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Pregnancy is one of the most-expensive episodes for insurers, averaging about $19,000 for pregnancy, vaginal delivery and postpartum care, and $26,000 for cesarean births. Compared with other industrialized nations, costs in the U.S. are nearly eight times higher.

And what do mothers in the U.S. get in return for this high-priced care? They get the highest death rate per 100,000 live births in the developed world, with 18.6 deaths recorded in 2022, compared with 5.5 deaths per 100,000 in the U.K. and zero in Norway. Death rates among black women are even higher, at 50 deaths per 100,000 live births, according to the CDC.

The federal government and the insurance industry have long recognized this problem, a combination of too few maternity care providers — especially in rural areas — lack of comprehensive support, higher incidence of obesity and chronic conditions and women delaying child birth until they’re older. In response, the government has adopted HEDIS (Healthcare Effectiveness Data and Information Set) measures related to prenatal and postpartum care, including pediatric visits for newborns. Most insurance plans, including Medicaid, also have incentives designed for women to receive additional benefits for scheduling regular care.

But reaching the latter population through mass texts, emails or phone messages can be difficult. A significant percentage don’t visit a physician after they discover they’re pregnant, and others may have food or housing insecurity that make them uneasy about seeking care. Many have jobs where taking a call or answering a text can’t happen during business hours.

What these women, their unborn children and possibly other children and partners need is comprehensive care that addresses any SDOH insecurities and provides the care they desperately require.

And that starts with one-on-one contact to establish a bond, the communications measure that people prefer.

Prenatal Care Not a Priority for Struggling Families

Medicaid is the No. 1 provider of pregnancy-related services in the United States, financing 41% of all births in 2023. In rural areas, Medicaid pays for 47% of all births.

 Many Medicaid recipients have difficulty meeting their day-to-day needs, and may be forced to prioritize basic living expenses such as food and electricity, making it clear why prenatal visits are delayed or missed. But receiving prenatal care is vital for both mother and baby. Pregnant women who don’t receive prenatal care are at risk for such complications as gestational diabetes, high blood pressure, infections and preeclampsia, jeopardizing the health of mothers and babies — and requiring costly hospital care for moms and NICU care for newborns. Babies whose mothers don’t receive prenatal care are three times more likely to have low birth rate and five times more likely to die during or shortly after birth when compared to mothers who received regular prenatal care.

That’s why addressing social determinants of health (SDOH) needs should be a critical component of any health plan engagement program, but that’s rarely the case. In many engagement programs, a few texts or emails are sent, with the member getting moved to an “unreachable” or “inactive” status if they don’t respond.

Engagement should be measured by actions taken and not by attempts, an important distinction when evaluating engagement vendors.

Address SDOH Needs to Increase Prenatal Compliance

While the aim of a maternity engagement program should be prenatal, postnatal and well-baby visits, a woman’s desire to schedule these visits is frequently overwhelmed by the day-to-day concerns previously mentioned, as well as difficulty in taking time off from work.

Providers are more likely these days to ask patients about their SDOH needs, but asking about them and solving them are different issues. An effective maternity program takes SDOH needs into account, understanding that solving a member’s unique challenges can help establish the trust necessary for the member to prioritize her health and that of her unborn child.

Sometimes, parents just need a dependable supply of diapers. Nearly one-half of families with young children cannot afford a sufficient diaper supply, and 25% have missed work or school because they don’t have enough clean diapers to leave their children in care. A single diaper costs less than 30 cents, so a small investment by the health plan engagement vendor can go a long way toward building a relationship with the member. Another member concern is the fear that a mother may be found “lacking” by having SDOH challenges, especially if other children are in the home.

That’s why one-on-one interaction is so critical. The initial focus is on solving the problems that prevent moms from attending appointments. To be effective, care coordinators should be in the same community where members reside, the better to tap into community resources versus members receiving generic referrals that may not be valid.

Why One-on-One is the Way to Go

Each American receives about two unsolicited texts every day, and the amount of unsolicited email is even worse, with 49% of Americans saying that’s where most of their spam comes from. Anecdotal evidence from Medicaid and exchange plan members show that they receive upwards of 20 automated messages weekly from various plan vendors. That’s probably why automated outreach by health plans has a response rate of less than 5%.

The personal touch of a one-to-one engagement plan can move the needle in ways that automated messages simply can’t, not only in terms of contact but also in terms of compliance. A report from the CDC notes that typical referrals (here’s a number to call or a website to visit) have a success rate of as low as 3%, compared to a success rate of up to 75% through a warm handoff, where a care coordinator does the heavy lifting to arrange member care.

Members, too, prefer the personal touch. A recent survey shows that 75% of people prefer talking to a real person for customer support.

Personal engagement is the key to improving prenatal and postnatal care compliance. By addressing social determinants of health and building trust through one-on-one support, health plans can remove barriers to care, improve outcomes for mothers and babies and reduce costly complications associated with inadequate prenatal care.

About Lauren Barca, MHA, RN, BSN

Lauren Barca, MHA, RN, BSN is VP of Quality of 86Borders, a human-first care coordination and member engagement company that helps health plan members overcome obstacles to care – especially among hard-to-reach populations.