Maternal Mental Health and Infant Mortality for Healthy Weight Infants

D e c e m b e r 2 0 1 6

Donald Wharton MD

Ohio Medical Director

Christopher Rond APRN, NP-C

Director Population Health, Outcomes

John Nisky PCC-S, NCC

Manager Behavioral Health

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• A nonprofit health plan and national leader

in Managed Care

• 27-year history of serving the low-income

populations across multiple states and

insurance products

• Currently serving over 1.5 million members

in Kentucky, Ohio, Indiana, West Virginia

• Preparing to serve Indiana and Georgia

Medicaid members in 2017

CARESOURCE

1.52Mmembers

Our MISSIONTo make a lasting difference in our

members' lives by improving their

health and well-being.

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We will always

put people over profit.

• Best-in-class administrative cost ratio delivers maximum

benefits to members while being responsible stewards of

government funds

• Serving members across the continuum of government

programs, coordinating care as their eligibility changes

• Comprehensive, member-centric models of care to

address our entire population’s health and social needs

• Help members navigate through daily life challenges and

obstacles

Our

COMMITMENTAs a non-profit, member-centric company, we are accountable to our

members and the communities we serve -

not shareholders.

90-92%

Medical Cost Ratio

6%Administrative

Costs

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450The number of new

members joining

CareSource each

month that we know

are pregnant

47% Male

53% Female10%

Market Share in KY

1.4 millionmembers

53.4%Market Share in OH

Serving

OH, KY(IN & GA in 2017)

364kMedicaid Expansion members

Medicaid Snapshot

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Infant Mortality by Birth Weight

1/3 of infant deaths

are Extreme Low

Birth Weight babies

Nearly 40% of infant

deaths are Healthy

Birth Weight babies

Infant Mortality Deaths In Hospital

Versus Discharged to Home

Shaded areas denote infants discharged to home after birth

Nearly half (48%) of all

babies are discharged

to home after birth

In 2013-14, Ohio ranked in the lowest

10 states for Infant Mortality

(regardless of race). Multiple state

and local agencies focus low-birth

weight and prematurity, while seldom

a focusing on the nearly 40% of infant

deaths that occur among those born

at a healthy weight.

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Background

The present study explored the

relationship between incidence of

infant mortality and maternal severe

mental illness (MSMI) or maternal

substance use (MSU) among healthy

weight babies.

Methods

Methodology

CareSource completed a cross-sectional research study of historically

billed claims between January 2011 and December 2014.

Identified mothers who delivered

babies born at healthy weight

(5.5 lbs or more) and that had

either SMI or SU diagnosis

while pregnant or during first 12

months after childbirth.

A logistic regression model was

used to estimate the odds ratio

for infant mortality based on the

presence or absence of severe

mental illness.

The likelihood of infant mortality was 69%

greater when a mother was diagnosed

with SU, and 73% greater among

mothers diagnosed with SMI (compared to

mothers that did not).

• Race did not significantly influence

rates of infant mortality in these

analyses.

Mothers who have babies with a healthy

weight of at least 2,500 grams, but are

diagnosed with either MSMI or MSU, need

at least equal attention as those who

deliver premature or low-birth weight

babies to help reducing infant mortality.

• 20% of healthy weight babies were

born to mothers who had SMI and/or

SU diagnosis.

Conclusion

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Next Steps

Analyze additional risk factors in the home (e.g., household traumas to assess domestic violence)

Further discovery to predict ‘triggering’ events

Collaborate on new interventions aimed at addressing each unique root cause

Incorporate vital statistics data into analysis when available in the future– Needed because claim diagnosis is not always enough to

identify root cause

Engagement Strategy

• Maternal-Child Program at CareSource

– Population-based approach to the clinical and quality management of both mother and baby from the prenatal period through the baby’s first year of life

– Multi-faceted, evidence-based approach to achieve the best possible health outcomes by utilizing high-risk case management, member incentive and educational programs, and community and provider partnerships

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Engagement Strategy

• What is the role of manage care

organization (MCO)?

– Identify pregnant women for case

management engagement

• Traditionally done via claims

– 90-120 day lag in identification

• Referral from providers

– Dependent upon provider/MCO relationship

– Regional Maternal Child Coordinator

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Engagement Strategy

• Evaluation for High-Risk CM

– History of preterm birth/low birth weight

– Fetal complications

– Chronic condition which may complicate

pregnancy (diabetes, hypertension, HIV, SLE,

sickle cell, asthma, seizure disorder, renal

disease, substance abuse, mental illness)

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Engagement Strategy

• Evaluation for High-Risk CM

– Current use of drugs or alcohol/recent drug

use or heavy alcohol use

– Current medication-assisted therapy for opioid

addiction

– Tobacco use

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Engagement Strategy

• Evaluation for High-Risk CM

– History of depression or postpartum

depression

– Mother with acute mental illness

– Social determinants of health

– Anyone who requests evaluation and/or

services

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Engagement Strategy

• Member engagement

– PRAF, Edinburgh

– Transportation

– Referral to housing, food, and utility resources

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Engagement Strategy

• Concerns and barriers

– Delay in identification for HRCM engagement

– Insufficient and scattered resources to

address social determinants of health

– Lack of behavioral health resources

• Expertise with this population

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Engagement Strategy

• Seeking input…

– How to better partner with communities and

providers for early identification of pregnant

women with mental health needs?

– How to better identify and support community

agencies/providers who specialize in this

population?

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Engagement Strategy

• Seeking input…

– Is it possible to coordinate high-touch HRCM

and behavioral health specialists?

– What other needs have you identified or

would like to discuss?

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Ohio Behavioral Health

Resources for Moms

County Organization Contact Info.

AllMaterinal Opiate Medical Support (MOMS)

Projecthttp://momsohio.org/moms/

CuyahogaCleveland Regional Perintal Network

(CRPN)http://crpn.net/

Franklin

Mental Health America of Franklin County

Perinatal Outreach and Encouragement for

Moms (POEM)

http://mhafc.org/get-help/maternal-

mental-health/about-poem-2/

Lorain Lorain County Maternal Depression Network

SummitSummit County Maternal Depression

Network

http://summitcountyfirstthingsfirst.c

om/working-groups/scmdn/

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Ohio Behavioral Health

Services for Moms

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County Organization Contact Info.

Athens Health Recovery Services http://www.metrohealth.org/mother-and-child-dependency-program

Cuyahoga

Bellefaire JCB http://www.bellefairejcb.org/

Connections http://connectionscleveland.org/pages/services.php

Matt Talbot for Women http://ccdocle.org/program/matt-talbot-for-women

MetroHealth http://www.metrohealth.org/mother-and-child-dependency-program

Ohio Guidestone http://www.ohioguidestone.org/index.php/programs-services/maternal-depression-counseling

Signature Health http://www.signaturehealthinc.com/

Franklin

CompDrug http://www.compdrug.com/treatment/pregnancy-and-parenting-support/

Maryhaven https://maryhaven.com/programs-services/adult-services/

Ohio Guidestone http://www.ohioguidestone.org/index.php/programs-services/maternal-depression-counseling

Geauga Signature Health http://www.signaturehealthinc.com/

HamiltonFirst Step Home http://www.firststephome.org/maternal-addiction

Whitehouse Behavioral Health http://wbh-ohio.com/index.php

LakeOhio Guidestone http://www.ohioguidestone.org/index.php/programs-services/maternal-depression-counseling

Signature Health http://www.signaturehealthinc.com/

Lorain

Bellefaire JCB http://www.bellefairejcb.org/

LACADA https://www.thelcadaway.org/services/womens-services

Ohio Guidestone http://www.ohioguidestone.org/index.php/programs-services/maternal-depression-counseling

Portsmouth The Counseling Center http://thecounselingcenter.org/what-we-do/programs/ssop-continuing-care.html

PortageOhio Guidestone http://www.ohioguidestone.org/index.php/programs-services/maternal-depression-counseling

StarkOhio Guidestone http://www.ohioguidestone.org/index.php/programs-services/maternal-depression-counseling

SummitOhio Guidestone http://www.ohioguidestone.org/index.php/programs-services/maternal-depression-counseling

Ohio Behavioral Health

Re-design/Carve-in

*OhioMHAS: Medicaid BH Re-design 201 Presentation (http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/20161028-BH-201-

slides.pdf?ver=2016-10-28-104151-273)

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Ohio Behavioral Health Re-

design/Carve-in (cont.)

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*OhioMHAS: Medicaid BH Re-design 101 Presentation (http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/BH-Redesign-101-slides-

OACBHA-5.04.16.pdf?ver=2016-05-19-103018-023)

Ohio Behavioral Health Re-

design/Carve-in: Fee Schedule

Current:

• Mental Health

(http://medicaid.ohio.gov/Portals/0/Providers/FeeScheduleRates/5160

-27-05Appendix2014.pdf)

• Alcohol and Other Drug

(http://medicaid.ohio.gov/Portals/0/Providers/FeeScheduleRates/ODA

DAS%20rates.pdf)

Proposed:

• Coverage & Limitations Workbook

(http://bh.medicaid.ohio.gov/Portals/0/About/20160822-Coverage-and-

Limitations-Workbook-updated.xlsx?ver=2016-08-23-101014-473)

• BH Provider Manual (http://bh.medicaid.ohio.gov/Portals/0/About/2016-

06-24-Manual-v1-1.pdf?ver=2016-06-27-103656-760)

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Ohio Behavioral Health Re-

design/Carve-in: Substance Use

Disorder (SUD) Benefit

26

*OhioMHAS: Medicaid BH Re-design 201 Presentation (http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/20161028-BH-201-

slides.pdf?ver=2016-10-28-104151-273)

Ohio Behavioral Health Re-design/Carve-in:

American Society of Addiction Medicine

(ASAM) Levels of Care

27

*OhioMHAS: Medicaid BH Re-design 201 Presentation (http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/20161028-BH-201-

slides.pdf?ver=2016-10-28-104151-273)

Ohio Behavioral Health Re-

design/Carve-in: SUD Residential

Benefit

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*OhioMHAS: Medicaid BH Re-design 201 Presentation (http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/20161028-BH-201-

slides.pdf?ver=2016-10-28-104151-273)

We are grateful for the opportunity

to collaborate with you and build

partnerships with heart.

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