Community Prenatal Case Manager Linking pregnant women to

Community Prenatal Case Manager: Linking pregnant women to prenatal care Mary. Jo Rosazza, RNC, MS Perinatal Health Program Director El Paso County Department of Health and Environment Colorado Springs, Colorado

El Paso County Demographics ¬ Population 541, 495 ¬ 8557 births ¬ 25% births paid by Medicaid ¬ LBW rate 9. 6% ¬ Pre-maturity rate 9. 4% 2002 CDPHE Health Statistics 2000 PRAMS data

El Paso County Demographics

Background ¬ Safety net role of HD Women’s Clinic ¬ Community Health Center transition to traditional model

Concerns ¬ Prenatal care 1 st Trimester 79. 6% ¬ No prenatal care 1. 2% (CDPHE 2001 Health Statistics) ¬ Pregnant women not receiving prenatal care as early as they wanted 26. 1% vs 19. 4% statewide (PRAMS 2000 data)

Source of Most PNC Visit ¬ Hospital Clinic ¬ Health Dept Clinic ¬ Private Dr. Office ¬ Comm. Health (CHC) ¬ Other Colorado PRAMS data 2000 14. 5% 4. 3% 65. 2% 7. 1% 8. 9%

Financial Sources of Prenatal Care ¬ PNC paid by: (can choose more than one option) Medicaid 26. 8% Personal Income 19. 2% Insurance 50. 7% Military/Tri-Care 19. 1% Colorado PRAMS data 2000

Beginning Transition ¬ Telephone survey to 19 OB/GYN offices and all FP offices ¬ 13 offices responded representing 29 OB/GYN, 7 FP, 1 nurse midwife

Survey Questions ¬ Weeks into pregnancy accepting new client ¬ Length of time scheduling 1 st visit ¬ Accepting Medicaid/PE ¬ Cutoff for accepting prenatal care transfers ¬ Accepting high risk clients ¬ Accepting undocumented immigrants ¬ Types of financial coverage

Involving the Community ¬ Establishing Prenatal Task Force Advisory Group ¬ Goal is to assure a quality system of care for all pregnant women in El Paso County ¬ Key members: Private OB providers Military medical personnel Birth centers nurse managers Community Health Center First Visitor

Task Force Discussion ¬ Increased military personnel ¬ Nursing/paraprofessional staff shortage ¬ Potential hospital bed shortage ¬ Medicaid reimbursement amount ¬ Length of time for Medicaid reimbursement

Task Force Discussion (cont) ¬ Medicaid timeframe for care for women prenatally and postpartum ¬ Lack of use of nurse midwives in the community ¬ Women without prior prenatal care that access ER for pregnancy related concerns

Next Steps ¬ Develop MOU with local Community Health Center ¬ Meetings over several months, looking at safety net role ¬ HD would continue to be a PE/Medicaid site to refer to all Medicaid providers, not just CHC ¬ Community Prenatal Case Manager developed as an assurance role ¬ MOU signed effective 3/02

Community Prenatal Case Manager Role ¬ Works with community providers, including hospitals, CHC and physicians ¬ Networking resources ¬ Follow-up with clients on required Medicaid application paperwork ¬ Obtaining referrals from ER on pregnant women without a provider

Results ¬ Letters sent to providers explaining role, future contact to identify concerns ¬ Contacts made to community agencies serving low-income pregnant women ¬ PE site gave list of OB providers accepting Medicaid, business card of CPCM and told client to call if problems accessing care

Results ¬ OB providers continue to identify concerns such as Medicaid time frames, CPCM able to followup on status with Medicaid office, extend PE if necessary ¬ HD survey asking length of time it took to make appointment and see OB provider for 1 st time ¬ CPCM able to contact specific provider and identify barriers ¬ Local city owned hospital began same service for pregnant clients in ER with no provider ¬ Individuals served: approx 100 through CPCM and hospital

Public Health Implications ¬ Community Involvement: Gives our organization a better understanding of community issues related to prenatal care for low-income women Fosters better communication with community OB/Family Practice Medicaid Providers

Public Health Implications ¬ Population-based focus: Coalition building activity to promote and develop alliances among constituencies for a common purpose Builds linkages, solves problems and enhances local leadership to address health concerns

Public Health Implications ¬ Assurance role: Meets several essential public health services including: Monitoring health status to identify community health problems Linking people to needed personal health services

Lessons Learned ¬ Agency staff turnover, focus was on individual clients, not community providers. Lost important piece of role ¬ Communication, communication ¬ Community involvement is needed for success ¬ Ongoing evaluation critical ¬ HD looking at replicating model with another at risk population

Contact Us ¬ El Paso County Department of Health and Environment 301 South Union Blvd. Colorado Springs, Colorado 80910 719 -578 -3257

Credits ¬ Thanks to the Colorado Springs Convention and Visitors Bureau and El Paso County Parks Department for the photos of our county.