How Aetna Medicaid outpaces the nation on maternal care for Florida's most vulnerable

In less than two years, Aetna's Medicaid program in Florida has outpaced the national average for NICU births through a partnership with ProgenyHealth, a case management platform serving mothers and their newborn children.

When Jennifer Sweet took over as CEO of Aetna Better Health Florida in 2020, the health plan was already hitting the national average for NICU births, but costs were continuing to climb every year. 

"We were questioning why we didn't have a better member contact rate, so we started to scratch the surface," she told Becker's. "We found that we really didn't have a line of sight into whether the families of a NICU baby were receiving the health literacy assistance that you need to manage a complex medical situation."

In 2022, Aetna partnered with ProgenyHealth on comprehensive NICU services for any pregnant member and their family unit. Each family receives a case manager who works with them to develop a custom care plan that helps to address specific social determinants of health, including food, clothing, shelter or educational resources.

After 17 months of working with Progeny, Aetna's Florida Medicaid plan is now 2 percent below the national average for NICU births and is trending downward faster than industry peers. The program has discharged 644 NICU cases, and there have been 370 referrals to a resource addressing a social determinant. The largest category was educational resources, including 77 lactation consults.

"Make sure that you're aligned with the values of your vendor and remember that we're hired to manage risk," Ms. Sweet said. "There's no secret sauce, it's really just doing it well and committing to doing it well."

Aetna Medicaid members can either self-refer to the program or are contacted by the health plan or their provider. The program has a contact success rate of 65 percent, with 84 percent of those members enrolling.

"On the side, we were building our own social impact infrastructure, and the Progeny partnership was a way to supplement those existing resources," Ms. Sweet said. Aetna's internal work includes prenatal provider incentives, fatherhood engagement programs and the use of doulas.

Following the success of the NICU initiative, Aetna added a maternity care management program through Progeny, which started Aug. 1. The Florida Medicaid plan has more than 240,000 members and the NICU and maternal care benefits are now available to all.

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