Lawmakers target successful program for at-risk babies and mothers for elimination

By Michelle Hughes - N.C. Child

This is a true story. It’s about a smart, homegrown program embedded in our state’s communities that has made tremendous progress in ensuring North Carolina mothers-to-be have healthy babies who grow up in healthy families. Unfortunately, this story may not have a happy ending, because state lawmakers are seriously considering dismantling the program this year.

It starts not long ago, in a Piedmont county in North Carolina, when a pregnant woman without health insurance went into labor, went to a hospital and delivered her child. It had been an unintended pregnancy, and her abusive domestic partner would not let her see a doctor for prenatal care before the birth.

But at the hospital after the child was born, the woman’s situation began to improve. She got access to health care and help dealing with her abusive domestic partner, thanks to Community Care of North Carolina (CCNC), a nationally recognized public-private partnership that coordinates care for at-risk pregnant women.

The woman, we’ll call her Audrey (not her real name), was found to be eligible for Medicaid, which would help cover her health care costs, and she was connected to an OB-GYN practice that participates in CCNC’s Pregnancy Medical Home program. She told her doctors she didn’t want to get pregnant again for at least two more years, and she received an IUD to prevent another pregnancy. Through her OB-GYN, Audrey was connected with a CCNC pregnancy care coordinator who provided her with resources to address her domestic violence situation and connected her with important social supports to help her care for her baby.

By coordinating care for women like Audrey and helping them navigate a complicated health system, CCNC is helping reduce infant mortality, which is at its lowest rate in state history–seven deaths for every thousand live births. That’s a great improvement over 1988, when our rate was 12.6 per thousand, the worst in the nation. CCNC also saves state taxpayers money at the rate of $3 saved for every dollar spent, according to a recent report by the State Auditor. And all the funds saved stay right here in the state.

Thousands of North Carolina mothers are being cared for through this innovative network of public and private resources that screens those most likely to have pre-term or low birthweight babies, and makes sure they are able to see a doctor for prenatal care and receive interventions, like progesterone shots, to prevent pre-term births. CCNC makes sure doctors get good data about their patients, gives doctors state-of-the-art guidance on caring for pregnancy complicated by conditions such as high blood pressure, and provides an important linkage to nurses and social workers at local health departments who help patients manage medications and roadblocks like transportation, child care, or as in Audrey’s case, domestic abuse.

This program is something every North Carolinian can be proud of. We figured out how to create a system that would manage many of the medical and life situation factors that contribute to infant deaths, and we are seeing results.

Despite these results, CCNC is squarely in the crosshairs of legislators looking to reform our state’s Medicaid system.

The Senate and House are negotiating different visions of Medicaid reform, but the basic starting point is that the state would end its contract with CCNC and instead offer its Medicaid business to three large managed care insurance companies. Other “provider led entities” (like hospitals, rural clinics and medical practices) could organize themselves to compete with the insurance companies for the Medicaid business. The profit motive is expected to drive cost savings, as the new providers try to predict their costs and deliver care within the funds allocated by the Legislature.

It may or may not work.

Some of the companies interested in North Carolina’s Medicaid contract have a troubling history of being fined or taken to court by states for delaying care to patients, submitting false claims, and discriminating against pregnant women and other high-risk patients. Click here and here to see examples.

What seems obvious is that we should not be in a hurry to abandon what works. In fact, it seems we ought to expand and build on it. Legislators ought to keep CCNC working, at least until there is a new system in place to coordinate care for pregnant women to ensure that all babies in our state get off to a strong and healthy start.

Michelle Hughes is the Executive Director of the children’s advocacy group N.C. Child.

By Michelle Hughes

N.C. Child

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