Using lean process improvement to develop a perinatal system of care for Medicaid insured pregnant women

Background: Medicaid reimburses for care coordination, through enhanced prenatal services (EPS), for Medicaid insured pregnant women in Michigan; yet only 30% of women receive services. A Lean process improvement strategy, commonly used in health systems, is an innovative approach being used in an AHRQ research project to address underutilization of care coordination and the development of a perinatal system of care. Objectives: 1) Demonstrate the use of Lean strategies (e.g. A3 planning, process mapping) used to initiate a system of care for Medicaid insured women; 2) Describe county level metrics supporting the need for process improvement. Methods: Stakeholders from state/local health departments, prenatal care, EPS, and health plans were engaged in the process. A leadership team completed A3 documents; a mapping team described a woman's current journey from Medicaid enrollment to the postpartum visit and planned an improved future system of care. Health data, interviews, and a survey were used to define the need and support root causes. Results: Lean maps depicted the complexity of care and identified opportunities to streamline the process. Recommendations for redesign included strategies for early engagement, integration of EPS care coordination and prenatal care, mental health coordination, transitions post-birth to primary care, and use of health technology to create a “virtual team”. County level (50% postpartum visit; 39% ED claims) and EPS program (29% first trimester enrollment) data supported the system change and recommendations. Conclusions: Lean strategies were effective in creating a common platform for multiple stakeholders to improve a community system of care together.