The Sampson County Health Department offers a prenatal program, pregnancy care management services. The program recently underwent a name transformation and is now called Care Management for High-Risk Pregnancy – CMHRP. The program was developed by the North Carolina Division of Public Health and the North Carolina Division of Medical Assistance and is designed to help Medicaid-eligible and non-Medicaid-eligible pregnant women who have factors priority risk factors to achieve a healthier pregnancy. Pregnancy Care Management serves Medicaid-eligible or non-Medicaid-eligible pregnant women who have a priority Maternal and Infant Impact Score (MIIS) associated with preterm birth, low birth weight, or other risk factors.
The transformation of Medicaid into managed care will take effect on July 1, 2021. The primary goals of Medicaid Managed Care are to show improvement in health plan performance, health care quality, and outcomes. Members are identified for the CMHRP program through referrals made by health plans for pregnant women who are considered priority patients. Care management for high-risk pregnancies is provided as a benefit for health care services covered by health plans. Members are encouraged to familiarize themselves with the standard and value-added benefits made available through the health plan in which they are enrolled. Medicaid recipients were enrolled in one of six health plans:
• Health blue
• Complete Carolina Health
• United Healthcare
• AmeriHealth Caritas
• NC Medicaid Direct
The criteria for providing services to Medicaid-eligible and non-Medicaid-eligible clients are the same; therefore, pregnancy care management staff will ensure that both populations receive the same high level of care management and care services.
Pregnancy care management services are provided by nurses and social workers with a focus on patient needs and risk status. The type and frequency of patient contact is determined by the individual needs and care plan of the patient in order to effectively achieve the desired outcomes.
Antenatal care providers can refer patients to CMHRP services by completing the pregnancy risk screening form at the first antenatal visit to identify risk factors early. If the pregnancy risk screening form is not used during referral, the pregnancy care manager will contact the patient to assess the presence of priority risk factors. Some priority risk factors include, but are not limited to:
• History of spontaneous preterm labor
• A history of low birth weight
• Unsafe living environment (homelessness, inadequate housing, domestic violence or abuse)
• Substance use
• Tobacco use
• Use of antenatal hospital
Services are available to any woman with Medicaid who lives in Sampson County, regardless of where she goes for prenatal care. Pregnancy care management staff receives a referral and contacts the person for follow-up care. Any medical provider or agency that works with pregnant women can refer clients. Clients with any of the above risk factors who are interested in the program can also contact pregnancy care management staff.
Pregnancy Care Management staff provide the following services:
• Follow-up on prenatal care issues and other clinical needs.
• Work with obstetrical providers and others who provide services to the pregnant woman to ensure that everyone is aware of her concerns and needs.
• Provide education regarding: the need to keep all prenatal appointments; understand and follow the instructions of the OB provider; and the importance of getting postpartum care.
• Arrange/assist with transition from OB provider to a primary care medical home as needed for the woman postpartum if she remains or becomes eligible for Medicaid after the postpartum period.
Pregnancy care management staff provide assistance with the 17P treatment program. 17P is a series of weekly injections offered to women who have had preterm labor and/or deliveries. The purpose of the injections is to help prevent preterm labor with the ongoing pregnancy. The services provided are:
• Educate client/family about 17P and its purpose
• Help the patient arrange for 17P injections and follow up when an injection is missed
Effective and ongoing communication and collaboration between the pregnancy care manager and the antenatal care provider of patient 17P is a key part of the program. The overall goal of the 17P program is to improve birth outcomes by reducing the rate of preterm birth, which is measured by the rates of low birth weight and very low birth weight, in addition to other indicators .
If you are a medical provider and want to refer a client; a pregnant woman; know someone who may be eligible for the program; or if you would like more information about the Pregnancy Care Management Program, please call the Sampson County Health Department at 910-592-113eExtensions 4230, 4973, or 4238.