Blue Review
A newsletter for Medicaid providers

May 2019

Prenatal and Postpartum Care for the Pregnant Patient

One indicator of population health is the infant mortality rate. Healthy People 2020leaving_site Icon tracks this indicator as a vital statistic to improve health care and health outcomes. According to the Centers for Disease Control and Prevention (CDC), the infant mortality rate for the U.S. was 5.8% in 2017. The rates ranged from 3.7% in Massachusetts to 8.6% in Mississippi. Although Texas’ rate of 5.9% was not the highest in the nation, the results have remained static since the 2017 measurement1. Preventing deaths of women and infants by ensuring appointment availability, identifying health risks, providing education, and advocating for your patients is necessary to decrease the infant mortality rate in Texas and the United States.

Blue Cross and Blue Shield of Texas (BCBSTX) wants to ensure that each of our members is receiving pre-natal care, post-partum care and follow-up care as indicated. Per Healthcare Effectiveness Data and Information Set (HEDIS®) specifications, members are to be seen for pre-natal care within their first trimester or within 42 days of enrollment into a BCBSTX health plan. For post-partum care, members should be seen on or between 21 and 56 days after delivery. Health care providers play an important role in keeping pregnant patients and babies healthy.

Best Practice Summary:

  1. Follow the HEDIS guidelines for prenatal and post-partum care to ensure your patients receive timely, appropriate care. Ensure members are being seen for pre-natal care within their first trimester or within 42 days of enrollment into a BCBSTX health plan. For post-partum care, ensure members are being seen on or between 21 and 56 days after delivery.
  2. Keep appointments open for members who are seeking prenatal and postpartum care and outreach to members on your panel who have not scheduled their necessary prenatal or postpartum appointments.
  3. Encourage your patients to enroll in our maternity program, Special Beginnings® to receive educational materials and support, along with access to an online resource center and more.

Other Resources
Providers can call the Medical Care Management Department at 1-855-896-2701 upon notification of any pregnancy to ensure your BCBSTX members can participate in the Special Beginnings program. Members may call 1-888-421-7781 to enroll in Special Beginnings.

Reference and review BCBSTX’s Preventive Care Guidelines and Clinical Practice Guidelines, and the Texas Health Steps for providers websiteleaving_site Icon for more information on this and other important topics for treating your patients.

Reference
1Centers for Disease Control and Prevention. Infant Mortality Rates by Stateleaving_site Icon, Jan. 15, 2019.

HEDIS is a registered trademark of NCQA.