Molina Healthcare of OhioFighting Infant Mortality in Ohio

Dr. Martin Portillo, MD FACPVice President and Chief Medical Officer

Wednesday, March 12, 2014

Molina Healthcare of Ohio

• Molina Healthcare began serving Ohio’s Covered Families and Children Medicaid population in 2005, and Aged, Blind or Disabled members in 2007.

• In 2008, Molina Healthcare was awarded a contract from the Centers for Medicare and Medicaid Services (CMS) to serve the Medicare population.

• In July 2013, Molina began offering Medicaid services statewide and for Children with Special Health Care Needs.

• Molina began serving members through the Health Insurance Marketplace on Jan. 1, 2014.

• On Jan. 1, 2014, the Ohio Department of Medicaid expanded to serve childless adults and parents up to 138% FPL through Adult Extension.

• Molina Healthcare will provide services for beneficiaries who are eligible for both Medicaid and Medicare in May 2014 as part of MyCare Ohio.

Membership: 262,000*Employees: 512Provider Network:• 16,793 network primary care and specialist providers• 189 hospitals• All six of Ohio’s children’s hospitals• Network includes providers statewide

*As of Sept. 30, 2013

Medicaid Statewide

Medicaid, Medicare, MyCare Ohio (May 2014)

Medicaid, Medicare

Serving since 2005

Medicaid, Marketplace

Medicaid, Medicare, Marketplace, MyCare Ohio (May 2014)

Infant Mortality in Ohio In 2010 infants less than one month old accounted for 69% of all infant deaths and

46% of all deaths.

Prematurity was the most frequent cause of infant deaths, accounting for 49%.

Congenital anomalies accounted for 13% of all infant deaths.

Where gestational age was known, 70% of the infants were born preterm (before 37 weeks gestation).

Sleep-related deaths (including sudden infant death syndrome or SIDS) accounted for 14% of infant deaths in 2010, more than any single cause of death except prematurity. Forty-six percent of sleep-related deaths were to black infants, which is disproportionate to their representation in the Ohio child population (17%).

Sixty-two percent of the sleep related deaths occurred in locations considered unsafe such as in adult beds and on couches. Fifty-five percent occurred to infants who were sharing a sleeping surface (bedsharing) with someone else at the time of death.

SIDS accounted for 3% of infant deaths. At least 54% of SIDS victims were exposed to smoke in utero.

3Source: Ohio Child Fatality Review Twelfth Annual Report

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Reducing Infant Mortality in Ohio

What Works… Reducing unintended pregnancy

Promoting the health of women

Improving access to prenatal and postpartum care

Improving the safety and quality of obstetric and neonatal care

Prevention Strategies Family Planning

Smoking Cessation

SIDS/SUID Prevention

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Maryland Experience: Access to Early Prenatal Care Quick Start services in local health departments

Expanding prenatal care services in underserved areas

Medicaid Accelerated Certification of Eligibility

Perinatal Navigators

Possible impact of changes among high risk groups 2008-2010

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Preterm Birth Women with a history of a spontaneous pre-term delivery are at increased risk of

pre-term birth in a current pregnancy. Of the approximately 400,000 pre-term births annually in the United States,

about 50,000 occur in women with a previous pre-term delivery.

Known Risk Factors for Preterm Birth

History of preterm birth Unintended pregnancy Previous fetal or neonatal death 3+ spontaneous losses Assisted reproductive technology

(ART) Genetic predisposition Folic acid deficiency

Environmental toxins Low pre-pregnancy weight Obesity Anemia Lack of social support Tobacco use Alcohol abuse Illicit drug use

Epidemiologic

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Molina Efforts to Reduce Pre-Term birth and Infant Mortality

17-P Project – Progesterone Therapy

Motherhood MattersSM

Smoking Cessation Efforts

Quality Interventions

Community Outreach and Engagement

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Ensure early identification of pregnancies – develop strategies. Implement Risk Screening program to assist in early identification of 17-P

candidates and triage to Case Management. > Increase screening rate of pregnant members – suggested goal 100%

within 5 business days of plan notification. Implement Molina Medical Coverage Guidance – progesterone therapy Educate Molina Staff – Provide guidelines, tools and easy access to

medication therapy. Train and educate clinical staff in identification and management of high

risk pregnancies . Educate the obstetrician and Maternal-Fetal Medicine (MFM)community

about Molina’s 17-P program and encourage utilization of program. Partner with specialty providers to assist in the delivery of high quality

healthcare .

Molina 17-P Project17 Alpha Hydroxyprogesterone

“Recent studies support the hypothesis that progesterone supplementation reduces preterm birth in a select group of women (i.e, those with a prior spontaneous birth at <37 weeks of gestation).”

*Meis P for the Society for Maternal–Fetal Medicine; 17 Hydroxyprogesterone for the Prevention of Preterm Delivery. Obstet Gynecol 2005;105:1128 –35.

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May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13Live Births 707 697 751 776 743 760 706 681 649 541 544 318VLBW 22 21 13 20 13 15 17 7 10 9 5 1VLBW Ratio 3.11% 3.01% 1.73% 2.58% 1.75% 1.97% 2.41% 1.03% 1.54% 1.66% 0.92% 0.31%Average 1.84% 1.84% 1.84% 1.84% 1.84% 1.84% 1.84% 1.84% 1.84% 1.84% 1.84% 1.84%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13

% V

LBW

Month/Year

Prematurity/VLBW: MHO Health Plan VLBW RatioAverage

Impact of Molina’s 17-P ProgramThe ratio of Very Low Birth Weights (VLBW) decreased from 3.11% in May of 2012 to

0.31% in April of 2013

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How Motherhood MattersSM work for Molina members: Earn up to $205 in rewards for keeping prenatal, postpartum and baby checkup

appointments. $25 Reward: For the first prenatal visit during the first three months of

pregnancy $50 Reward: For 10 visits during the second and third trimester $25 Reward: For a postpartum visit three to eight weeks after the delivery $105 Reward: For keeping the baby’s well care appointments

Motherhood MattersSM

Motherhood MattersSM - A mothers-to-be program that supports members throughout their pregnancies. To promote timely prenatal, postpartum and well infant care, members receive educational pregnancy material and are eligible for rewards for receiving recommended services.

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It is estimated that 13-22% of women smoke during pregnancy – a risk factor for pre-term delivery. Risks associated with smoking in pregnancy:

Molina Smoking Cessation Intervention – Free and Clear® Free and Clear® is a smoking cessation program from Molina Healthcare. Participants in Free and Clear® receive free one-on-one counseling, educational materials,

and a toll-free quit line to call at any time for support.

Molina promotes the March of Dimes’ “5 A’s” Approach to Smoking Cessation: The 5 A’s are:

Ask about tobacco use Advise to quit Assess willingness to make a quit attempt Assist in quit attempt Arrange follow-up

Smoking Cessation

Preterm Birth Low Birth Rate Premature Rupture of Membranes (PROM) Perinatal Mortality

Intrauterine growth restriction (IUGR) Placenta previa Abruptio placentae Sudden infant death syndrome (SIDS)

Additional Molina Quality Interventions

Newly Enrolled and Newly Identified Pregnant Member Incentive: To promote timelyprenatal visits and early detection of high-risk pregnancies, newly enrolled or identifiedpregnant members receive a call and postcard encouraging a prenatal appointment.Assistance in scheduling an appointment is offered. If the visit is completed within 30days of enrollment, the member receives a gift card.

Pregnancy Care Connection: To promote timely prenatal care and early detection ofhigh-risk pregnancies, Molina Healthcare has partnered with Pregnancy CareConnection to contact hard-to-reach members to schedule prenatal visits. The memberreceives a gift card if the visit was completed within 30 days of enrollment.

Mount Carmel Obstetrics Provider Incentive: To improve rates of recommendedprenatal and postpartum care, obstetric groups receive bonus payments for meetingHEDIS® rate goals for prenatal and postpartum care.

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Additional Molina Quality InterventionsPassport to Perks – Well Child Exams: To improve the utilization of recommended preventive health services, members receive a gift card for receiving the following services:

Well Child Exams (0-15 months) Well Child Exams (3-6 years) Adolescent Well Exams (12-21 years)

Ronald McDonald Care Mobile: Molina has partnered with Nationwide Children’s Ronald McDonald Care Mobile, making it easier for our members to have healthier kids by bringing checkups, immunizations, tests and doctors closer to their home. This is a small, targeted mailing to members who have missed preventive care services (0-21 years). Based on their zip code, members will be mailed the appropriate event letter.

Lead Screening Education: Molina educates members about the dangers of leadpoisoning through our Be your Best: Lead Poising in Children brochure. Through thebrochure we inform members that pregnant women exposed to lead can pass it to herunborn baby. Lead also can be passed to a baby through the mother’s breast milk. Thebrochure also provides guidelines for lead poisoning testing for kids.

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Initiatives to Partner with Communities to Improve Maternal and Infant Health

Community Partnerships:

Molina contracts with the Council on Healthy Mothers and Babies to reach pregnant members in an effort to get them in to see a physician in the first 30 days of pregnancy.

In 2013, Molina partnered with Glimcher Properties to sponsor three shopping mall Baby and Toddler Expos in Montgomery, Fairfield and Licking counties.

In 2013, Molina participated in six community-wide baby fairs/showers and donated refreshments, door prizes and/or sponsorship dollars.

Molina works with WIC, Help Me Grow and Head Start in target counties to provide them with Molina benefits information, Motherhood Matters program literature and appropriate health information.

Throughout 2013, Molina Community Outreach distributed resource bags to WIC offices and at various community events, with the following contents: Be Your Best Prenatal Care brochure, Motherhood MattersSM brochure, childproofing your home tips, ODJFS EPSDT/Healthcheck information, Be Your Best Immunizations and also included baby lotion, baby wipes and/or forehead thermometers.

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Thank You!

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Dr. Martin Portillo, VP, Medical Affairs and CMO614-212-6481

Martin.Portillo@MolinaHealthCare.com