Why are healthy pregnancies important?

Having a healthy pregnancy is one of the best ways to have a healthy birth and a healthy child. Things like getting early and regular prenatal care and support from ancillary services such as care coordinators or doulas can play a role in helping women have a healthy birth outcome. Women on Medicaid and women of color are less likely to receive early prenatal care and other supports and are more likely to have a negative outcome for themselves or their baby. HealthPartners is working to improve access to prenatal care and supports for pregnant women, especially women of color to reduce these disparities.

What did we do to improve pregnancy care among our members?

HealthPartners Healthy Pregnancy program supports members who are pregnant and have a higher risk for complications in their pregnancy. Members who enroll in this program get extra support from a nurse throughout their pregnancy.

We expanded how we identify women for the program to be more inclusive of known high-risk populations.
We offer a Healthy Pregnancy assessment where women can answer questions about their current health and their pregnancy, including support services they may benefit from.
We offer Medicaid members an incentive for women to take the Healthy Pregnancy assessment and an incentive to complete at least three calls with a Healthy Pregnancy nurse.

We created the MyPregnancy experience which offers on-line education and support to all members during the pregnancy.

Members regularly receive relevant information based on their answers to the healthy pregnancy assessment and their due date.
We created content that covers topics important to people on Medicaid such as benefits for car seats, doulas, breastfeeding support, insurance coverage for newborns and postpartum health issues.
Resources are personalized based on the member’s race and ethnicity, preferences identified in the assessment, and their location in Minnesota.
We connect members to online educational materials and videos about pregnancy, including information about nutrition, breast feeding, newborn care, mental health and well-being, and pregnancy complications like preeclampsia and gestational diabetes.

Doulas are a covered benefit for women on state health insurance in Minnesota, but a lot of people do not know that. We wanted to make doulas more available to anyone who would like to work with one.

HealthPartners created a video, Value of a Doula, that explains what members can expect when working with a doula and how to get a referral to a doula. We translated the video into Somali, Spanish, and Hmong so more members can learn about this benefit. We also created an educational blog post about doulas for the HealthPartners website to help spread awareness of the value of a doula.
HealthPartners worked with our primary doula agency to certify several more doulas to serve women on Medicaid, focused on training doulas who are Black, Indigenous, and other women of color. The agency went from having 40% of their doulas being Black, Indigenous and people of color, to 70%. This increases access to doulas of color for women of color.
We gave two organizations with a doula program grants to cover the costs for continued development of their programs as they grow.
We educated our staff about the availability of doulas and our provider network about the value that doulas can bring to women, especially women of color
We increased the amount we pay for doulas who work with our Medicaid members.
We supported legislation to remove barriers for doulas to bill for Medicaid services and increase the reimbursement rate for the service.

To encourage members to complete their postpartum care appointment, we offer Medicaid members an incentive to complete their postpartum appointment. We reach out to all members after they deliver to let them know about the incentive and the incentive their child can receive if they get all their immunizations by the time they turn 2 years old.

How do we collaborate with providers?

HealthPartners sent information to our provider network about the disparities that women of color face, the availability of the Healthy Pregnancy program and the value that doulas offer pregnant women.

We collaborated with the other Minnesota Medicaid health plans to offer webinars to providers about racism in health care and how to achieve health equity. These webinars were well attended and people who attended felt they learned new information and skills.

What challenges did we face?

It can be hard to identify and contact women early in their pregnancy to tell them about available services. Sometimes women cannot get scheduled for their first prenatal appointment timely and we do not receive claims until much later, so we do not know they are pregnant.

We often do not have a current mailing address, email address, or phone number for members. The Healthy Pregnancy program outreach is phone call based so people may not want to use their limited minutes to talk to the Healthy Pregnancy nurse.

The amount of payment by Medicaid for doula services is much lower than for doulas who are privately paid. This discourages doulas from agreeing to serve women on Medicaid. The changes to the Medicaid reimbursement rate in 2024 should help to alleviate that barrier. However, the process to register with the state as a Medicaid provider is very complicated and may still be a barrier for some.

Results

In 2023, a total of 36,742 members received the My Pregnancy messages with education customized for the trimester of their pregnancy. An additional 12,185 visited the other content and resources on the My Pregnancy site.

The most common page visited was the benefits page, followed by the delivery preparation page.
The average time spent on the site per visit was 18.6 minutes.
American Indian (19.7 minutes) and Black (22 minutes) members spent longer on the site than other groups.

The HealthPartners rate for women who get prenatal care early in their pregnancy remains fairly steady, but the number of members who seek postpartum care continues to decline. We will continue to work to educate our members about the importance of this visit for their overall health.

Ongoing work

Much of this work started in 2021 and is ongoing. We will monitor prenatal and postpartum care rates and other measures of birth outcomes to see how effective these programs are. We will continue to work with our provider network, our Healthy Pregnancy program, and the community to improve pregnancy care and reduce disparities in birth outcomes for all women.