A Baltimore HMO is paying some of its patients to take care of themselves.
As part of a new prenatal health program, the Johns Hopkins Health Plan is giving $10 vouchers to expectant mothers, covered under the state's medical assistance plan, for having regular checkups and attending health-education classes.
The voucher system, which will be extended to pregnant women who also attend smoking cessation or drug-detoxification programs, is the "incentive" part of Better Beginnings, a prenatal health and education program started by the health maintenance organization Nov. 1.
Better Beginnings is open to all HMO members enrolled at the plan's four city offices, but only medical assistance patients are "being offered that incentive to attend their appointments," says Karen Brodsky, program coordinator.
The four centers serve about 650 pregnant women a year. About half of them are Medical Assistance patients, she says.
And many of these patients are teen-agers, whose age, education, eating habits and home situations put them at risk of having small and premature babies. Better Beginnings is intended to eliminate some of these problems.
Here's how the program works:
When a woman is scheduled for a regular prenatal checkup (once a month through most of the pregnancy but more frequently in the eighth and ninth months), she also will be scheduled to attend a health-education class. If she has the checkup and attends the class, she will get a $10 voucher that she can cash at the health center. She will get a voucher each time she comes to a checkup and class.
Each patient could have as many as 15 appointments, Brodsky says, although she assumes the average will be closer to 10.
The classes will stress health and nutrition, says Brodsky. As her pregnancy progresses, each woman will visit a pediatrician to learn about child care and be offered childbirth education classes. She also will see a social worker once -- more frequently if necessary -- during her pregnancy.
In addition to the regular checkups, smokers who are referred to, and attend, smoking-cessation clinics will be given $10 for each class they attend. And women with drug- or alcohol-abuse problems who complete detoxification classes will be given an additional $10 each time their drug screening is "clean," Brodsky says.
Brodsky would not say how much money is budgeted for the incentive program. At an average of $100 per patient ($10 a visit for 10 visits), plus more for smokers and drug and alcohol abusers, the program would cost at least $30,000 to $35,000 annually.
"The cost of the incentive program will be much less than the cost of [caring for] a baby if it were born with serious health problems," Brodsky says. If a woman receives $150 from the incentive program over the course of her pregnancy, "the money will help her and will help her baby."
Caring for an infant with acute health problems can easily cost $50,000, Brodsky says. If predictable problems can be avoided in only one baby, "the whole program will be worth it," she adds.
There will be some savings, too, in normal deliveries, Brodsky says. As part of Better Beginnings, mothers who have uncomplicated, vaginal deliveries and healthy babies will be able to leave the hospital within 24 hours rather than 48 hours, which is now the norm for most mothers.
Some women already leave the hospital in one day, and Better Beginnings is hoping to increase that number by 20 percent.
Through the program, a home health care worker will visit the woman and her baby the day after they return home from the hospital to be sure they are progressing and will make an appointment for the mother's six-week post-partum checkup. "The home-health visit could be repeated, if necessary," Brodsky says.
HMO officials are hopeful that a woman who has had good health care during her pregnancy would be encouraged to continue it for herself and her child.
"We really think it will make a difference," she says.