From 3M Health Information Systems
Three questions with Megan Carr: Maternal health and other payer trends to watch out for this year
I sat down with the 3M Health Information Systems Vice President of Regulatory and Payer Solutions Megan Carr to reflect on health care trends and how having access to data can positively impact maternal outcomes.
Maternal health has long been a crisis, but has recently received some high profile media coverage. What can health care organizations do to make efforts more effective?
Maternal and infant health is a critical and complex health care crisis in the U.S. that we must address. The Centers for Disease Control and Prevention (CDC) recently reported that more than 1,200 women in the U.S. die due to maternal causes in 2021 and that the rates of maternal deaths have continued to increase from 2018-2021. Just as troubling, though, is the fact that the CDC also reports that 80 percent of those deaths were preventable. As we work to tackle this problem, data is vital for identifying high risk individuals as well as evaluating provider and system quality of care performance. Noting that Black and Native American women are experiencing significantly higher rates of maternal mortality, regardless of education, income and other factors, we also need to use data to uncover contributing factors, such as health inequities and other social determinants of health (SDoH).
Of course, we believe in risk adjusting to compare medically alike patients to better highlight where care provision or outcomes differ – so then we can study them, learn about them and address them. Clinical and performance data can come together to help health systems surface best practices, such as, which patients’ providers should focus specific care management efforts or proactively intervene to improve patient outcomes. Understanding the patient, their risk factors and the quality of the care they receive at this really important time in their lives is central to improving maternal and infant health.
What other trends you are seeing in 2023 as it relates to regulatory and payers?
Equity and quality are priorities across the board – for all patients. For us at 3M, understanding value and quality is something that we build our products around and are helping payers and providers gauge their performance against. Right now, equity, value and quality are key focus areas payers and providers alike are trying to do more about both for the patient and efficiency of the system. We definitely see our state and commercial payer clients focusing on value-based care and value-based payments and moving the needle on better outcomes and lower costs. Value-based care can mean anything these days, but we have to focus on the core intent, which is to improve patient health and outcomes and reduce costs. That is what value truly means. You can see payers really leaning more and more into that core meaning.
On the state regulatory side, state health care and Medicaid leaders have a lot on their plates. Of note, they are actively working through Medicaid redetermination and the significant effort it takes to review eligibility for enrollees who have been on Medicaid since the beginning of COVID-19. As part of that, people will roll off Medicaid coverage if they don’t respond to the state’s request for them to refile and some states are working to understand the health status or disease burden of these outstanding patients to prioritize outreach efforts. Risk adjusting these outstanding patients at the clinical level is one way to help with those prioritization initiatives.
Another is proposed rule recently issued by the Centers for Medicare & Medicaid Services (CMS) that looks at Medicaid transparency and quality, including state directed payments. If the proposed changes are implemented, ways in which states deploy the state directed payments could change, including the need to tie them to utilization and delivery of services as well as be used to advance at least one of the states managed care quality goals. States could respond to these potential new requirements by establishing uniform hospital rate programs, such as with 3M APR-DRGs or EAPGs. In addition, 3M quality tools, many of which are interconnected to 3M APR-DRG and 3M EAPGs, offer a natural tie-in to quality for the states.
What has you excited to get up and go to work in the mornings?
There are so many exciting things happening in my 3M HIS world right now. To be a part of the effort to improve value-based care continues to be a huge priority. We’ve always been focused on creating solutions that support value-based care. Take Medicaid redetermination, as I mentioned. If the states want to identify the most vulnerable patient and help them re-enroll in Medicaid coverage, our 3M™ Clinical Risk Groups (CRGs) methodology can be a tremendous help by identifying the health status and burden of illness of individuals in an identified population. We have other payment methodologies that can help make sure that state directed payments are tied to value, by providing appropriate classifications for the resources and reasons used according to patients’ admission and clinical characteristics.
In addition, it is always exciting to talk about the new solutions from 3M HIS. Especially one that is so aligned with the growth trend right now with the majority of procedures taking place in ambulatory settings. Our new 3M™ Ambulatory Potentially Preventable Complications (3M AM-PPCs) methodology was created to help hospitals and payers improve ambulatory outcomes and reduce costs with generated actionable insights. And it is so exciting that U.S. News & World Report will be using these tools as well.
Another new methodology that I care deeply about is our 3M™ Severe Maternal Morbidity solution. We already talked about the growing need for effective solutions for maternal care, and we wanted to give commercial payers and state governments a solution to help contain this ongoing crisis and move the needle. This integrated solution can help organization identify and trend risk-adjusted maternal outcomes.
I am really grateful to be a part of a company that can deal with such diverse issues and still play an important and vital role in being helpful to achieve the right goals. No matter what the trend is we always seem to have something that can align to help create a solution.
Sara Brown is a marketing communications specialist at 3M Health Information Systems.
Megan Carr is the head of the regulatory and payer solutions team at 3M Health Information Systems.