Recently, we gathered a number of health plan directors working on high-risk pregnancy care management to discuss a common problem: how to identify which members to enroll in their programs. Rapid and accurate identification is essential to reduce the costs and complications of a high-risk pregnancy.

As participants used our resources, they connected frequently to share their progress and challenges. Read below for our tips to revamp your care management strategy.

1. You already have all the right data, but it’s in the wrong places. The problem is not that plans lack the right data. The problem is that they have too much data in too many places. The first step our cohort members took was to collect data on high-risk pregnancy members from across the organization and state and merge them into an accessible, living document. We supplied a list of potential data sources that cohort members could browse for inspiration.
2. Valid data makes a big difference once you start conducting outreach. You don’t want to reach out to a member about a pregnancy, only to hear they already gave birth (or that they’re not actually pregnant!). One study found that 17% of pregnancy care management enrollees were enrolled after delivery (Health Plan Care Management Report, 2015). There’s not much a plan can do for a member once she has already had a NICU delivery, so it’s crucial to find valid data on members who are in their first or second trimesters.
3. Providers can be a valuable pipeline for detecting members—if you make reporting easy. When members’ care needs arise, they go to their provider before they go to their plan. If you give providers an easy method for sharing these needs, they can help you identify high-risk members. One plan in our cohort created a form providers could fill out to get members enrolled in care management and has been impressed by the increased accuracy of the referrals and their risk level.
4. When your target list is too long, use past outcomes data to prioritize members. It’s possible to have too much of a good thing, even in care management. One plan in our cohort was too successful at identifying high-risk members—their care managers couldn’t keep up with the volumes. So they doubled down on stratification to make sure they’re focusing on the subpopulations with the most need, such as pregnant members with hospital admissions.
5. Making initial contact is hard. So invest your time when you do. Plans still struggle to enroll the right members in care management. Only 30-40% of the plan’s targets end up enrolling. But investing more time for a personal conversation can make a difference. One plan in our cohort found that once the member was contacted, making a personal connection on the initial outreach call by clarifying the benefits of care management for that specific member’s needs could drive enrollment rates to 90%+.

In our high-risk pregnancy care management cohort, plans adapted Health Partners Plan’s successful strategy to improve their own pregnancy identification processes. If you’re interested in applying these learnings at your organization, follow this step-by-step guide with associated resources—such as a metrics rubric, a list of outreach questions, and a strategic planning document.