, with an average of 1,709 members per quarter that were identified as new members, a 29% increase from There was an average of 443 members per quarter identified as high risk, a 9% increase from There was an average of 394 high risk members actively engaged with a High-Risk Maternity Care Advisor. These members received one-on-one telephonic contact and educational materials specific to their high-risk condition. There was an average of 841 members per quarter who received postpartum outreach calls, an 44% increase from An average of 67 referrals per quarter was made to WIC, HANDS and Healthy Start, an 82% decrease from New members received individual educational mailings. Ability to impact birth outcomes: Potential areas of impact (in addition to a reduction in healthcare costs) Education of pregnant members, pre-current and post-pregnancy management, increase the percentage of deliveries at 37 weeks gestation, increase the frequency of prenatal visits for gestational age, ensure members receive adequate prenatal care, increase compliance in relation to recommended postpartum visits to reduce postpartum complications, reduce the rate of LBW and VLBW infants, decrease the frequency of elective induction or delivery at < 39 weeks gestation, decrease smoking rates and the rate of maternal and infant postpartum readmissions, and improve the quality of life of members. IV. Member Participation Eligible members are identified and added to the Mommy Steps Program, and program mailings are sent. Members that return pregnancy risk questionnaires are considered enrolled. Members may opt-out of the Program and elect not to receive services by notifying any of the Mommy Steps Program staff or the Care Connector Program, either telephonically or in writing /9/18 FINAL Page 2 of 7

4 V. Integrating Member Information Passport utilizes Lucina Firefly, an integrated informatics technology platform for clinical record management of the maternity population. In Firefly, all users can view information that is specific to the member such as demographics, eligibility, member s clinician, spoken language, and preferences on receiving educational materials or phone contact. Users also can enter additional addresses or phone numbers, which the member may give as an alternative way to reach them that is not associated with the state file download that is used to populate the basic demographic fields in Firefly. In addition, Firefly users can perform the following activities: Edit demographic information and preferences, as needed. Upload documents related to the member and/or the member s care that need to be visible to all users in order to facilitate seamless care coordination. View all the documentation that has been entered as it relates to the member. View any correspondence that the member has sent to Passport, or that Passport has sent to the member. View the member s established care coordination assessment and plan of care. View historical data or closed cases. This data allows everyone interacting with the member to have access to the most current and available data in order to make every member contact count to its fullest potential and improve coordination of care by all users having the same information. VI. Population Identification Eligible members for the Mommy Steps Program are identified primarily through clinician notification of pregnancy to Passport but can include the following: Data collected through the utilization management (UM) process, examples include, but are not limited to: hospital census report, emergency room (ER) Utilization reports, and UM staff Data collected through the Care Connector Team health and wellness outreach representatives Referrals from clinicians This includes, but is not limited to: OB clinicians, Departments of Health (DOH), and Teen Pregnancy programs Referrals from other Passport departments, examples include, but are not limited to: Care Management (CM), EPSDT, and Member Services Referrals from subcontractors This includes, but is not limited to: 24-Hour Nurse Line Self-referrals from members Referrals from hospital educators/discharge planners Data collected through the Health Risk Assessment Form (HRA) Data collected through the weekly Pregnancy Report (PRG) Data collected through monthly claims reports Members who meet the criteria are eligible for the Mommy Steps Program. This determination of eligible members occurs daily. In addition to identifying members daily, members may be adjusted from low risk to high risk. 5/9/18 FINAL Page 3 of 7

5 Program Participation Requirements: Continuous Age Diagnosis enrollment Utilization Pharmacological All pregnant members Pregnancy All enrolled pregnant members N/A N/A VII. Member Contact Eligible members are identified weekly and receive one of the following welcome packets depending on known and unknown risks, including: Welcome letter for members with known risks (Appendix A), or Welcome letter for members with unknown risks (Appendix B), and Pregnancy Screening Tool (Appendix C). Both welcome packets include information on (Appendix D): Smoking cessation resources The importance of early and regular prenatal care Community resources such as WIC, HANDS, Healthy Start Care Messaging Program Available treatment for drugs and alcohol, mental health services Domestic violence support line Dental and vision service contacts Legal assistance contacts Support group information for loss of an infant State transportation service contact numbers Members who call Passport are screened for any high-risk conditions that could result in poor birth outcomes, demographics are verified, and members are given the Care Connector Team contact number to call with any questions or if anything changes during the member s pregnancy. In addition, the members receive: Postpartum telephonic outreach to screen for postpartum complications, educate on the importance of scheduling a postpartum visit, newborn visits, and newborn enrollment with Medicaid and Passport, other available resources, and answer any questions. All identified pregnant members with any of the following will be considered high risk (Appendix E): Substance Abuse Homelessness Domestic Violence Teen Pregnancy (18 years and younger) Chronic Hypertension (CHTN) Diabetes (Type 1, Type 2 and/or Gestational Diabetes (GDM)) 5/9/18 FINAL Page 4 of 7

6 History of Pre-term Delivery (<37 weeks) Triage (for Mommy Steps Team only) Pregnant members identified as high risk receive outreach from a High-Risk Maternity Care Advisor. The High-Risk Maternity Care Advisor: Assesses the member s needs utilizing a maternity-specific assessment. Coordinates care with the clinician involved in the member s care. Establishes and maintains contact with the member to evaluate and revise the plan of care as needed. Educates the member and/or caregiver on the importance of medication adherence, attending scheduled appointments, adherence with self-monitoring activities, and adherence with screenings/lab tests. Educates the member and/or caregiver on lifestyle changes that may improve the member s birth outcome such as diet/weight management, medication adherence, exercise, smoking cessation, avoidance of drugs and alcohol, and regular clinicians visits. Outreach to members continues throughout eight weeks postpartum. Conducts the Patient Health Questionnaire (PHQ) 2 during antepartum and postpartum contact as a depression prescreening tool and based on the results, completes the Edinburgh Postnatal Depression Scale (EPDS) Assessment, to identify members in need of referral for behavioral health services. Provides the member with assistance/information regarding available community resources. Provides the member and/or caregiver with additional written and/or verbal information targeted to the member s specific diagnoses. VIII. Clinician Notification and Involvement Participating clinicians in the health plan are made aware of the Mommy Steps Program by the following: Quick Reference Guide distributed to new clinicians with information regarding how the High- Risk Maternity Care Advisor works with pregnant members and instructions on how to access and utilize the program services (Appendix F) The Passport Provider Manual The Provider Orientation Kit (Appendix G) The Passport Provider enews Clinician outreach visits by Provider Network Account Manager Passport s Perinatal Care Clinical Practice Guidelines are available to all participating clinicians. Guidelines are reviewed and updated at least every two years and anytime new scientific evidence is published. 5/9/18 FINAL Page 5 of 7

7 IX. Member Satisfaction with the Mommy Steps Program Passport s Mommy Steps Program has a systematic method of evaluating member satisfaction with all areas of maternity services. A Satisfaction Survey (Appendix H) is distributed to all high-risk pregnant members that engaged with a High-Risk Maternity Care Advisor after discharge from the program. Questions address member experiences with the Mommy Steps Program and High-Risk Maternity Care Advisor in the areas of: The effectiveness in helping the member understanding high risk pregnancy. The professionalism of the High-Risk Maternity Care Advisor. The helpfulness received from the High-Risk Maternity Care Advisor. The guidance received from the High-Risk Maternity Care Advisor about making decisions. The usefulness of the educational materials provided. The survey results are tracked and analyzed to identify opportunities to improve satisfaction with the Mommy Steps Program. Results are reported quarterly by the Manager of High Risk Maternity Management or his/her designee, with the goal of 90% or above in member satisfaction with all areas of services. The member has the option to be contacted by the Manager of High Risk Maternity Management or his/her designee, regarding inquiries about the Mommy Steps Program. Two (2) attempts are made by the Manager of High Risk Maternity Management or his/her designee, to contact the member. If outreach is unsuccessful, then the Manager of High Risk Maternity Management or his/her designee, will send out the Satisfaction Survey Return Call Letter (Appendix I) and wait two (2) weeks for a reply. All outreach to the member are tracked for reporting purposes. Complaints and/or inquiries regarding the Mommy Steps Program can be received by Member Services or through the Care Management Department. Complaints and inquiries through Member Services are documented in EXP, a customer-service software package that records, tracks, and reports on all member and clinician inquiries and complaints allowing for real-time on-line communication between departments. Complaints or inquiries through the Care Management Department are resolved in the Care Management Department and then forwarded to Member Services for documentation in EXP. Additionally, all member complaints regarding services are forwarded to the Manager of High Risk Maternity Management or his/her designee, for follow-up. The Manager of High Risk Maternity Management or his/her designee, conducts a quantitative and qualitative analysis of complaints and inquiries regarding services, annually. This analysis is used to identify patterns of member complaints and opportunities to improve satisfaction with the Mommy Steps Program. Changes to the Mommy Steps Program are made as needed. X. Annual Evaluation The annual evaluation of the Mommy Steps Program is conducted by Passport s High-Risk OB Care Advisors, the Manager of the High-Risk Maternity Management, the Director of Medical Management Care Coordination, the Medical Director of Women s Health, the Director of Quality, and the Chief Medical Officer, or designee. 5/9/18 FINAL Page 6 of 7

8 Objectives, activities and outcomes are evaluated at a minimum of annually to: Measure participation rates. Determine whether the Mommy Steps Program has demonstrated improvement in birth outcomes and quality of care provided to pregnant members. Evaluate the overall effectiveness of the Mommy Steps Program. Allow for exploration of barriers and limitations of the Mommy Steps Program. Revise areas as needed to improve effectiveness of the Mommy Steps Program. Formal measurements of Frequency of Ongoing Prenatal Care, Initiation of Prenatal Care and Postpartum Care are performed annually through HEDIS 1 reviews using HEDIS methodology. Program goals for LBW, VLBW, and Preterm Births are based on Healthy People 2020 and are measured on delivery information obtained through facility notification of delivery. Results are utilized to revise the program and set the program goals for the following year. More frequent barrier analyses are performed on an ongoing basis and adjustments to the Mommy Steps Program are made accordingly. Final approval by the Quality Medical Management Committee: May 6, 2014 August 14, 2015 June 14, 2016 May 16, 2017 May, HEDIS is a registered trademark of the National Committee of Quality Assurance (NCQA). 5/9/18 FINAL Page 7 of 7

9 Appendices A. Welcome Letter for Members with Known Risks B. Welcome Letter for Members with Unknown Risks C. Pregnancy Screening Tool D. Welcome Packet Resources E. High Risk Stratification Tool F. Provider Quick Reference Guide G. Provider Orientation Kit H. Mommy Steps Program Satisfaction Survey I. Mommy Steps Satisfaction Survey Return Call Letter

10 Member Welcome Letter for Members with Known Risks Appendix A [Date] Congratulations on your pregnancy! The maternity program at Passport called Mommy Steps knows that becoming a mom is a big step in your life. Your prenatal care, the care you get during pregnancy, is very important and will help you have a healthy pregnancy. Understanding what to do can put you at ease and will make all the difference. 3 Steps to a Healthy Pregnancy: 1. Attend all of your regular doctor visits and prenatal appointments. 2. Eat healthy foods. 3. Make good choices do not smoke, use alcohol or drugs. If you have any major changes in your pregnancy, please tell your doctor and give us a call at You may call us Monday through Friday from 8 am to 6 pm Eastern Time. TDD/TTY users please call Si habla Espanol, por favor llamme Pasos de Mama: Remember! To keep your Passport benefits, DCBS/Medicaid needs your most recent address on file at all times. Please report any address changes to the office where you applied for Medicaid the DCBS office, SSI office or Benefind. If you have questions, you may call our Member Services team at Sincerely, Mommy Steps EVOH73499 APP_4/17/2017

11 Member Welcome Letter for Members with Unknown Risks Appendix B [Date] Congratulations on your pregnancy! The maternity program at Passport called Mommy Steps knows that becoming a mom is a big step in your life. Your prenatal care, the care you get during pregnancy, is very important and will help you have a healthy pregnancy. Understanding what to do can put you at ease and will make all the difference. 3 Steps to a Healthy Pregnancy: 1. Attend all of your regular doctor visits and prenatal appointments. 2. Eat healthy foods. 3. Make good choices do not smoke, use alcohol or drugs. We d like to learn more about you and your health needs. Please fill out the enclosed Pregnancy Screening Tool and mail it back in the postage-paid envelope. If you have any major changes in your pregnancy, please tell your doctor and give us a call at You may call us Monday through Friday from 8 am to 6 pm Eastern Time. TDD/TTY users please call Si habla Espanol, por favor llamme Pasos de Mama: Sincerely, Remember! To keep your Passport benefits, DCBS/Medicaid needs your most recent address on file at all times. Please report any address changes to the office where you applied for Medicaid the DCBS office, SSI office or Benefind. If you have questions, you may call our Member Services team at Mommy Steps EVOH73497 APP_4/17/2017

12 Pregnancy Screening Tool Appendix C

13 Pregnancy Screening Tool Appendix C

14 Welcome Packet Resources Appendix D

15 Welcome Packet Resources Appendix D

16 Welcome Packet Resources Appendix D

17 Welcome Packet Resources Appendix D

18 Welcome Packet Resources Appendix D

19 Welcome Packet Resources Appendix D

20 Welcome Packet Resources Appendix D

21 Welcome Packet Resources Appendix D

22 Welcome Packet Resources Appendix D

23 Welcome Packet Resources Appendix D

24 Welcome Packet Resources Appendix D

25 High Risk Stratification Tool Appendix E

26 Provider Quick Reference Guide Appendix F

27 Provider Orientation Kit Appendix G

28 Mommy Steps Program Satisfaction Survey Appendix H

29 Mommy Steps Program Satisfaction Survey Appendix H

30 Mommy Steps Satisfaction Survey Return Call Letter Appendix I [Date] [Member] [Address] [City, State, Zip] Dear Member, We have received your Satisfaction Survey and see that you would like to speak with someone at Passport. I am very happy to talk with you and help answer your questions. However, I have been unable to reach you by phone. You may call me back at , press 0, then press [ext]. I look forward to hearing from you! Sincerely, [Name and Credentials] [Title] Passport Health Plan HLTH40658 APP_10/7/2014