Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Communicating With Vulnerable Populabions: <strong>Medicaid</strong> 173
shut off. She also arranged for Lisa's phone to be reconnected. The coordinator then went
down to the local AFDC offices and filled out all the necessary forms so Lisa could start
receiving the financial benefits for which she qualified.
The stress in Lisa's life diminished dramatically. In fact, at her next pregnancy checkup,
her doctor said he couldn't believe the change for the better in her physical condition.
Lisa remained at home for the rest of her pregnancy, giving birth to a healthy nine-pound
baby boy.
Without the assistance of a Medica Health Plans social worker, Lisa's difficulties might
have taken longer to resolve, which might have resulted in a less favorable outcome for her
pregnancy and a high cost hospital stay for a premature infant. Fortunately, the nurse working
with Lisa's health care provider not only recognized the seriousness of Lisa's situation,
but knew to call Medica Health Plans' social service coordinators for help.
REACHING OUT TO WOMEN WITH HIGH-RISK
PREGNANCIES
In April 199S, Medica Health Plans launched a one-year study to see if offering social services
as well as medical services to low-income pregnant women with very high-risk pregnancies
could have a positive influence on the outcome of their pregnancies. For the study,
which was named the Prenatal Trend Control Project, Medica Health Plans selected 351
pregnant women with very high-risk pregnancies from new enrollees in its Medica Choice
<strong>Care</strong> (<strong>Medicaid</strong>) health plan-women who were under the age of 18, for example, or who
had gestational diabetes, or who were living in a homeless shelter.
The project has staff who call each of the study's pregnant women regularly to ask them
how they are doing. They work in conjunction with Medica Health Plans' social service
coordinators and Trend Control prenatal nurses. If one of the pregnant women is having a
medical problem, the prenatal coordinator passes that information on to a nurse. If the
woman is having a social services problem-whether it be difficulty paying for a heating
bill, getting out of an abusive relationship, or simply finding an affordable crib-the prenatal
coordinator gathers that information and passes it on to one of Medica Health Plans'
social service coordinators.
Women who have only a few needs may be called by a prenatal coordinator only once
a month while those with significant difficulties may be called every week. If a woman
smokes, she is contacted at least every other week to help her stop smoking.
How much of an impact such efforts will have on the outcome of the women's pregnancies
will not be known until late in 1996 when all the enrolled women's babies have been
born and Medica Health Plans' experts have analyzed the financial, birth, and pediatric outcome
data collected during the study.
CREATING COMMUNITY PARTNERSHIPS
Many of Medica Health Plans' innovative programs for <strong>Medicaid</strong> recipients had their beginnings
in Medica, the managed care company that merged in 1994 with HealthSpan, a health
care delivery system, to form Allina Health System.
With the merger, however, came even broader opportunities to reach out to Minnesota's
vulnerable populations. Many exciting new projects have been developed as a result.
Allina believes strongly that it must work in partnership with community groups to
understand more clearly the barriers to quality care for low-income people and what can be
done to remove those barriers. As Gordon Sprenger, Allina's executive officer, told members
of the American Hospital Association when he became chairman of that organization early
in 1996, hospitals and other health care organizations must not only help the ill and injured,