July 2017

Prenatal and Postpartum Care Effects on Population

One of the best indicators of the health and prosperity of a population is the infant mortality rate. Healthy People 2020 tracks this indicator and drills down to the racial and ethnic groups for infant mortality rates.

According to the most recent data from 2014, the infant mortality rate is 5.8 percent. Caring for pregnant mothers is an important aspect of having healthy infants and reducing the infant mortality rate. As providers, you play an important role to ensure your patients have proper care, not only in the prenatal months, but in post-partum care as well.

High-risk and Third Trimester Members
Members who are perceived to have a “normal” pregnancy must be seen within 14 days of calling for an appointment. Members who are deemed “high-risk” must be seen within five days of calling for an appointment. High-risk patients can include women with high blood pressure, diabetes or other contributing factors. In addition, providers need to keep open appointments for patients in their third trimester. Patients in their third trimester, with or without prenatal care, must be seen within five days of requesting an appointment. While these are state requirements, they are also for the safety and care of pregnant mothers.

The table below represents year-over-year trends for the Prenatal/Post-partum Care HEDIS^® measure.

To ensure HEDIS compliance:

• for the prenatal component of the measure, members must be seen within the first 42 days of enrollment for a prenatal exam.
• for the post-partum component of the measure, members must be seen 21-56 days after delivery for a post-partum checkup.

Remember to document the great care you provide to our shared members to demonstrate your work and dedication.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).