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  • 1

    Puff Free Pregnancy Effectiveness of the Program on an

    Ohio Medicaid Population

    Janice Linehan PA-C Amy Poole-Yaeger MD

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 2

    Puff Free Pregnancy

    Todays Presentation

    Introduce the Start Smart for your Baby Program

    Review health issues surrounding smoking during pregnancy

    Describe the Puff Free Pregnancy Program

    Demonstrate program outcomes

    Discuss the future direction of program

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 3

    Centene Corporation

    Provides health plans, programs and related services

    Managed care of government sponsored programs Medicaid, TANF, SSI, SCHIP, foster care, special needs plans

    Health plan services offered in 10 states with multiple product lines

    7 health management companies, including Nurtur, our disease management partner in Puff Free Pregnancy

    1.7 million members

    Children Women who are pregnant Adults (aged, blind, disabled) Foster care Long-term care

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 4

    Start Smart for Your Baby

    Centene-wide, comprehensive pregnancy management program

    Wellness and Disease Management

    Case management Care coordination

    Supports educational and social

    needs

    Extends from pre-conception to the first 1-2 years of life of the child

    URAC Best Practice Platinum Winner

    URAC/GKEN Best Practice Winner

    http://www.urac.org/accreditationEducation/11thAnnualSummit.asp

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 5

    Goals of Start Smart

    Case manage high-risk pregnancies Reduce adverse health care events

    Educate and empower members to take part in improving their health and the health of their unborn babies and newborns Improve birth outcomes such as:

    Fewer low birth weight deliveries Fewer neonatal ICU admissions Fewer neonatal ICU days / 1000 births

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 6

    The Centene Pregnancy Landscape

    Our pregnant member ethnic makeup is diverse

    Average age of pregnant women in our plans is approximately 24.5 years

    Most (around 80%) of our pregnant women have at least a high school education

    Asian

    1%

    African-

    American

    28%

    Caucasian

    20%Hispanic

    21%

    Native American

    0%

    Unknown

    30%

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 7

    Multifaceted Approach Involves All Parties and Has Multiple

    Touch-points

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 8

    The Notification of Pregnancy Form

    Identifies pregnant members as early in pregnancy as possible

    Provider version and member version

    Assigns proprietary risk score

    Case management referral of high-risk members

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 9

    Pregnancy and Smoking - Incidence

    Pregnant Medicaid women are 2.5 times more likely to smoke than those not on Medicaid1

    Pregnant Medicaid women have a higher smoking

    prevalence (24%) compared to those with private insurance (7%)2

    Based on our NOP data 10-15% of our pregnant members are documented smokers

    Source: 1. Lipscomb LE, Johnson CH, et al. PRAMS 1998 Surveillance Report. Atlanta: Division of Reproductive Health,

    National Center for Chronic Disease Prevention and Health Promotion,CDC,2000. 2. CDC. Preventing Smoking and Exposure to Secondhand Smoke Before, During, and After Pregnancy, 2007

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 10

    Smoking and Education

    27% of women with 9-11 years of education smoke during pregnancy compared to 2% of women with some college education

    42.7% of non-Hispanic white women with 9-11 yrs of education smoke during pregnancy

    Source: Martin JA, Hamilton BE, et. al. Births: Final data for 2002. National vital statistics report: vol.

    52, no. 10, National Center for Health Statistics. 2003

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 11

    Pregnancy and Smoking - Risks

    Pregnant smokers are 1.5 to 3.5 times more

    likely to have a low birth weight baby Almost of all SIDS deaths have been

    attributed to prenatal maternal smoking Fetal Mortality rates 35% higher among

    pregnant women who smoke than nonsmokers

    Source: Pollack,H, Sudden Infant Death Syndrome, Maternal Smoking During Pregnancy, and the Cost-Effectivesness of Smoking Cessation Intervention,: American Journal of Public Health (91(3):432-36, March 2001

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 12

    Effects on Children

    Parents who smoke have children who are more vulnerable to: respiratory illnesses middle ear infections impaired lung function behavioral and developmental problems

    Parental smoking estimated to cause direct medical expenditures

    of >$4.5 billion per year for smoking-caused problems in infants and children as well as to treat pregnancy/birth complications

    Source: Hu. FB et al., Prevalence of asthma and wheezing in public schoolchildren: association with

    maternal smoking during pregnancy, Annals of Allergy, Asthma and Immunology 79(1):0-84.July 1997

    Aligne. CAA, Stoddard JJ. Tobacco and Children: An Economic Evaluation of the Medical Effects of Parental Smoking, Archives of Pediatric and Adolescent Medicine.151:648-53.July 1997

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 13

    Smoking Cessation Can Make a Difference

    Quitting by the 1st trimester results in infant weight and body measurements comparable to infants of nonsmokers1

    Quitting at any time is a health benefit to mom and baby

    Source: US Dept Health and Human Services. Women and Smoking: a Report of the Surgeon General.2001

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 14

    State Medicaid Coverage

    2006 review by the CDC found: 14 states provided tobacco cessation counseling

    specifically for their pregnant women on Medicaid 39 states covered some form of evidence-based

    cessation counseling 28 states covered at least one category of FDA-

    approved cessation drug

    State Medicaid coverage for tobacco cessation and treatment is sporadic and, even if it is deemed comprehensive it may not be tailored to address the unique needs of specific populations like pregnant women who smoke

    Source: CDC, State Medicaid Coverage for Tobacco-Dependence Treatments United States, 2006, MMWR57(05):117-122, February 8, 2008.

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 15

    Puff Free Pregnancy

    A Unique Approach

    Researched current available programs & best practices

    Involve OB providers

    Enlist health plan care managers for additional support

    Provide tool kit to support cessation

    Identify and break down barriers

    Provide non-judgmental one-on-one support

    Allow unlimited calls with health coach

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 16

    Capitalize on a Teachable Moment

    Educate member on negative health effects of smoking during pregnancy

    Acknowledge barriers such as stress, mental health issues, economic situation

    Empower member to help improve the health of her baby

    Assist member to avoid second hand smoke

    Impress health benefits of smoke free environment for infants & children

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 17

    Program Design

    Program is based on clinical guidelines published by The American Congress of Obstetricians and Gynecologists (ACOG) and US Public Health Service

    Nurtur Coaches are Certified Tobacco Treatment Specialists with additional training on counseling on cessation during pregnancy

    Coordination with provider to inform when their patient has joined, when weve lost contact and when the member has completed the program

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 18

    Program Design

    The Program incorporates:

    An individualized cessation plan

    Quit date preparation

    Identification of tobacco cues and coping strategies

    Stress Management techniques

    Relapse Prevention

    Tool kit w/ educational materials with appropriate health literacy (4-5th grade)

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 19

    Program Specifics Medical Providers identify pregnant smokers to health plan

    with the Notification of Pregnancy Form

    Outbound calls made to explain program and enroll member

    Members who are ready to make a quit attempt and are

  • NATIONAL HEALTHY START ASSOCIATION 12TH ANNUAL SPRING CONFERENCE 20

    Current Status

    Currently 5 Medicaid health plans

    Total enrolled to date: 680 (consented to program)

    331 completed the program (48%)

    349 lost to follow up (51%)

    22% quit rate (of all enrollees, including those lost to follow up)

    25% cut back on amount of smoking (of all enrollees, including those lost to follow up)

  • NATI