Maternity Care Coalition American Public Health Association – October 2001

Trends in Managed Care Services to Pregnant

Women

A Case Study of Maternity Care Coalition’s Experience in Southeastern Pennsylvania

American Public Health AssociationAtlanta, Georgia - October 2001

JoAnne FischerHeidi Worley

Maternity Care Coalition American Public Health Association – October 2001

Maternity Care Coalition Programs

MOMobile • Case-finding & referral

• Case Management• Follow-up

Supporting Pregnant, New

Parents

Early HeadStart• Intensive interventions

• Child development

Women’s Health, Children’s Futures,

• Research, Education, Advocacy

Healthy Living• HIV Prevention

•Community Education

Maternity Care Coalition American Public Health Association – October 2001

MOMobile Outreach

• 2012 New Families Enrolled

• 10 Sites

• 39 Site Staff

Maternity Care Coalition American Public Health Association – October 2001

MOMobile Families

• 20% Teens

• 59% African-American; 21% Latino/Hispanic; 10% White; 10% Others

• 66% on public benefits

Maternity Care Coalition American Public Health Association – October 2001

MOMobile Case Management, Education and Family Support

• 3,339 Families Served

• 21,951 Education Contacts

• 45 Parent Outreach Meetings, 560 Participated

• 3,301 Home Visits

• 5,281 Referrals

Maternity Care Coalition American Public Health Association – October 2001

Negotiating Health Insurance

• Last year, assisted 241 & signed up 68 families for CHIP

• Refer uninsured and immigrant families to federally funded health centers

• Assist families on how to negotiate mandated managed care & plan contractor changes

Maternity Care Coalition American Public Health Association – October 2001

Medicaid Managed Care in PA

Enrolled 1999Southeast (Philadelphia 5 county) 454,000

Southwest (Pittsburgh 10 county) 250,000

Lehigh/Capital(Allentown 10 county)167,000*

Total Medicaid managed care PA 871,000

Total Medicaid population PA1,415,926

62% of total Medicaid population covered by managed care

*eligible population; program started 10/01/01

Maternity Care Coalition American Public Health Association – October 2001

Babies

• Total Southwest Births: 7,739

• Total Southeast Births: 14,075

Maternity Care Coalition American Public Health Association – October 2001

Southeast PA

28%

24%

48%

Maternity Care Coalition American Public Health Association – October 2001

MCC History with Managed CareManaged Care in Pennsylvania • 10 years (1915 HIO waiver) • HealthChoices - mandated in Feb 1997• 75% enrolled voluntarily• Nearly 500,000 recipients enrolledMCC History with MCOs• Collaborative program sponsorship and pilots• Statewide Advocacy • Relationships with Decision makers MCC Market research• Focus groups 1996• Survey 1997• Campaign 1997

Maternity Care Coalition American Public Health Association – October 2001

Medicaid Managed Care Evolves in Southeast PA

Early years

New market

Learning curve

Capitation and Selection

Inclusive rates

Maturation

Mandatory participation

Experience

Special needs

population

Behavioral health carve out

Maternity Care Coalition American Public Health Association – October 2001

MCC Heyday

• MOMobile clients demand provider inclusion• MCC contracts with all 4 Medicaid MCOs• Contracted services vary and include:

– Outreach, Case Finding & EPSDT Enrollment– Assessment, Home Visiting & Case Management

• MCC builds capacity for electronic data and claim submission

• Total MCO revenue FYE 6/1999: over 100,000 (4% of budget)• MCC is national model for community based

organizations contracting with MCOs

Maternity Care Coalition American Public Health Association – October 2001

MCC Tried to Make It Work

Necessary but not sufficient• Good reputation and customer satisfaction

and demand• Significant number of members in the region• Strong infrastructure

– MIS reporting– Financial billing capacity– Direct services protocols & QA

Maternity Care Coalition American Public Health Association – October 2001

Upstaged by welfare reform

• Families confused, in denial, panicking

• Caseworkers misinformed, hesitant to impart information

• Role of public sector not fully defined & coordinated

• Regional media market not providing county-specific information for consumers

• MA consumers were incorrectly dropped because they were linked to welfare rolls

Maternity Care Coalition American Public Health Association – October 2001

MCC’s Response

• Developed brochure; 5 languages, distributed 20,000

• Assisted City with urgent, targeted outreach • With Legal Services, challenged TANF work

requirements for teen parents in school• With Women’s Law Project, advocated for State

to change domestic violence exemption rule

Maternity Care Coalition American Public Health Association – October 2001

Upstaged by CHIP• 1997 – SCHIP legislation passed• Pennsylvania becomes national model for private

HMO based CHIP plan• PA develops Reaching Out – CHIP outreach

initiative

MCC Responds• MCC key in RWJ Covering Kids pilot• MCC trains staff and develops protocols and

database enhancements for CHIP enrollment

Maternity Care Coalition American Public Health Association – October 2001

Lessons Learned

• Interest from MCOs in early stages of market development

• Commitment to community shifted, as did the leadership, ownership, relationships and visibility of plans

• When the going gets tough, community groups go first

• Public health not an MCO priority

Maternity Care Coalition American Public Health Association – October 2001

MCC’s Agenda Moving Forward

• Continued commitment to Medicaid sponsored outreach and case management services

• CBOs and community health workers can help beyond enrollment – essential to reaching most isolated groups

• Understanding of public benefits and system navigation a major strength of CBOs

• More dialogue necessary within PA and nationally