Online Program

Affordable Care Act: Improving Health Service Utilization in Childbearing Women

Wednesday, November 4, 2015 : 9:00 a.m. - 9:10 a.m.

Lee Anne Roman, MSN, PhD, Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, East Lansing, MI
Jennifer Raffo, MA, Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, MI
Stephen Rechner, MD, Spectrum Health, Grand Rapids
Cristian Meghea, PhD, Department of Obstetrics, Gynecology & Reproductive Biology and Institute for Health Policy, Michigan State University, College of Human Medicine, East Lansing, MI
Background: The Patient Protection Affordable Care Act provides opportunity for many low- income women to continue Medicaid and receive preventive/primary care before the next pregnancy.  We examined health service utilization in a population of pregnant women who had pre-existing Medicaid insurance and those with pregnancy-related Medicaid to identify targets for care improvement. We included Medicaid enhanced prenatal/postnatal care (EPC) utilization that is available to all Michigan Medicaid-insured women.

Methods: A cohort analysis of Medicaid-insured mother-infant pairs in Kent County, Michigan (singleton births, 2009, N=4,484) was conducted using linked vital records and claims data from the Michigan Department of Community Health Warehouse (*p=<0.01).

Results: Half of all pregnant women had pre-pregnancy Medicaid.  Compared to women without prior Medicaid, 24% of women with pre-existing Medicaid (vs. 25%) had inadequate/intermediate prenatal care; 65% (vs.67%) initiated first trimester care; 41% (vs.25%*) enrolled in EPC; and 21% (vs.5%*) had 3 or more prenatal emergency department (ED) visits.  While 56% (vs.43%*) completed a postpartum visit, 15% (vs.7 %*) used the ED during 8 weeks post-birth.  In the postpartum year, of those who had Medicaid before/after birth, 22% (vs.8 %*) had 3 or more ED visits.

Conclusions: Women with prior Medicaid were more likely to engage in EPC and postpartum visits, but there was still low participation; one in five women had frequent prenatal or postnatal ED use.  EPC programs, in 66% of states, could be optimized with targeted interventions to help newly-insured women use health resources. Community improvement strategies and early implementation findings will be discussed.

Learning Areas:

Public health or related research

Learning Objectives:
Describe health service utilization in childbearing women; discuss community implementation strategies initiated for service utilization improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am health services researcher/master’s-prepared nurse. I have led a team of researchers to inform improvements and conduct a rigorous evaluation of the Michigan enhanced prenatal services (EPC) program and am conducting a similar evaluation of a federal Healthy Start program. I lead an AHRQ five year research and demonstration project to develop a population perinatal system of care and, based on the submitted study, will discuss early implementation strategies and preliminary service utilization improvements.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5061.0: Impact of ACA on MCH