DY574_261023_br 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

DY574_261023_br Distribution of Deliveries by Mother’s Age (CY05-07) 77% of Deliveries in Indiana Medicaid Occur Between Ages Years Old (CY ) Source: MedInsight, June 2008

DY574_261023_br Distribution of Gestational Age CY07 Birth Records for Medicaid Enrolled Women Source: ISDH/OMPP combined birth record data. Singleton births in CY07 only. Page 3 40% births 38 wks or less46% C-section 38 wk or less

DY574_261023_br Distribution of Preterm Births by Race CY07 Birth Records for Medicaid Enrolled Women Source: ISDH/OMPP combined birth record data. Singleton births in CY07 only. Page 4

DY574_261023_br First Trimester Prenatal Care: CY07 Birth Records for Medicaid Enrolled Women 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 1 st Trimester Prenatal Care. State of Indiana Average 80.6% ( ) Healthy People 2010 Goal = 90% Page 5

DY574_261023_br Weeks of Pregnancy at Time of Enrollment in MCO CY08: Prior to PE Fewer than 20% of women that deliver in a health plan are enrolled during the 1 st trimester or prior to pregnancy As many as 50% of women that deliver in a health plan are not enrolled until the 3 rd trimester 2 nd and 3 rd trimester enrollment leave women and newborns vulnerable Action Taken: Presumptive Eligibility for Pregnant Women implemented July 1, 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

DY574_261023_br 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 Page 8

DY574_261023_br 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 Page 9

DY574_261023_br Notification of Pregnancy July 1, November 15, 2009 Total NOPs submitted: 3,929 Women are entering care earlier in pregnancy, with 50% between weeks of pregnancy at time of the Notification of Pregnancy (NOP)

DY574_261023_br NOP Data July 1, November 15, 2009 Approx. 20% <18 y/o Race White 77% Black 17% Other 4% Asian 1% Ethnicity Non-Hispanic 95% Hispanic 5% Diagnosis of Pregnancy Risk Normal Pregnancy n= 2,784 (70%) High Risk Pregnancy n= 1,185 (30%)

DY574_261023_br NOP Data –Social Risk Factors July 1, November 13, 2009 Of women screened with NOP, N=3,969

DY574_261023_br NOP Data – Substance Abuse Status July 1, November 13, 2009 Of women screened with NOP, N=3,969

DY574_261023_br NOP Data – Tobacco Use Status July 1, 2009-November 13, 2009 Of women screened with NOP, N=3,969

DY574_261023_br February 2009Data prepared by OMPP DMA Smoking During Pregnancy – CY07 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 Statewide Average 17.9% February 2009Page 15Data prepared by OMPP DMA

DY574_261023_br Women Smoking During Pregnancy, CY07 Data Source: ISDH/OMPP combined birth record data. Singleton births during CY 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 Marion8,78121% Lake3,65215% Allen2,60324% St. Joseph1,93421% Elkhart1,72423% Vanderburgh1,25933% Tippecanoe1,00124% Page 16

DY574_261023_br If women quit smoking during pregnancy Baby get more oxygen Baby’s lung function better Decreases chances of baby being born too early Mom 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

DY574_261023_br 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

DY574_261023_br 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

DY574_261023_br 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 QUIT-NOW ( )

DY574_261023_br 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

DY574_261023_br 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