Maternity Management Program

Every day one in eight babies born in the United States arrives too soon. Premature birth can happen to any pregnant woman. It is a serious, common and costly problem. According to the March of Dimes, as of 2008, one in seven babies (15.4% of live births) were preterm in Louisiana. Between 1998 and 2008, the rate of infants born premature in Louisiana increased nearly 5 percent. There is a need for early prenatal care and case management intervention.

The Maternity Management Program is designed to improve pregnancy outcomes, reduce neonatal hospitalizations, and reduce all costs associated with preterm births and other complications of pregnancy. We provide prenatal education, promote safe health behaviors and enhance the management of maternity care for women identified at high risk for premature labor and delivery.

A successful Maternity Management Program is dependent on the coordination of healthcare services and resources. The physician plays a key role in the delivery of the program and this program is intended only to compliment the medical care received by the physician.

Our Care Management team includes physician advisors, registered nurses, pharmacists and behavioral health specialists.

Our Maternity Management Program has two main components.

    1. To identify members who are at risk and conduct an assessment to evaluate the pregnant mothers risk for premature delivery or complications such as diabetes and hypertension. The Care Management Nurse then coordinates the most appropriate plan of care and services while providing ongoing education and support of the mother-to-be and family members. Participants in the program will receive helpful information to help make healthy choices during pregnancy, then at the time of delivery our nurse will work closely with the health care providers and inpatient care management as needed.

    2. To provide resources to those pregnant mothers who are not at risk, but may need additional information and resources during pregnancy and postpartum.  Member will be referred to the text4babySM program.

Eligible Members

The program is available to Blue Cross and Blue Shield of Louisiana, HMO Louisiana, Inc. and Federal Employee Program (FEP) primary members 18 to 50 years of age for those groups who have maternity coverage.

The selection is based on hospital claims, encounters, pharmacy data and laboratory data and physician notification or self referrals.  We analyze claims data to assess relative health risk, identify medical conditions and provide a member-centric clinical profile

The program is not available to members who have other insurance as primary, are a hospice care recipient or nursing home resident.  This is a voluntary program and members may “opt out” of the program at any time.

Physicians receive the following when their patient enrolls:

  • Written or telephonic notification if their patient is receiving ongoing nurse calls along with the nurse's contact information.
  • Notification of their patients who may be in need of healthcare services via a care coordination nurse call.
  • Patient referral by Blue Cross nurses when member does not have an established patient-physician relationship.
  • Access to claims-based Blue Health Records with up to three years of claims history (through iLinkBLUE)

Resources

National Health Mothers Healthy Babies Coalition

American Congress of Obstetricians and Gynecologist

How can I contact a nurse?

If you wish to contact a nurse to inquire about our programs, please call the Case and Disease Management Unit at 1.800.317.2299.

To refer a member for a care management program:

Complete the CMDM Referral Form and fax it to 225.298.3184.