News & Commentary

Addressing ways to lower infant, maternal mortality and preterm birth rates

February 5, 2018

The United States is one of the most developed countries in the world and yet it ranks poorly in many measures of maternal/child health.

  • In 2014, the United States was ranked 26th in a report of developed countries, with an infant mortality rate of 6.1 deaths per 1,000 live births.
  • In the U.S., maternal mortality has risen to 26.4 deaths per 100,000 live births, according to a recent report by NPR and ProPublica.
  • Preterm birth rates in the U.S. account for more than one in nine total births, placing it among the top 10 countries with the most preterm births in the world, alongside Indonesia, the Democratic Republic of the Congo and Brazil, according to a report by the World Health Organization.

While these statistics are eye-opening, there are concerted efforts being made in the health care community by providers and health insurers, to decrease these rates and make the U.S. a better, safer place for women to have children.

Initiatives that improve access to care, enhance prenatal care and increase early recognition of pregnancy are greatly needed. Because Anthem plans cover nearly 10 percent of all births in the U.S., the company believes that it has a great opportunity and a responsibility to improve the state of maternal and child health care. Anthem operates provider collaboration initiatives, support programs and other data-driven efforts that have all shown promise in improving the state of maternal and child health. Anthem’s Maternal Child Services (MCS) team takes on the challenges in maternal and infant health, acknowledging that confronting these systemic issues means addressing them upstream and supporting women through their entire lives—not just once they become pregnant. Their programs align with Anthem’s mission of making health care simpler, more accessible and more affordable, so that expectant mothers can focus on their health and the health of their child.  In this way, education, support and innovative programs can ease the challenges of pregnancy, childbirth and neonatal care. 

Provider collaboration & facility quality programs

Though the outcomes of pregnancy are influenced greatly by pre-pregnancy factors, health care providers have a huge impact on women during pregnancy. Women put their faith in their chosen provider and health center to deliver the best care for them and their child. Focusing efforts around provider collaboration, means offering resources and support to provider partners, including:

  • In person meetings with Practice Consultants, whose function it is to talk with OB providers and office administrators about the pre-and post-natal programs and support systems available to their patients.
  • Communicating with providers about best practices for closing gaps in prenatal care and reducing preterm birth rates.
  • Sharing comparison data on key quality measures such as low risk C-section rates, preterm birth and low birth weight rates

Anthem also promotes collaborating with hospitals to incorporate quality improvement efforts and performance-based incentives into those relationships. It measures these facilities by their efforts to gain and maintain a certification that connote baby-friendly policies and procedures that support breastfeeding. Through such programs health plans can implement safety procedures bundles for pregnancy and delivery care to reduce maternal mortality.

Additional programs can offer incentive opportunities to participating providers for meeting cesarean delivery and preterm birth metrics, or offer rewards to hospitals that meet early elective delivery and low-risk cesarean measures. This process leverages care delivery data that allows providers to make the best decision for those patients. 

Support beyond the doctor’s office

Improvements to infant and maternal health care can also be made outside the doctor’s office. Anthem supports the development of programs grounded in the understanding of life course modeling, which shows that reproductive patterns between generations are cyclical[1]. Anthem seeks to disrupt this cycle, with community based supports and programs that reach young women and men with educational and reproductive planning materials before reproductive age.

The MCS team also supports federally-funded programs that provide at-home RN visits to eligible, at-risk expectant mothers through the duration of their pregnancy and for two years postpartum.  These professionals coach expectant mothers to ensure that they are maintaining a prenatal care regimen that will benefit them and their children before, during and after birth, and help avoid catastrophic medical complications that end in mother or infant death. Anthem supports the referral of expectant mothers that meet program criteria in eligible locations for these programs, to ensure that they receive as much support as possible.

Additionally, telehealth services can offer lactation support to new mothers and provides access to electronic breast pumps. Increasing access to support and tools helps improve outcomes for both mother and child during this critical time. 

Anthem also supports the promotion of programs to combat the lesser-known challenges of child birth, including addressing Post-Traumatic Stress Disorder (PTSD), a common affliction for parents after a difficult birth and necessary NICU stay for the child. Counseling and other behavioral health services are offered for parents who experience PTSD, since those parents can have a harder time caring for their newborns, potentially leading to long term developmental barriers for infants. Anthem’s own experience has shown such programs to have an excellent success rate, with 77 percent of those parents identified as having PTSD accepting referrals for treatment. At a one-month follow up, 80 percent of those who accepted referrals remained engaged with their provider.

Data drives improvements

The more information that can be made available to women and expectant mothers, the more likely that outcomes will improve. If women had greater access to their data and to public health data more generally, they would be able to hold the system accountable for their care. Anthem is especially interested in initiatives that act on the need for more public reporting.

One example of a highly-functional system is the California Maternal Quality Care Collaborative. Their online platforms generate rapid-cycle performance metrics for maternity care providers in the state. Platforms like this drive improvements, since unlike renal disease and diabetes, women who are pregnant can shop for their provider—they can choose their experience. It is the responsibility of health care providers and health insurers to make that information available. Efforts are underway across the country to improve outcomes for expectant mothers and newborns. Through provider collaboration, support programs and data-driven quality improvement platforms, preterm birth and infant and maternal mortality rates can be diminished and a healthier future can be born. 

 

[1] For example, if your grandmother has your mother very young, your mother is more likely to have you at a young age, and so forth.

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