Pregnant women with opioid addiction often face obstacles in managing their treatment, including finding a doctor and battling with insurance paperwork. At a vulnerable time, they often stumble and relapse because of these problems.
While treatment for the disease is relatively straightforward, the communication between insurers and providers can be riddled with clerical errors and prone to delays.
To solve the problem, a group of medical providers and health insurance companies in Indiana started a partnership called MOMentum, a collaboration among three insurance entities, (networks called managed health care plans) and nine community mental health clinics around the state. MOMentum has developed a streamlined system for handling these at-risk pregnant womens’ care — and to ensure the health and safety of both mother and baby.
Side Effects reporter Emily Forman spoke with one leader of MOMentum, Megan Fisher, Director of Addiction Recovery services at the Bowen Center, a community mental health center in Fort Wayne.
Emily Forman: What is MOMentum?
Megan Fisher: So MOMentum is a collaboration between ... the community mental health centers and the ...managed care entities, and the whole goal behind it was to get some momentum going behind the collaboration of the insurance companies and the treatment providers to make sure that the pregnant women are a priority.
EF: What is the motivation to give pregnant women special help?
MF: We recognized that there's an epidemic and we need to do something about it.
You're looking at a huge population of people suffering and we don't have enough resources to handle all of it, but you have to make a crack somewhere. It's easier to hone in on something — like the pregnant client population — and make them a priority and figure out what it is we need to do than to say to the state as a whole, ‘OK we have to fix this epidemic.’
It feels overwhelming. And it’s hard for people to not be champions for a pregnant woman in need.
EF: How does MOMentum prioritize pregnant women? You’ve mentioned that quick access is one way.
MF: And the other benefit...is very good communication and collaboration between us and the insurance company for all those case management needs. So now the insurance company is aware they're in addiction treatment, but they're pregnant. So they need to make sure they're hooking up with their obstetrician, with their primary care provider, with any other needs that they might have in a medical or mental health arena.
So the insurance company acts as sort of that point of contact to make sure there's no barriers on that side of it: to them getting all the care that they need for themselves and the baby post-pregnancy.
EF: So it seems like the biggest hurdle related to medication-assisted treatment is that insurance companies require time-consuming prior authorizations. How does MOMentum handle this situation?
MF: We still have to get it authorized, but it eases the process. It's an understanding on both sides that this is a priority client. Because of the pregnant woman being so high-risk, we've agreed that we're going to do that, we're going to ease the process for them.
We just have to send a referral to the [insurer] to make sure they know this is somebody who's been identified as a MOMentum client, and then that starts the conversations going back and forth so they approve the referral. We initiate services and we start wrapping around with all that case management and everything. So the process isn't very different. It's just the communication is heightened and the data tracking is heightened.
And maybe it will help inform how we can break down some of those barriers with insurance companies across the board in the future, you know? So that's another component: that we can kind of educate the insurance world [to] look at everything that standing in the way of people getting help. How can we fix the system?
EF: You’ve said that getting pregnant women on medication-assisted treatment, or MAT, reduces neonatal abstinence syndrome, (babies going through withdrawals after birth). How has MOMentum helped with this?
MF: ...Before medication-assisted treatment services, pregnant women were giving birth to babies that were spending two weeks in a [neonatal intensive care unit] in a hospital, which is extraordinarily expensive and very dangerous for the baby ... we're talking about hundreds of thousands of dollars of hospital bills for women that can't afford those kinds of bills.
Well, if we introduce MAT medications during pregnancy, we're showing these women are giving birth with zero days in the NICU. They're having a traditional hospital stays of, you know, 48 hours, 72 hours, and then moms going home with a baby who's perfectly healthy. And I think, just at the Bowen Center, since we've started we have gone over $1 billion in hospital charges saved.
This story was produced by Side Effects Public Media, a reporting collaborative focused on public health.