Patient Grouping as a Driver of Value in Health- Case Study: Severe Maternal Morbidity (SMM)

Catherine Stemper ^a, Catherine Brett ^b

Introduction
Mississippi, with one of the United States' highest maternal mortality rates, is taking proactive steps to manage its Medicaid maternal population. Recognizing that generalized geographic data often overlooks critical insights, the state is implementing targeted strategies to provide high quality perinatal care. Despite significant investments in technology and maternal health services, Mississippi's persistently high maternal mortality rate underscores the need for a deeper understanding of maternal morbidities and associated risk factors.

Methods
The cross-functional team, guided by the Mississippi Department of Medicaid, focused efforts to pinpoint SMM population cohorts using patient classification methodologies, exploring the development of predictive case management techniques, managed care performance metrics, and incentive strategies aimed at fostering high quality results. SMM population cohort research also explored social, racial, lifestyle, and geographic factors contributing to maternal health outcomes.

Results
This research has led to the development of innovative initiatives, including a risk score tool to assess postpartum risk of severe morbidity and mortality for statewide implementation. This tool, informed by observed outcome measures and delivery trends within Mississippi's Medicaid-financed population, aims to identify perinatal beneficiaries at risk of experiencing severe maternal morbidity (SMM) events. With Medicaid responsible for 57% of deliveries (Births Financed by Medicaid | KFF) in Mississippi, such proactive measures are crucial in combating maternal mortality and improving maternal health outcomes.

Discussion/Conclusions

1. Approaches in integrating clinical expertise with preventable morbidity outcome measures to identify cohorts of perinatal women at risk of complications.
2. Lessons learned in developing risk profiles and establishing evidence-based protocols for post-partum care.
3. Considerations for implementing strategies to advance managed care plan accountability metrics for maternal morbidity.
4. Evaluating actionable performance metrics for hospitals and providers

^a Solventum, United States
^b Mississippi Division of Medicaid, United States

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