Mississippi’s maternity program is extremely insufficient

Since January 2011, the state of Mississippi has contracted a NY based company, ActiveHealthⓇ Management, a former subsidiary of Aetna and currently owned by CVS Health. 

ActiveHealth Management purportedly provides comprehensive health and wellness management services to the State and School Employees Health Insurance Plan to improve health among more than 197,000 active employees, dependents, spouses and retirees.  

The company has received four consecutive contracts valued at a nearly $64,000,000. Yet, it has not produced one evaluation report on its efficacy because the Department of Finance Administration does not require it to assess employees’ health outcomes.

According to Cindy Bradshaw, former State Insurance Administrator, DFA administers patient satisfaction surveys about their experiences within the ActiveHealth Management program. Patient satisfaction surveys are designed to determine how a person feels about or perceives her/his experience with something or someone; it does not determine whether the experience was effective and to what degree.

This is particularly concerning for pregnant state employees who are at risk for pre-term births and Cesarean deliveries, the No. 1 surgery in the state of MS and the nation.

Annually, Mississippi pays for over 90% of prenatal care and births in the state through Mississippi Medicaid and Blue Cross Blue Shield of Mississippi plans. In 2022, members in both plans experienced comparable Cesarean delivery rates. About 39% of BCBS of MS members experienced a Cesarean delivery and 37% Medicaid members, according to data from the Mississippi State Department of Health. Also, 20% of BCBS members and 21% of Medicaid members, whose labor was induced, subsequently delivered via a Cesarean. The State paid an estimated average of $27.4 million for Medicaid-members and $30.6 million for BCBS-members who had Cesarean deliveries.

Furthermore, those members who had a first-time Cesarean delivery have a 90% probability of experiencing a repeat procedure because only a handful of providers in Mississippi will attempt to deliver a vaginal birth after a Cesarean delivery. 

Liz Welch, DFA’s executive director, said she wasn’t aware of the birth outcomes of state employees and would request a report from BCBS of MS, the state’s plan administrator. I am almost certain she did not.

Since 2019, I have administered a community health worker program that provides preventive based services to pregnant residents, including state employees. I have found ActiveHealth Management’s maternity program to be extremely insufficient and ineffective as it does not address the complex underlying risk factors influencing common negative birth outcomes in Mississippi. 

Underlying preventable risk factors affecting most pregnant women in Mississippi are maternal obesity and smoking that can lead to gestational hypertension, preeclampsia, gestational diabetes, Cesarean deliveries, preterm babies, low birth weight babies, NICU babies, and maternal and infant mortality. Annually Mississippi residents experience the highest rates of maternal obesity (37.6%), fetal deaths (9.5), Cesarean deliveries (39%), preterm births (15), low birth weight (13), maternal mortality (43) and infant mortality (9.2) in the nation. 

ActiveHealth Management’s maternity intervention involves nurses making three phone calls to  pregnant state employees and one call after the baby is born. 

The nurse asks a list of general questions such as, “how’s your overall health,” “how’s your pregnancy going so far,” “any medical concerns,” “are you taking prenatal vitamins,” “what you know about pre-eclampsia,” etc. 

There is no face-to-face engagement between the employee and nurse, including no home visits and no birth support. The nurse doesn’t assist the employee with developing a prenatal dietary and exercise plan, a birth plan, healthy birth practices to prevent medically unnecessary labor inductions, and Cesarean deliveries.  She does not provide crucial childbirth education and breastfeeding and postpartum support, which is needed in the home.

Providing exclusive phone support during pregnancy has been shown to reduce risk for depression, but it does not improve risky health behaviors, e.g. smoking, sedentary, unhealthy foods or birth outcomes. Data show that neither phone nor short message support are effective at reducing prenatal smoking, improving prenatal body mass index, reducing preterm births, and Cesarean deliveries.

In contrast, there is considerable evidence showing that community health worker programs, which provide in-personal maternal health education and birth assistance, are significantly effective at changing risky behaviors and improving healthcare decisions that lead to better prenatal health and birth outcomes.

Community health workers can provide a supportive social network, motivate and drive pregnant patients at risk to make healthy lifestyle changes that reduce maternal obesity, stress and anxiety and improve physical health, which subsequently reduces maternal morbidities associated with pre-eclampsia, preterm births, and Cesarean deliveries.

In 2021, I initiated a dialogue with ActiveHealth Management’s medical leadership about enhancing its program through the integration of community health workers.  My suggestion was met with resentment and rejection. They stated they would do no more than their contract requires.

The State will issue a new RFP in 2025 and likely renew ActiveHealth Management’s contract.  It should seriously consider reducing the value of the contract and redirecting a substantial amount of funding to the Mississippi Department of Health’s Community Health Worker Program.

The MS Department of Health could train, certify, and strategically deploy community health workers across the State to deliver evidence based, maternity services, which would be more feasible and effective than ActiveHealth Management’s telephonic/virtual program.

— Getty Israel, MPH, is a population health specialist in the Jackson area.