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Office of Medicaid Policy and Planning Birth Record and Outcome Data. Presented by: Dr. Caroline Carney Doebbeling, MD, MSc Director, Healthcare Evaluation, Research, Outcomes, and Quality. Distribution of Deliveries by Mother’s Age (CY05-07). Source: MedInsight, June 2008.

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office of medicaid policy and planning birth record and outcome data

Office of Medicaid Policy and Planning Birth Record and Outcome Data

Presented by:

Dr. Caroline Carney Doebbeling, MD, MSc

Director, Healthcare Evaluation, Research, Outcomes, and Quality

distribution of gestational age cy07 birth records for medicaid enrolled women
Distribution of Gestational AgeCY07 Birth Records for Medicaid Enrolled Women

40% births 38 wks or less

46% C-section 38 wk or less

Source: ISDH/OMPP combined birth record data. Singleton births in CY07 only.

Page 3

distribution of preterm births by race cy07 birth records for medicaid enrolled women
Distribution of Preterm Births by RaceCY07 Birth Records for Medicaid Enrolled Women

Source: ISDH/OMPP combined birth record data. Singleton births in CY07 only.

Page 4

first trimester prenatal care cy07 birth records for medicaid enrolled women
First Trimester Prenatal Care:CY07 Birth Records for Medicaid Enrolled Women

State of Indiana Average 80.6% (1996-2005)

Healthy People 2010 Goal = 90%

Source: ISDH/OMPP combined birth record data. Singleton births during CY07 only. OMPP claims data used to identify prenatal care visits during the first trimester.

Note: 60 Counties have less than 60% of Medicaid enrolled pregnant women obtaining 1st Trimester Prenatal Care.

Page 5

weeks of pregnancy at time of enrollment in mco cy08 prior to pe
Weeks of Pregnancy at Time of Enrollment in MCOCY08: Prior to PE
  • Fewer than 20% of women that deliver in a health plan are enrolled during the 1st trimester or prior to pregnancy
  • As many as 50% of women that deliver in a health plan are not enrolled until the 3rd trimester
  • 2nd and 3rd trimester enrollment leave women and newborns vulnerable
  • Action Taken: Presumptive Eligibility for Pregnant Women implemented July 1, 2009.

Source: HEDIS 2009 Reports (CY08 Data)

prenatal strategy address modifiable risk factors early and systematically
Prenatal Strategy: Address Modifiable Risk Factors Early and Systematically
  • Early Prenatal Care
  • Identification of Risk Factors
  • Interventions for Modifiable Risk Factors
  • Patient Centered Systems of Care
presumptive eligibility pe for pregnant women
Presumptive Eligibility (PE) for Pregnant Women

Page 8

  • Started July 1, 2009
  • Over 180 locations trained as Qualified Providers (QPs)
  • Over 4,300 women enrolled in PE since July 1, 2009
  • PE provides coverage of outpatient prenatal care services, including physician visits, labs, transportation, behavioral health services, and other outpatient services.
  • PE requires that women complete the Medicaid enrollment process
  • PE women are immediately enrolled in an MCO and must select a PMP
notification of pregnancy nop july 1 2009 septemer 7 2009
Notification of Pregnancy (NOP)July 1, 2009 – Septemer 7, 2009

Page 9

  • Began collecting July 1, 2009
  • Comprehensive risk assessment
    • Maternal Medical and OB risk factors
    • Tobacco and Other Drug Use
    • Psychosocial risk factors
    • Weeks of current pregnancy, previous birth outcomes
  • Utilized by Medicaid-enrolled providers and supported by all MCOs
    • Electronic submission
    • $60 incentive paid to physician for timely and complete submission of data using Web interChange
    • Nearly 4,000 risk assessments have been received by OMPP and the MCOs since July 1, 2009
notification of pregnancy july 1 2009 november 15 2009
Notification of Pregnancy July 1, 2009- November 15, 2009

Total NOPs submitted:

3,929

Women are entering care earlier in pregnancy, with 50% between 13-27 weeks of pregnancy at time of the Notification of Pregnancy (NOP)

nop data july 1 2009 november 15 2009
NOP DataJuly 1, 2009 - November 15, 2009
  • Race
    • White 77%
    • Black 17%
    • Other 4%
    • Asian 1%
    • Ethnicity
    • Non-Hispanic 95%
    • Hispanic 5%
  • Diagnosis of Pregnancy Risk
    • Normal Pregnancy n= 2,784 (70%)
    • High Risk Pregnancy
    • n= 1,185 (30%)

Approx. 20% <18 y/o

nop data social risk factors july 1 2009 november 13 2009
NOP Data –Social Risk FactorsJuly 1, 2009- November 13, 2009

Of women screened with NOP, N=3,969

nop data substance abuse status july 1 2009 november 13 2009
NOP Data – Substance Abuse Status July 1, 2009- November 13, 2009

Of women screened with NOP, N=3,969

nop data tobacco use status july 1 2009 november 13 2009
NOP Data – Tobacco Use Status July 1, 2009-November 13, 2009

Of women screened with NOP, N=3,969

smoking during pregnancy cy07
Smoking During Pregnancy – CY07

2005 Statewide Average 17.9%

Source: ISDH/OMPP combined birth record data. Singleton births during CY07 only. Statewide average for smoking during pregnancy (ISDH Maternal and Child Epidemiology Reports).

Note: Race data pending. Preliminary reports from Marion County indicate a higher proportion of white women smoking.

Data prepared by OMPP DMA

Data prepared by OMPP DMA

Page 15

February 2009

women smoking during pregnancy cy07
Women Smoking During Pregnancy, CY07

Counties >1,000 Births:

County Births % Smoking

Marion 8,781 21%

Lake 3,652 15%

Allen 2,603 24%

St. Joseph 1,934 21%

Elkhart 1,724 23%

Vanderburgh 1,259 33%

Tippecanoe 1,001 24%

Data Source: ISDH/OMPP combined birth record data. Singleton births during CY07. 2005 statewide average for smoking during pregnancy is 17.9% (ISDH Maternal and Child Epidemiology Reports)

Important Note: The majority of counties (68) have 30% or more Medicaid women attesting to smoking during pregnancy.

Page 16

tobacco cessation during pregnancy
Tobacco Cessation During Pregnancy

If women quit smoking during pregnancy

Baby get more oxygen

Baby’s lung function better

Decreases chances of baby being born too early

Mom experiences easier breathing and more energy

The effects of maternal smoking

  • Nicotine withdrawal
  • Increased crying and irritability
  • Breathing problems (lungs poorly developed)
  • Increased health problems (colds, ear infections, asthma)
tobacco cessation efforts current
Tobacco Cessation Efforts – Current

Current Status

  • MCO Welcome Packet includes tobacco cessation materials directed to the general population
  • Materials in the form of Member Handbook
  • MCOs send pregnancy packets if they determine a woman is pregnant
      • NOP facilitates this process
  • Prior to NOP, the MCO only knew about tobacco use if the woman was assessed by the MCO
      • Very few formal notifications of pregnancy occurred
  • Collaborated with MCOs, ISDH, IPN, ITPC to develop tobacco cessation material for pregnant women on Medicaid
tobacco cessation efforts future
Tobacco Cessation Efforts - Future

Future Status

  • MCOs will continue to send pregnancy packets to members if pregnancy is identified
  • The pregnancy packet will include the recently developed flyer
  • Provider training regarding Quitline Referral process will be provided in 2010
  • Some MCOs are distributing IPN’s Perinatal Substance Abuse DVD to providers
medicaid flyer for pregnant women
Medicaid Flyer for Pregnant Women

Nicotine Withdrawal Is Extremely Painful for Your Baby.

Smoking while pregnant causes

• Babies to suffer from nicotine withdrawals

• Ear infections, asthma and increased colds

• Hyperactivity, learning and behavioral problems

Quitting is hard, but there is help. It’s free. It’s easy. It’s confidential.

Call 1-800-QUIT-NOW (1-800-784-8669)

additional ompp activities
Additional OMPP Activities
  • Sunny Start
  • Indiana Coordinating Council (ICC)
  • Participated in Teen/Unplanned Pregnancy Event at Black Expo in 2009
  • OMPP staff regularly coordinates with ISDH MCH staff and Indiana Perinatal Network staff
  • OMPP Quality Committees and Subcommittees
    • Quality Strategy Committee
    • Neonatal Quality Subcommittee
tune in
Tune In
  • Data systems being built to link to week of enrollment, HEDIS scores, and outcomes
  • Earliest outcomes from PE not expected until July 2010 (gestation + claims run-out)
    • Sample size likely too small to be meaningful until end 2010
  • Modification of NOP to meet clinician needs
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