April 3, 2023

Medicaid Providers Take Note: Submitting the Pregnancy Risk Assessment Form Can Save Babies’ Lives

Beejadi Mukunda, MD, VP & Market Chief Medical Officer, Ohio, CareSource

Ohio has an unacceptably high rate of infant mortality: For every 1,000 live births, 6.7 babies die before their first birthday. It’s a tragedy compounded by inequity: The rate for African American infants (13.6 per 1,000) is nearly triple that of white infants (5.1 per 1,000), and the single most common factor is babies being born too early. What can we do about that? The Ohio Department of Medicaid (ODM) has a tool that can make a difference, but many health care providers don’t know about it or don’t use it. That needs to change.

For patients at risk of pregnancy complications and preterm birth, nothing reduces that risk more than early intervention by the appropriate health-care providers. This is especially true for Medicaid members, many of whom face multiple barriers to good health such as poverty, limited education, limited transportation options and language barriers.

That’s why ODM has long encouraged providers to take a critical step when they learn a patient is pregnant: Determine any special health concerns the patient may have by completing the Pregnancy Risk Assessment Form (PRAF) and send that form to the department. That allows the department to notify the patient’s Medicaid managed care organization, which can then offer the patient the interventions that could make the difference between a healthy, full-term baby and a much-worse outcome.

Often, simple steps can have a big impact: Taking the hormone progesterone during pregnancy helps the uterus expand and has been shown to reduce the likelihood of miscarriage, especially in women who have had previous miscarriages. Using ultrasound to monitor the length of the cervix could reveal if the cervix begins to shorten too early, indicating a risk of preterm labor.

But health plans can’t encourage these and other important interventions if they haven’t been informed of the risk factors or don’t even know the patient is pregnant. In addition, making sure the health plan knows of a pregnancy prevents the patient from being disenrolled and losing Medicaid coverage while she is pregnant.

Unfortunately, relatively few providers use the PRAF. Of the 16,107 pregnant patients listed on Medicaid rolls as of mid-March, practitioners had submitted PRAFs for fewer than 5,500, or about 34%. ODM tries to reduce barriers to using the PRAF by compensating providers for the service: $90 for using a recently updated electronic version and $19 for filing the older, paper form. By one estimate, large health care systems could be collecting up to $1 million each per year if they routinely submitted PRAFs for every pregnant patient.

Much more important, however, are the missed opportunities for each patient whose pregnancy goes unreported. While Ohio’s rate of infant mortality — defined as a child dying before turning a year old — remains stubbornly high, organizations are at work across the state attacking the problem. The Ohio Perinatal Quality Collaborative is a statewide consortium of perinatal providers, hospitals, policymakers and government entities that uses quality improvement science and continuous data collection to try new strategies and quickly determine which ones work best.

Community-based efforts like CelebrateOne in Columbus, Cradle Cincinnati and First Year Cleveland provide education and resources for expectant moms and new parents.

Wider use of the PRAF can put more pregnant patients in contact with those resources and result in more safe pregnancies and healthy babies.

ODM has worked to make the form easier to use and further improvements are in the works. In a previous version, providers had to fax one form to the patient’s county of residence and a separate copy to her health plan. The new, web-based “PRAF 2.0” automatically notifies the appropriate county, health plan and any home health providers on record for the patient. It allows progesterone prescription, approved by the Ohio Board of Pharmacy, to be faxed to the patient’s pharmacy of record.

Much of the information that goes into the PRAF already exists in patients’ electronic medical records, creating the possibility that completing and submitting the form could be automated.

But for now, if we are to meaningfully reduce infant mortality in Ohio, we need more providers to know about the PRAF and take action to use it, and I’m grateful to OAHP for the opportunity to spread the word.