Strengthening the Payer/Provider Partnership for Better Maternal Health

Elevance Health’s OB Practice Consultant and Quality Incentive Programs Show That Collaboration Can Improve Health Outcomes.

Courtney Polk knows a lot about maternal health: A mother of two, she has spent her entire 17-year career in maternal-child health as a labor and delivery nurse and then as an obstetrics practice consultant (OBPC) with Elevance Health. In this role, she partners with maternal healthcare providers around the state of Texas to support them as they work to improve maternal health outcomes.

For many maternal healthcare providers in Texas, Polk is a trusted resource to ensure they are receiving the necessary support from the health plan to improve quality. Across the country, Elevance Health’s affiliated health plans cover one out of every eight of the nation’s births. In 2019, Medicaid was the source of payment for 42% of all births in the United States.

As an OB practice consultant, Polk works with care providers, some of whom are participating in the OB healthcare quality incentive program (OBQIP). She and other OBPCs around the country use real-time quality data to encourage and speed up the adoption of evidence-based practices. They communicate available member programs, incentives, and best practices, and are available to answer questions about Medicaid and other relevant policies and procedures.

For care providers that participate in OBQIP, the OB practice consultants work closely with them to understand their current processes and then provide information on best practices. The healthcare quality incentive program can help improve quality, help to ensure claims are billed correctly, and make sure practices receive credit for their high-quality care delivery.

With OBQIP, which launched at Elevance Health in 2016, care providers are also given financial incentives for achieving high-quality measures, such as:  

• First prenatal visit in the first trimester
• Low rate of C-sections
• Babies born at a healthy weight
• Full-term births
• Cervical cancer screenings

“Much of my time is spent reviewing and sharing quality data with care providers,” Polk said. “On each of the performance indicators, they earn points for meeting set metrics. The goal is to help those care providers improve health outcomes for people who are pregnant and their babies.”

Dr. Jeffrey Sandate, an OB/GYN at Women’s Specialty Center in Dallas, Texas, says the practice’s clients are from all socio-economic backgrounds and professions and their needs and situations vary. “Some [of those needs] are medical such as preeclampsia, placenta previa, or gestational diabetes,” he said. “Some are health-related social needs like transportation, housing, interpersonal safety, or employment.”  

“Sometimes medical practices are so busy that they may not be able to get someone in for an initial appointment and they’re scheduling them weeks out,” Polk said, “so we work with them to manage their workflow so they can prioritize those initial visits.” The research shows that the sooner someone gets access to prenatal care, the better the outcomes for their pregnancy.

“We have noticed that postpartum visits have increased since we have been part of the program,” Sandate said. “Having the patient data available has helped us reach out to the patients who need additional testing or to follow up for postpartum care.”

Polk also shares with care providers information about innovative programs in their area that are covered by Medicaid. For example, she said, one program is called My Advocate, and it provides proactive, culturally reflective outreach and education via a member’s mobile device. Another, Performance Kitchen, delivers nutritious frozen meals to people who have gestational diabetes or gestational hypertension. In some areas, members can access doula services through their state’s Medicaid plan as well as through grants to community organizations from the Elevance Health Foundation.

Elevance Health employs OB practice consultants across the country — all of whom have maternal healthcare expertise. Our research shows the programs are working. Care providers who worked with an OBPC and participated in the OBQIP program from 2020-2021 saw, on average:

• 9% reduction in primary C-section rates.
• 19% reduction in low-birth weight.
• 5% reduction in total birth costs.
• 91% increase in postpartum visit adherence.

“We know that our care provider partners are key stakeholders and drivers of the maternal consumer experience, so we’ve developed initiatives that make meaningful and impactful improvements in the way we support, connect, and collaborate with our providers,” said Dr. Tiffany Inglis, Carelon national medical director for maternal-child and women’s health. “We’re working to drive health beyond healthcare and helping our obstetric specialty providers to advance the best maternal health outcomes possible.”