High-Risk Pregnancy

To promote the health of women with a high-risk pregnancy, AultCare offers a successful High-Risk Pregnancy program. The program promotes a robust identification practice, a concentrated engagement process, and measurable outcomes.

Process and Intervention

AultCare’s High-Risk Pregnancy Program consists of four components: early identification, member assessment, risk stratification through the removal of barriers and identification of intended outcomes, and high-risk maternity solutions.

Identification AultCare’s objective is to identify high-risk pregnancies as early as possible. One way to achieve this is by reviewing claims data. Other factors contributing to this identification process include:  Individual predictive modeling  Increased communication with Obstetrics and Gynecology (OB-GYN) practices  Implementation of an assessment for those high-risk pregnancies

Member Assessment The AultCare Case Management and Disease Management teams work alongside the member to complete an assessment of the mother’s current health and needs, and the future needs of the baby.  Age  Medical risk  Mental health  Substance abuse  Past birth history  History of Spontaneous Abortion (SAB)/Therapeutic Abortion (TAB)

High-Risk Pregnancy

Removal of Barriers and Identify Intended Outcomes Members are placed in a specific risk stratification class based on their level of risk and specific healthcare professional needs. 1) Low Risk a. Members are advised to complete routine prenatal care. 2) Mild Risk a. A chronic disease state has been identified (i.e., high blood pressure, high blood sugar). b. Members will require more hands-on care and follow-up from AultCare’s clinical team. 3) High Risk a. AultCare’s clinical team coordinates appointments to pediatric specialists and specific testing. b. Care coordination encompasses Durable Medical Equipment (DME), medications, testing, usage of network providers, and benefit utilization. c. Referral management for cost effective usage of resources. d. Self-management education, risk factors, diet, signs of preterm labor and other complications, maternal health during and after pregnancy, as well as childcare.

Engagement Incentive To encourage impacted members to participate, AultCare offers an incentive upon successful completion of specific levels of care based on their individual needs.  Completion of prenatal care.  Participation in appropriate identified risk level interventions.  Completion of postpartum care.

Outcomes

Through the course of this program, AultCare focuses on these goals.  The successful delivery of a healthy newborn and the health of the mother.  Help lower PMPM costs.