Member Support
TECHNICAL BRIEF
Healthy Start for Babies
Maternity Care
| SELF-FUNDED GROUPS
Pregnancy and Birth
Claims Triggers
Program Referrals
Provider Referrals
High Risk
Low Risk
Program Intensity
Self Enrollment
Risk Stratification
SUPPORTING HEALTHY PREGNANCIES WITH HELP FOR MOMS-TO-BE
1%
9%
Health Status Continuum
24/7 Access
Maternity
Care Manager
35%
Healthy,
Active
55%
At Risk, Pre-Condition
Chronic
Complex
Resources for a
healthier pregnancy
Expecting a child can be a very special and
exciting time. It can also be very challenging
and stressful, especially when trying to
stay focused and productive at work. Our
Maternity Care program provides your
expectant employees or spouses with
the support and information they need
during pregnancy. By enrolling in the
program and getting proper prenatal care,
employees can increase the chances of a
healthier pregnancy. The Maternity Care
program helps members make healthier
lifestyle choices and lower their risks for
pregnancy-related complications.
Premature births in the U.S.
Premature birth is a serious health
problem that costs the United States
more than $27 billion annually, according
to the Institute of Medicine. It is the
leading cause of newborn death, and
babies who survive an early birth often
face the risk of lifetime health challenges,
such as breathing problems, cerebral
palsy, mental retardation and others.
Preventing premature birth
Medical research has shown a positive
association between high-quality prenatal
care and improved birth outcomes and
lower overall costs. Unfortunately, the
PAISC.com
reality is that more than 12 percent of
all pregnancies experience some sort of
complication, according to the March of
Dimes. These complications can happen
to anyone at any time, but early detection
and assessment of risk factors can be
instrumental in detecting and possibly
preventing conditions which could lead
to maternal death, miscarriages, birth
defects, premature births and low birth
weight babies. Many premature babies
require care in a newborn intensive
care unit (NICU), which has specialized
medical staff and equipment that can
deal with the multiple problems faced by
premature infants.
Maternity Care managers
The core of the Maternity Care program
is one-on-one support from qualified
professionals that specialize in pregnancy
care. Program care managers are
registered nurses with experience in
obstetrics. They work with members and
their providers to help coordinate care.
And, they are available from the first
trimester through the first few weeks of
parenting to answer questions, provide
information and support, and monitor risk
factors to support a healthy pregnancy
and delivery.
low riskhigh risk
Everyone expecting a child hopes
for an easy pregnancy, safe delivery
and a healthy, happy baby. Babies
born between 37 and 42 completed
weeks of pregnancy are called full
term, with most pregnancies lasting
around 40 weeks. However, in the
United States, about 12.8 percent of
babies (more than half a million) are
born prematurely. And, the rate of
premature birth has increased by 36
percent since the early 1980s.*
The Maternity Care program
provides education and personal
care management to augment and
support healthy prenatal care.
*
March of Dimes, October 2009
PAI
Program Components
All participants in the Maternity Care
program receive this core set of
materials and intervention with care
managers. The greater the member’s
risk factors, the higher the level of
engagement and intervention with the
dedicated care manager.
> A dedicated maternity care
manager — a registered nurse
with obstetrics experience
> Welcome mailing from maternity
care manager — includes care
manager’s photo and direct contact
information
> Access to care manager by
telephone
> 24/7 access — a registered nurse
is always available to answer
pregnancy or baby care questions
> Educational materials — designed
to drive healthier lifestyle choices
> A free book — members can
choose from
Maternity Care Program
Program availability
Maternity Care is an option for PAI self-funded groups.
Identifying risk factors
Members enroll as soon as pregnancy is confirmed and complete an initial pregnancy
assessment survey by phone, which helps identify potential risk factors and stratify
program participation. Low-risk members receive educational mailings and inbound
access to a personal maternity care manager. Members who smoke are at risk and
are encouraged to participate in a tobacco cessation program for moms-to-be. Highrisk members receive greater intervention including outbound call support from their
dedicated care manager and provider coordination when appropriate.
Core program overview
Maternity Care is a key source of educational information for your expectant employees,
reminding members about the importance of visiting their doctors regularly to ensure
proper prenatal care. Proper diet, exercise, vitamins and rest are also emphasized.
All Maternity Care program participants are assigned to a dedicated maternity care
manager: the higher the member’s risk factors, the greater the interaction. All members
receive periodic mailings timed to coincide with the stages of pregnancy. See the table
on the next page for program details by risk group. It is important for your employees
to remember that the Maternity Care program does not replace proper prenatal care
received from a doctor. Participants should always check with their doctors before
following any medical advice.
– What to Expect When
You’re Expecting
– When You’re Expecting
Twins, Triplets or Quads
–G
ood Housekeeping Illustrated
Book of Pregnancy and Baby Care
– From One Child to Two
–M
ayo Clinic Guide to a
Healthy Pregnancy
Member
Telephone
Support
Program
Assessment
Survey
Targeted
Mailings
Maternity
Care Manager
Educational
Materials
Pregnancy risk stratification and associated program outreach
Upon enrollment, each program participant is assigned a maternity care manager. The care manager is a personal nurse
that contacts members either in writing or by phone throughout the pregnancy, especially if risk factors change during
pregnancy. Also, if groups elect the 24-hour Nurse Advisor program, registered nurses are available 24 hours a day, seven days
a week to answer any questions. And Maternity Care doesn’t end when the baby arrives; nurses are still available to
answer baby care questions. New parents also receive reminder cards about well-baby checkups and immunization
requirements. The reminder cards can also include benefit information.
Enrollment
n
n
First Trimester
Second Trimester
Third Trimester
High Risk
Educational Only Program
Outbound Intervention
Initial pregnancy assessment survey
Personal maternity care manager assigned
n
n
n
elcome mailing
W
Gift book selection
n Tobacco cessation program kit
n
n
n
n
Inbound calls to maternity care manager
Mailing with breastfeeding brochure
n Second pregnancy assessment survey
n Breastfeeding book if requested via form in brochure
n
n
n
n
n
Postpartum
Low Risk
Inbound calls to maternity care manager
Mailing with brochure
Inbound calls to maternity care manager
Mailing with postpartum and depression brochures
n Well-baby care reminder mailings
Initial pregnancy assessment survey
Personal maternity care manager assigned; outbound call to member
elcome mailing
W
Gift book selection
n Ongoing outbound calls by maternity care manager
n Provider coordination when necessary
ngoing outbound calls by maternity care manager
O
Provider coordination
n Mailing with breastfeeding brochure
n Breastfeeding book if requested via form in brochure
ngoing outbound calls by maternity care manager
O
Provider coordination
n Mailing with brochure
n
n
utbound call by maternity care manager
O
Mailing with postpartum and depression brochures
n Well-baby care reminder mailings
n
n
n
n
MATERNITY CARE
| TECHNICAL BRIEF | SELF-FUNDED GROUPS
Providing a healthy start
Member advantages
With proper prenatal care, your expectant employees or their
spouses have a much greater chance of having healthier
pregnancies, safer deliveries and healthier babies. With
a support system in place that includes Maternity Care,
members are able to make healthier lifestyle choices and
manage their pregnancies more easily. This leads not only to a
better birth outcome, but also to less stress and more focused
employees during their pregnancies and upon the delivery of
their babies.
The personal contact and support received from maternity
care managers provide peace of mind during what can be a
very stressful time. Add in the comfort of knowing answers to
worrisome questions are just a phone call away any time night
or day, and members can focus more on the positive aspects
of their pregnancies. Outreach mailings supplement the oneon-one interactions with care managers by providing education
about key topics timed to coincide with pregnancy milestones.
Your direct health care costs for a healthy, full-term delivery
are significantly lower than costs for premature delivery or
other pregnancy- and birth-related complications. And while no
program or treatment plan can guarantee a perfect pregnancy
and delivery, medical research shows a positive correlation
between high levels of prenatal care and improved birth
outcomes.
Employer advantages
The Maternity Care program enhances core health benefits
by providing extra care and support to ensure members are
receiving necessary care at the highest quality:
> Educates members and their families to make healthier
lifestyle choices during pregnancy
> Monitors direct health costs associated with costly
pregnancy and birth complications
> Provides employees with peace of mind that allows positive
focus on family and work
> Works to positively impact productivity and minimize lost
workdays
For more information about our Maternity Care program, we invite
you to contact your PAI Marketing Representative at 803-462-0151.
PAI-ER-1049-9-2012