ProgenyHealth 2024 Maternal & Infant Health Report Spotlights Payer Interventions

Health plan efforts featured among the 5 key trends, insights, and predictions that will mark the year.

U.S. maternal mortality doubled between 1999-2019, with the Centers for Disease Control and Prevention estimating that up to 80% of these deaths are preventable. These devastating statistics are from the 2024 report A Troubling Reality, a Hopeful Future from ProgenyHealth, LLC, a tech-enabled women's healthcare company focused on Maternity and NICU Care Management.

Payers are one group targeting better outcomes. The report features maternal health interventions from four health plans: Aetna Better Health of Florida, Community Health Choice, Western Sky Community Care of New Mexico Health Care Service Corporation (HCSC).

Susan Torroella, ProgenyHealth CEO, provided exclusive quotes on payer roles and on all five multi-stakeholder trends from the report, including:

1. Stronger Health Plan Interventions
2. A Promising Shift in Healthcare Research
3. Bettering Maternal and Infant Care through AI and Machine Learning
4. The Rise of Virtual Prenatal and Postpartum Healthcare
5. New Definitions of Risk 

Trend: Maternal health outcomes are benefitting from stronger health plan interventions

As noted in the ProgenyHealth report: “While progress toward equitable, accessible maternal and infant healthcare has been slow, it continues to be steady — and these innovative new avenues for improvement show that plans are committed to reversing these alarming trends.”

ProgenyHealth’s CEO agrees: “In our experience, payers want to make a difference. They understand that they are uniquely positioned to drive collaboration among partners who can positively impact maternal and infant health.”

Focus areas include:

• Stay-at-home-but-stay-in-touch prenatal care
• Postpartum care
• Associated mental health care for women who develop anxiety and depression after delivery (10% and 20%, respectively)

Home care links to the ProgenyHealth report Trend #4: The Rise of Virtual Prenatal and Postpartum Healthcare. CEO Torroella says: “Technology and digital tools are changing the playing field for women who live in maternity deserts. Remote patient monitoring devices, virtual healthcare, and mobile apps can help close gaps during the prenatal and postpartum stages.”

All focus areas will require increased payer reimbursement including from Medicaid programs. Many have extended postpartum coverage for up to a full year after birth. The ProgenyHealth report notes that “commercial plans are taking notice—and devising their own solutions to the maternal and infant health emergency.”

What four health plans are doing

The ProgenyHealth report features these examples:

• Aetna Better Health of Florida — An initiative to reduce the rising c-section births associated with  higher infant mortality. Aetna has partnered with ProgenyHealth to deliver an integrated Maternity & NICU Care Management program for health plan members.
• Community Health Choice (Houston) — A multi-pronged approach to address the Black infant death crisis. In addition, CHC members have access to a ProgenyHealth app for self-enrollment in Maternity Care Management programs in early pregnancy. Nearly 15% of MCM enrollments have come through this “digital front door.” 
• Western Sky Community Care of New Mexico — A doula network, with services available via 24/7 digital appointments for births, postpartum mental health resources, and many others.
• Health Care Service Corporation (HCSC) — The Blues plan has created the Centering Pregnancy program to improve access and expand coverage through mobile health programs in multiple states.

Payer intersections that improve maternal and infant health

Speaking on maternal and infant health, ProgenyHealth CEO Torroella tells HealthLeaders: “No one entity can solve this issue – it will take a team of contributors.”

As an example, Torroella identifies a clear payer-provider intersection point: maternal health co-occurring conditions.

“More women are beginning their pregnancy with pre-existing conditions such as diabetes or high blood pressure, which puts them at higher risk for maternal mortality or morbidity,” says Torroella. “What we’ve seen is that it isn’t just one condition leading them to our program, it’s often multiple conditions that require complex care management. The sooner we can identify those issues and begin working with those women, the better the outcomes.”

ProgenyHealth’s payer results

ProgenyHealth’s Maternal & NICU Care Management teams seek to improve health outcomes and reduce costs for commercial health plans, Medicaid payers, and large employers. NICU Care Management results from the company’s website include:

• An ROI of 2:1 or better and 12-16% in savings
• 10-15% reduction in Length of Stay and up to 50% in readmissions and reduced ER visits
• A 90%+ member satisfaction rate

Artificial intelligence and machine learning have played a role.

“As a tech-enabled women’s health company,” says Torroella “our own platform has predictive and prescriptive analytics to aid our clinical teams in decision-making. Still, our most important asset is our people, who use technology to help them make meaningful connections with those we support.”

She adds: “We have made so many advances in healthcare, and yet pregnant women are at greater risk today than their mothers were,” says Torroella. “We simply must do better when it comes to maternal and infant health.”