HJAR Sep/Oct 2019

40 SEP / OCT 2019 I  HEALTHCARE JOURNAL OF ARKANSAS COLUMN MEDICAID Arkansas Medicaid pays for nearly two-thirds of pregnancy and newborn nursery care in the state. Because of this substantial focus on perinatal care delivery, the Arkansas Department of Human Services (DHS) Division of Medical Services (DMS) has begun several initiatives over the last 10 years to improve outcomes and help newborn Arkansans get off to a good start. Early Elective Delivery Reduction: Clini- cal research demonstrated worse outcomes and increased costs when babies are born before 39 weeks. Historically, many obste- tricians and expectant mothers electively planned deliveries after 37 weeks when lung development is usually mature in utero. In 2011, nearly 60 percent of nonspontaneous deliveries prior to 39 weeks inArkansas were elective. Arkansas Medicaid made reduction of early elective deliveries part of its hospital Pay for Performance program, which led to a dramatic decrease in elective nonsponta- neous deliveries prior to 39 weeks. Today, only 1 percent of nonspontaneous deliver- ies in Arkansas Medicaid are elective prior to 39 weeks. Exclusive Breast Feeding at Discharge: The benefits babies get when started out on breast milk instead of formula are well docu- mented in the medical literature. Arkansas had one of the lowest rates of breast feeding after discharge in the country, and its hos- pitals did not score well on “breast feeding friendliness” surveys conducted by the Cen- ters for Disease Control (CDC) and the March of Dimes. In response, DMS created a metric to promote breast feeding and institutional activities that facilitate breast feeding by new mothers. Breast feeding rates in newmothers covered byArkansas Medicaid are up 50 per- cent since the start of this focusedmessaging. Low Risk Caesarean Sections: Caesarean section (C-section) rates have their contro- versies. Substantial variation exists among hospitals with rates ranging from 15 percent to over 50 percent in some obstetrical units (as an aside, Brazil has the highest rate in the world, approaching 70 percent). Obstet- rics experts frown on high C-section rates because of the risk of wound infections and other post-partum complications to mother and newborn. This issue is further compli- cated by controversies regarding the safety of vaginal birth after a woman has had a pre- vious C-section. Thus, reduction of initial C- section rates could lower the likelihood of a subsequent C-section in a future pregnancy. Healthy People 2020 targeted 24 percent as the rate for low-risk, first-time C-sections (healthy mothers with babies presenting in the vertex position in utero). The DMS Pay for Performance program had succeeded in lowering the rate from the high 20s to below the Healthy People target, but the state had slipped back to the high 20s in a recent evalu- ation. As a result, fewer hospitals have quali- fied for that metric toward their bonus goal, and DMS continues to focus on the issue. Long Acting Reversible Contraception (LARC) Education: Arkansas has the high- est teen pregnancy rate in the country. The rates are especially high in 18- and 19-year- old women. Intrauterine devices (IUD) and hormone implants are reversible and highly INNOVATIONS IN ARKANSAS MEDICAID PROMOTE HEALTHY MOTHERS AND NEWBORNS