Preventing Preterm Delivery Through Trust, Engagement and Innovative Support
After a difficult first pregnancy, a mother was highly motivated to ensure her second pregnancy went well. Unfortunately, determination isn’t always enough. To follow her doctor’s orders and help her pregnancy reach full-term, she needed support – and she found it through ICM’s Healthy Mother Baby Program.
New Complications
With her first birth experience, the mother had experienced a difficult delivery and premature birth, resulting in a prolonged neonatal hospital stay for her baby.
When she became pregnant with twins, she was determined to do everything possible to carry the babies to full-term.
However, her second pregnancy was also considered high risk due to several factors, including her age and history of obstetric complications. Her doctor ordered early and sustained bed rest to reduce the risk of preterm delivery.
Seeking Support
ICM’s Healthy Mother Baby Program provides prenatal support that addresses medical risks as well as other barriers and real-world circumstances. Through its wholistic, high-touch and personalized approach, the program helps members follow provider recommendations and mitigate avoidable risks, which can result in better outcomes as well as financial savings.
Sometimes ICM identifies potentially enrollees for the Healthy Mother Baby Program during preauthorization. In this case, the member learned about the program during open enrollment and was eager to enroll when she later became pregnant with twins.
More than 60% of twins are born prematurely and may need help breathing, eating, staying warm and fighting infection as a result. Women carrying multiples also have a higher risk for various other complications, including gestational hypertension and anemia.
Earning Trust
The member understood that bed rest was important, and she was highly motivated to follow her doctor’s orders and carry her twins to full-term – but it wasn’t that easy.
During a screening call with an ICM nurse, the member admitted that she was struggling to follow the bed rest order despite her best efforts. Through a conversation built on trust and a strong rapport, the nurse uncovered the non-clinical barriers that had been fully apparent before.
- The member had no family or social support available in the home.
- Her partner worked long shifts outside the home.
- She was responsible for caring for an active toddler and managing household tasks.
In the end, despite a strong desire to follow her provider’s recommendations, the member simply did not have the support needed to remain off her feet for significant portions of the day.
The nurse recognized that without intervention, the inability to maintain bed rest placed both the pregnancy and the babies at considerable risk.
An Innovative Solution
The member’s inability to follow her doctor’s bed rest orders posed a clinical risk and could contribute to a premature delivery. Recognizing this, ICM’s case manager proposed an innovative and non-traditional solution.
Rather than defaulting to costly inpatient care or accepting the likelihood of preterm birth, ICM proactively contacted the health plan sponsor to recommended temporary inhome support to assist with toddler supervision, light housekeeping and basic daily tasks.
After thoughtful discussion and review of the clinical and financial implications, the plan agreed to fund an aide at $1,500 per month for the remaining seven months of the pregnancy. The aide was hired and remained with the family through delivery. This support allowed the member to follow her provider’s bed rest orders.
With in-home support in place, the member successfully adhered to prescribed bed rest and carried the pregnancy to full term. Both babies remained healthy and were delivered without complications.
What were the savings?
By preventing a pre-term delivery and the associated NICU admissions and extended neonatal care, the plan’s estimated savings exceeded $400,000.
The solution also gave the member’s partner peace of mind and the ability to remain focused at productive at work, resulting in additional savings for the employer.
The ICM Difference
How can you get bed rest while watching a toddler?
Not all risks are clinical in nature, and not all instances of noncompliance are intentional, but traditional utilization reviews sometimes miss the real-world circumstances that can result in higher risks and costs.
With early engagement and consistent outreach, ICM nurses build relationships that engender trust, allowing ICM to identify risks that may otherwise be overlooked. Once risks and barriers are identified, ICM strives to find clinically appropriate solutions. Sometimes these solutions fall outside of standard coverage definitions, such as covering an aide to help with childcare and chores, but ICM proactively engages plan decision-makers to make a fact-based, data-driven case for coverage.
This wholistic approach allows ICM to support healthy mothers and baby’s while also reducing costs in the long run.