1. Medicaid Initiatives to Improve Maternal and Infant Health
Marsha Lillie-Blanton, DrPH
Chief Quality Officer & Director, Division of Quality, Evaluation, and Health Outcomes
Center for Medicaid and CHIP Services, CMS
HRSA’s Region IV and VI Infant Mortality Summit

2. CMS Aims: Coverage as Pathway to Better Care, Better Health, Lower Costs
Through
Improvement
Better Care
of Individuals

3. Medicaid/CHIP’s Role in Achieving the “Three Part Aim” for Mothers and Children in Medicaid
At least 2 of 3 adult women covered by Medicaid are in their reproductive yrs
Medicaid covers 4 of 10 births and about 2 of 3 publically-funded family planning services, including
Prenatal and post-partum care
Gynecological services
Testing and treatment of sexually transmitted diseases
Medicaid/CHIP cover about 34% of all children under age 18
Sources: National Institute for Reproductive Health; Kaiser Family Foundation: Health Reform: Implications for Women’s Access to Coverage and Care, December 2009; Dubay et al, Health Affairs 2007.

4. The Challenge & Opportunity

5. Infant Mortality Rates for Mothers Age 20+, by Race/Ethnicity and Education, 2003-2005
Infant deaths per 1,000 live births:
African American, Non-Hispanic
American Indian/Alaska Native
White, Non-Hispanic
Asian and Native Hawaiian/Pacific Islander
Hispanic
Less than High School
High School
College+
NOTES: Data reported for 37 states, DC, and NYC. DATA: Centers for Disease Control and Prevention/National Center for Health Statistics, National Vital Statistics System, Linked Birth/Infant Death Data Set. SOURCE: Health, United States, 2008, Table 19.

6. What Factors Influence Health and Health Care Disparities?
Economic & Social Opportunities and Resources
Living & Working Conditions in Homes and Communities
Medical Care
Personal Behavior
SOURCE: Robert Wood Johnson Foundation Commission to Build a Healthier America, 2008

7. CMS Efforts Underway to Improve Maternal and Infant Health

8. Neonatal Outcomes Improvement Project
3 Pilot States – Arkansas, North Carolina, Ohio
AR telemedicine outreach program (TOUCH), decrease in inappropriate deliveries of VLBW and early-gestational age babies in TOUCH sites by 5%, $10K savings per transport
NC showed a 43% decrease in the rate of elective preterm deliveries, NICU admissions and newborn complications; 75 % reduction in NICU catheter infections in participating hospitals
OH reduced the number of statewide pre-term births by 8,256; decreased NICU admissions by ~200

9. Perinatal Outcomes Symposium, June 2011: Where Are We? Where Can We Go?
Profile of Interventions to Improve Perinatal Outcomes
Ascension Healthcare Case Study
Nurse Family Partnership
Healthy Start Program & Freestanding Birth Centers
Key Components of an Agenda to Advance Perinatal Outcomes
Primary preventive strategies
Preconception/interconception care
Linking data sets across systems (Medicaid & Public Health)
Women and children’s accountable care homes
Engaging communities 9

10. Webinars Patient Safety in Neonatal Intensive Care Unit - May 2011
Joe McCannon (Senior Advisor to CMS Administrator)
Mary Applegate, MD (OH Medicaid Medical Director)
Improving Birth Outcomes in Medicaid: Healthy Babies, Lower Costs - June 2011
Jeffrey Schiff, MD (MN Medicaid Medical Director)
Scott Burns, MD, FAAP (March of Dimes Foundation Senior VP) 10

11. New Ideas: Maternity Care Measures in CMCS Core Set of Quality Measures
Voluntary, State Report of Measure Sets
Initial Core Set for Children in Medicaid/CHIP:
Frequency of ongoing prenatal care
Timeliness of prenatal care
Cesarean rate for low-risk first birth women
% of live births weighing < 2500 grams
Initial Core Set for Medicaid Eligible Adults
Elective delivery prior to 39 weeks completed gestation
Appropriate Use of Antenatal Steroids
Postpartum Care Rate 11

12. New Ideas: Testing of Promising Practices
Working with the CMS Center for Medicare and Medicaid Innovation (CMMI) to test interventions and/or new models of care that address medical and social factors that contribute to prematurity-related poor birth outcomes, including new or not widely used approaches to:
maternity care
psycho social support systems
payment strategies 12

13. New Ideas: Encouraging and Supporting Use of Evidence-Based Maternity Care Practices
Share successful experiences of State Medicaid agencies with other States (e.g. Breastfeeding Issue Brief to be released in Jan 2012)
Offer financial incentives to State Medicaid agencies that achieve improvements on a national set of performance measures for maternal and infant health
Create opportunities for Medicaid agencies to implement models of care or interventions that show promise in bridging multiple determinants of pregnancy outcomes (e.g., medical, social, nutrition)
Encourage States to include maternity care performance measures in Medicaid managed care contracts

14. Medicaid/CHIP Partners in Improving Maternal & Infant Health
Collaboration
with States
within CMS (CMMI,OCSQ,OMH, CCIIO)
with other HHS agencies (AHRQ, HRSA, CDC)
outside Government (Providers, Advocacy Groups, Professional Associations) 14

15. How Should CMS Target Its Resources to Improve Maternal & Infant Health?
Submit your ideas to:
Subject line: Improving Perinatal Outcomes 15