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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

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Distribution of Deliveries by Mother’s Age (CY05-07)

0

2000

4000

6000

8000

10000

12000

11 15 19 23 27 31 35 39 43 47 51 55

Mother's Age at Time of Delivery

Del

iver

ies

77% of Deliveries in Indiana Medicaid Occur Between Ages 19-30 Years Old

(CY 2005-2007)

Source: MedInsight, June 2008

DY574_261023_brDistribution of Gestational AgeCY07 Birth Records for Medicaid Enrolled Women

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

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40% births 38 wks or less 46% C-section 38 wk or less

DY574_261023_brDistribution of Preterm Births by RaceCY07 Birth Records for Medicaid Enrolled Women

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

69.01% 66.82% 59.86% 58.94%

18.85% 23.38% 29.58% 29.39%

10.21% 7.99% 8.45% 10.42%

1.93% 1.81% 2.11% 1.24%

0%

20%

40%

60%

80%

100%

37-38 weeks 34-36 weeks 32-33 weeks <32 weeks

Preterm Birth Distribution by Race

Other

Hispanic

Black

White

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DY574_261023_brFirst Trimester Prenatal Care:CY07 Birth Records for Medicaid Enrolled Women

35-39%4

40-44%8

45-49%13

50-54%15

55-59%20

60-64%12

65-69%14

70-74%5

0

5

10

15

20

25

Num

ber

of C

ounties

Percentage with 1st Trimester Visit

Medicaid Enrolled Women With 1st Trimester Prenatal Care

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.

State of Indiana Average 80.6% (1996-2005)Healthy People 2010 Goal = 90%

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DY574_261023_brWeeks 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.

12.9%7.2%

48.8%

27.7%

3.4%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<0 1-12 13-27 >28 Unk

Perc

enta

ge

Weeks of Pregnancy

Weeks of Pregnancy at Time of Enrollment (HEDIS®, 2009)

Source: HEDIS 2009 Reports (CY08 Data)

DY574_261023_br 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

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Presumptive Eligibility (PE) for Pregnant Women

• 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

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Notification of Pregnancy (NOP)July 1, 2009 – Septemer 7, 2009

• 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

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41%

51%

8%

Number of Weeks of Pregnant

1-12 Weeks 13-27 Weeks 28+ Weeks

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)

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0%

10%

20%

30%

40%

50%

60%

Mother's Age at Time of NOP

NOP DataJuly 1, 2009 - November 15, 2009

Approx. 20% <18 y/o

RaceWhite 77%Black 17%Other 4%Asian 1%

EthnicityNon-Hispanic 95%Hispanic 5%

Diagnosis of Pregnancy RiskNormal Pregnancy

n= 2,784 (70%)High Risk Pregnancy

n= 1,185 (30%)

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0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Homeless No Family Support

No Telephone Learning Disability

Unstable Home

Lives Alone History of Rape

Tranportation Problems

Unemployed

Social Risk Factors

NOP Data –Social Risk FactorsJuly 1, 2009- November 13, 2009

Of women screened with NOP, N=3,969

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NOP Data – Substance Abuse Status July 1, 2009- November 13, 2009

Of women screened with NOP, N=3,969

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NOP Data – Tobacco Use Status July 1, 2009-November 13, 2009

Of women screened with NOP, N=3,969

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February 2009Data prepared by OMPP DMA

Smoking During Pregnancy – CY07

15-19%2

20-24%10

25-29%12

30-34%36

35-39%19

40-44%10 45-49%

3

05

101520253035404550

Num

ber

of C

ounties

Percentage Smoking During Pregnancy

Women Smoking During Pregnancy

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.

2005 Statewide Average 17.9%

February 2009Page 15Data prepared by OMPP DMA

DY574_261023_brWomen Smoking During Pregnancy, CY07

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.

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%

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If women quit smoking during pregnancyBaby get more oxygenBaby’s lung function betterDecreases chances of baby being born too earlyMom 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 During Pregnancy

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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 – Current

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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

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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)

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• 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

Additional OMPP Activities

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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