Case Management: A Pathway to Better Maternal Health

The United States finds itself in a concerning position regarding maternal health, boasting the highest maternal mortality rate among all high-income nations. Recent data from 2023 indicates a rate of 18.6 deaths per 100,000 live births-a figure more than double that of comparable countries. The situation is particularly stark for Black women, who experience a mortality rate of 50.3 deaths per 100,000 live births, highlighting a critical disparity.

Understanding and actively managing risk factors associated with pregnancy, especially preterm births, can make a profound difference. These risk factors can range from previous preterm births and multiple pregnancies to substance use and short intervals between pregnancies. Early intervention, from the moment a pregnancy is confirmed, is key to fostering healthier pregnancies and possibly reducing these alarming statistics, while also contributing to lower healthcare costs.

A recent report from ProgenyHealth underscores the necessity of a multifaceted strategy for identifying and managing maternal health risks, with a specific focus on mitigating the dangers of premature births. The report offers valuable insights for health plans, suggesting a “high tech, high touch” approach to risk management that can lead to improved outcomes and reduced overall birth-related costs.

As Linda Genen, MD, MPH, ProgenyHealth Chief Medical Officer, explains, the focus is shifting beyond purely medical concerns to encompass behavioral health and the social determinants of health. “This means treating people as a whole,” she stated, “which includes factors such as anxiety, diet, substance abuse, and postpartum depression.” This integrated view recognizes that a pregnant person’s well-being is influenced by a complex web of interconnected factors.

Adopting an integrated maternity and NICU (Neonatal Intensive Care Unit) care management approach can lead to several key improvements:

• Swift identification and enrollment of members into support programs.
• Accurate risk stratification and continuous reassessment of maternal risk levels.
• Engaging members through mobile app-based support tools.
• Providing dedicated telephonic case management services.
• Implementing support interventions that address clinical issues, social determinants of health, and promote health equity.
• Offering complete NICU utilization and case management services if a NICU admission becomes necessary.
• Extending care management support for both mother and infant for up to 12 months post-delivery.

dr. Ellie Stang, ProgenyHealth founder and executive chairwoman, notes that health plans are increasingly seeking innovative partners who are proactive in managing maternity cases. “They seek partners who can manage these cases holistically to drive health equity and quality outcomes for their members,” she shared.

Photo: KidStock, Getty Images

How can case management address the social determinants of health impacting a pregnant woman experiencing housing instability?

Understanding the Core of Maternal Case Management

Maternal case management is a collaborative process involving healthcare professionals, social workers, and the expectant or new mother to navigate the complexities of pregnancy and postpartum care. It’s more than just scheduling appointments; it’s about proactively identifying risks,coordinating services,and empowering women to achieve optimal health outcomes. This approach is particularly crucial for women facing high-risk pregnancies, socioeconomic challenges, or pre-existing health conditions. Key terms frequently enough used interchangeably include pregnancy case management and maternal health coordination.

Identifying Women Who Benefit from Case Management

Not every pregnant woman requires intensive case management. However, certain factors considerably increase the need for this specialized support. these include:

high-Risk Pregnancies: Conditions like gestational diabetes, preeclampsia, multiple gestations (twins, triplets), or a history of pregnancy complications.

Socioeconomic Factors: Poverty, lack of insurance, housing instability, food insecurity, and limited access to transportation.

Underlying Health Conditions: Chronic illnesses such as heart disease, diabetes, hypertension, mental health disorders (depression, anxiety), and substance use disorders.

Age: Adolescent pregnancies and pregnancies in women over 35 are often considered higher risk.

Limited Health Literacy: Difficulty understanding medical information or navigating the healthcare system.

History of Adverse Pregnancy Outcomes: Previous preterm birth, stillbirth, or neonatal death.

Key Components of Effective Maternal Case Management

A robust maternal health case management program incorporates several essential elements:

1. Comprehensive Assessment: A thorough evaluation of the woman’s physical,emotional,social,and financial needs. This includes a detailed medical history, psychosocial assessment, and risk stratification.
2. Individualized Care Planning: Developing a personalized plan of care based on the assessment findings, outlining specific goals, interventions, and timelines.
3. Care Coordination: Connecting the woman with appropriate resources and services, such as:

Obstetric care

Prenatal education classes

Nutrition counseling

Mental health services

Social services (WIC, SNAP, housing assistance)

transportation assistance

1. Ongoing Monitoring & Support: Regular follow-up to assess progress, address challenges, and adjust the care plan as needed. This can involve phone calls, home visits, or clinic appointments.
2. Advocacy: Helping the woman navigate the healthcare system and advocate for her needs.
3. Health Education: Providing information on topics such as prenatal nutrition, breastfeeding, infant care, and postpartum depression.

The Role of Technology in Modern Case Management

Digital health tools are increasingly being integrated into maternal case management programs. These include:

Telehealth: Remote consultations with healthcare providers, improving access to care, especially for women in rural areas.

Mobile Health (mHealth) Apps: Providing reminders for appointments,medication adherence,and self-monitoring of vital signs.

Electronic Health Records (ehrs): Facilitating seamless dialog and information sharing among healthcare providers.

Remote Patient Monitoring (RPM): Utilizing devices to track physiological data (blood pressure, glucose levels) remotely.

These technologies enhance the efficiency and effectiveness of case management, leading to improved outcomes.

Benefits of Implementing Maternal Case Management Programs

The positive impacts of effective case management in maternal health are considerable:

Reduced Preterm Birth Rates: Proactive identification and management of risk factors can help prevent preterm labor and delivery.

Lower Maternal Morbidity & Mortality: Improved access to care and early intervention can reduce the risk of complications during pregnancy and childbirth.

Improved birth Outcomes: Healthier babies with higher birth weights and fewer neonatal complications.

Increased access to Care: Connecting women with needed resources, particularly those facing barriers to care.

Enhanced Patient Satisfaction: Women feel more supported and empowered throughout their pregnancy journey.

Cost Savings: Preventing complications and hospitalizations can lead to lower healthcare costs in the long run.

Real-World Example: Nurse-Family Partnership (NFP)

The Nurse-Family Partnership is a nationally recognized, evidence-based program that provides intensive home visiting by registered nurses to first-time, low-income mothers.nurses begin home visits during pregnancy and continue through the child’s second birthday.Studies have demonstrated significant positive outcomes, including reduced rates of child abuse and neglect, improved maternal employment, and increased school readiness for children. This exemplifies the power of sustained, individualized support.

Practical Tips for Implementing Accomplished Programs

Collaboration is Key: Foster strong partnerships between healthcare providers, social workers, community organizations, and government agencies.

Cultural Competency: Ensure that case managers are culturally sensitive and able to address the unique needs of diverse populations.

Data-Driven Approach: Track key metrics to monitor program effectiveness and identify areas for advancement.

Ongoing Training: Provide case managers with ongoing training on best practices in maternal health and case management.

Patient-Centered Care: Prioritize the woman’s preferences and goals throughout the process.

Address Social Determinants of Health: Recognize and address the underlying social and economic factors that impact