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Case Study

Reward program improves outcomes and reduces costs by $128 PMPM​​

By April 29, 2021July 19th, 2021No Comments

Analysis shows better outcomes and 3:1 ROI on incentivized Medicaid program

Babies born to mothers who do not receive prenatal care are three times more likely to have a low birth weight and five times more likely to die than the infants of mothers who do get care. On average, 11 percent of infants born to mothers insured by Medicaid were preterm and about 10 percent had low birthweight. More than half of these mothers are overweight or obese and nearly 15 percent smoked cigarettes before becoming pregnant, increasing the likelihood of poor maternal outcomes. 

That’s one of the primary reasons Medicaid insurers create programs to encourage mothers to receive prenatal care. Another is quality measures such as the timeliness of prenatal care and the number of live births typically are monitored by government regulators, and plan performance influences whether a Medicaid contract is renewed. Maternity care management programs incentivize enrolled members to complete recommended prenatal, postpartum and well-baby visits. Members who achieve the program requirements receive gift cards or baby equipment such as strollers. ​​

A national health plan chose Softheon Technologies to independently evaluate the performance of its incentivized Medicaid maternity care management program.​​​​