2 weeks Ago
FILE - A pregnant woman stands for a portrait in Dallas, Thursday, May 18, 2023. (AP Photo/LM Otero, File) ORG XMIT: NY840 Facebook Twitter WhatsApp SMS Email Print Copy article link Save A state audit found that pregnant Medicaid patients in Louisiana often struggle to access prenatal and postpartum care because there aren’t enough nearby doctors who accept the government-funded health insurance, provider lists are frequently inaccurate and many people lack reliable transportation, especially in rural areas. The report, released Monday by the Louisiana Legislative Auditor , reviewed the state health department’s efforts to improve maternal health — an area where Louisiana has long ranked among the worst in the nation .
Despite increased attention and funding, the share of pregnant women in the state who did not receive first-trimester prenatal care rose from 22.5% in 2018 to nearly 26% in 2023. Medicaid patients were most affected, with three out of four missing timely care.
The majority of new babies in Louisiana, 63.5%, are born to women insured by Medicaid. Spending without results The audit found that the Louisiana Department of Health spent nearly $400 million on maternal health reform through the Managed Care Incentive Payment program from Feb 2020 to March 2024, but some initiatives were duplicative or lacked measurable outcomes.
“A lot of money is being put toward it, but there aren't a lot of measurable outcomes or new things being created,” said Chris Magee, a data analytics manager at the auditor’s office. Among the examples cited in the report: $12.8 million was paid for initiatives related to breastfeeding policies and assessing them for inclusion in the state’s breastfeeding initiative , even though all 16 participating hospitals already had such policies and 15 of the 16 were already part of the initiative.
$4.26 million was paid for the submission of a risk-stratification tool already developed and in use by Woman’s Hospital in Baton Rouge. $13 million was paid for initiatives that duplicated efforts already funded under another LDH Medicaid program, including reducing C-section rates, even though LDH paid Managed Care Organizations an additional $15.
1 million for the same goal. “In essence, LDH paid for the same improvement twice,” the audit said. However, some internal programs did show improvement compared to some of the externally funded programs.
The audit highlighted the Louisiana Perinatal Quality Collaborative and the Safe Births Initiative as examples of data-driven programs with measurable outcomes that have improved maternal health. Patients suffer At 21 weeks pregnant, a Louisiana woman couldn’t get care because there were no in-network Medicaid OBGYNs in her rural area, according to one complaint. Another pregnant resident missed multiple prenatal appointments because Medicaid-provided transportation never picked her up.
At 30 weeks, her doctor threatened to stop seeing her because of the missed visits. Chelsea Fazande talks about her pregnancy with Natalie Harvey, a certified nurse midwife with Ochsner Baptist, in New Orleans on Wednesday, July 26, 2023. Fazande went on to deliver a baby girl named Willow.
(Photo by Chris Granger | The Times-Picayune | NOLA.com ) One of the audit’s most striking findings was that 37.5% of Louisiana parishes had no practicing OB-GYNs serving Medicaid patients.
In areas with listed providers, nearly one in five had not seen any Medicaid patients in the previous six months. Patient complaints reviewed by the auditors showed transportation was a big issue . “There's a big disconnect between what the provider network looks like versus what it actually is," said Magee.
The audit found that Managed Care Organizations, which are responsible for coordinating care for most Medicaid enrollees, did not maintain accurate lists of providers, which is “one of the most basic things” they should do, said Magee. The auditors verified that the list was inaccurate by checking it themselves. “If we can do it, they should be able to do it with their own internal data,” Magee said.
LDH agrees with audit An increase in payment rates might address the provider shortage, said Magee, and analyzing complaints and improving oversight of the MCOs could help more Medicaid patients get connected to care. In response to the audit, LDH agreed with all of the Legislative Auditor’s recommendations. State health officials acknowledged problems with provider network accuracy and access to care, and noted efforts such as a 2024 initiative to clean up MCO provider directories.
The department also recognized the need for improved case management and transportation services, and emphasized its commitment to improving maternal health outcomes. In a February public letter , Dr. Ralph Abraham, Louisiana’s Surgeon General, identified maternal and infant mortality as a priority for the health department.
A spokesperson, however, said officials would not immediately be able to answer questions about efforts to improve access and hold MCOs accountable. ‘A long-term game’ The report said that rural areas could be better served by setting up remote care, increasing the number of nurse midwives and making it easier for them to practice, starting group prenatal care and increasing home visiting . While LDH has two home visiting services, they serve just 6% of births.
Prenatal care allows for the diagnosis of diabetes or hypertension, which can make pregnancy more dangerous for babies and moms and should be monitored, said Dr. Rebekah Gee, an OB-GYN and founder of Nest Health, which provides in-home primary care to patients . A provider can spot mental health issues or review medications for safety during pregnancy, she said.
But only a handful of appointments need to be in a doctor’s office setting, said Gee, who oversaw LDH as secretary of health from 2016 to 2020. Many patients could be seen at home or virtually. Nest is launching in Arizona and plans to include prenatal appointments in that state, but has found it challenging to partner with health plans to do the same in Louisiana.
Gee said a bigger issue is that pregnancy is often treated as separate from women’s overall health. But to support a healthy pregnancy, care needs to start before conception and continue during and after birth. Many women start prenatal care late, don’t receive postpartum care and lack regular care between pregnancies, she said.
“Pregnancy is a stress test on women’s health, and we are failing that stress test,” Gee said. A lack of care sets up moms and babies for poor health outcomes, impacting their entire lives. “Doing whatever you can to make those networks more robust is important, because this really is a long-term game,” said Magee.
.
