When it comes to care management, early identification of a high-risk member could result in both a more healthy member and significant cost savings. While there are a great number of high-risk populations that health plans track, one particularly important population is expectant Mothers. Below, we delve into how Health Plan Partners (HPP) used data to identify their population of high-risk pregnancies and the care management program they created to provide proactive support.

Often, the hardest part of care management is actually identifying the members who need it. A notable high-risk population is expectant mothers, and rightfully so. According to Fair Health, the average price for having a baby in the US can range drastically from $5,000 to $28,500. Further, due to the increased rates of C-sections in the US, the overall costs associated with births are expected to increase.

There are four types of risk factors that could bring a relatively low-cost pregnancy to a high-cost, high-risk pregnancy: maternal age, medical history, surgical history, and pregnancy-related issues.

Table 1: Factors that can contribute to a high-risk pregnancy

But even with the risk factors outlined in the literature, it is challenging for plans to identify high-risk pregnancies for three main reasons:

1. Plans are unable to predict pregnancies from past claims as they can for most illnesses
2. Pregnant member data is not in a centralized source, but rather spread across multiple sources
3. Plans only have 9 months to both identify the member and intervene

Health Partners Plan, a Medicaid plan based in Pennsylvania, recognized these issues and sought to not only identify their high-risk, expectant mothers, but to also create a care management program to support them: The Baby Partners Program.

First, HPP’s data analytics team identified the available data sources that could help them both identify newly expecting mothers and potential risk-factors. Next, they created an automated weekly data pull that would consolidate all relevant data sources to create a list of high-risk pregnant members. This list is sent to the Baby Partners care management team. Within 24 hours of receiving the list, the Baby Partners Team proactively reached out to these members to offer tailored information and resources to help ensure the health of both the mother and the baby.

Within the first year of the program’s inception, over 1000 expectant mothers were contacted and HPP saw a 14% reduction in risk of low birthweight babies, 20% increase in post-partum office visits, and $1.5M in savings in the first 3 months for participating babies.

The results speak for themselves. In fact, the numbers are so impressive that other plans have leveraged this strategy. Click here to watch a video and see how The Advisory Board helped implement this strategy at the Health Plan of San Joaquin and helped them increase their monthly number of identified high-risk pregnancies by 38%. This is just one statistic that resulted in immediate expansion of this prenatal care management program.