Table 2.
Rates of Utilization of Care During Preconception, Pregnancy and Post-Delivery, Stratified by Medicaid and Commercial Health Insurance Plans
| Utilization in each time period | Complicated pregnancy | Comparison pregnancy | |||
|---|---|---|---|---|---|
| GDM | DM | HDP | Total | Total | |
| Medicaid health insurance | N = 2,367 | N = 344 | N = 4,690 | N = 6,671 | N = 20,658 |
| Utilization of post-delivery care, % | |||||
| Postpartum obstetric visit | 67.4 % | 65.1 % | 63.8 % | 65.0 % | 61.5 % |
| Emergency room visit in 3 months post-delivery | 12.2 % | 16.9 % | 14.2 % | 13.6 % | 11.7 % |
| Glucose testing* in 3 months post-delivery | 5.7 % | 14.8 % | 2.1 % | 3.3 % | 0.5 % |
| Insurance coverage ≥ 6 months after delivery, % | 47.4 % | 66.9 % | 57.0 % | 54.2 % | 49.7 % |
| Primary care visit in 12 months post-delivery | 55.0 % | 69.6 % | 57.0 % | 56.6 % | 51.7 % |
| Emergency room visit in 12 months post-delivery | 44.6 % | 57.8 % | 50.3 % | 49.1 % | 45.8 % |
| Glucose testing* in 12 months post-delivery | 15.2 % | 49.1 % | 8.7 % | 11.1 % | 3.5 % |
| Insulin† in 12 months after delivery | 1.2 % | 26.7 % | 1.3 % | 1.8 % | 0.0 % |
| Oral diabetes medication† in 12 months post-delivery | 1.0 % | 13.1 % | 0.9 % | 1.1 % | 0.0 % |
| Antihypertensive medication† in 12 months post-delivery | 3.9 % | 14.5 % | 9.8 % | 7.1 % | 0.4 % |
| Utilization of pregnancy and preconception care, % | |||||
| Receipt of early‡ prenatal care | 37.7 % | 51.9 % | 36.4 % | 37.5 % | 34.2 % |
| Emergency room visit | 15.9 % | 28.4 % | 20.0 % | 19.2 % | 17.5 % |
| Insurance coverage ≥ 3 months before delivery§, % | 22.1 % | 44.2 % | 33.6 % | 30.3 % | 27.5 % |
| Primary care visit | 30.8 % | 42.8 % | 32.6 % | 32.5 % | 29.1 % |
| Obstetrician/gynecology visit | 26.8 % | 22.4 % | 20.4 % | 22.3 % | 16.9 % |
| Emergency room visit | 40.0 % | 51.3 % | 37.8 % | 38.8 % | 35.4 % |
| Commercial health insurance | N = 499 | N = 78 | N = 637 | N = 1070 | N = 2941 |
| Utilization of post-delivery care, % | |||||
| Postpartum obstetric visit | 48.7 % | 56.4 % | 52.6 % | 50.7 % | 44.6 % |
| Emergency room visit in 3 months post-delivery | 4.6 % | 10.3 % | 6.0 % | 5.5 % | 3.8 % |
| Glucose testing* in 3 months post-delivery | 11.4 % | 26.9 % | 4.7 % | 8.2 % | 0.5 % |
| Insurance coverage ≥ 6 months after delivery, % | 91.2 % | 88.5 % | 88.7 % | 88.4 % | 89.8 % |
| Primary care visit in 12 months post-delivery | 57.4 % | 68.1 % | 63.9 % | 60.0 % | 49.5 % |
| Emergency room visit in 12 months post-delivery | 16.0 % | 30.4 % | 22.8 % | 20.3 % | 12.5 % |
| Glucose testing* in 12 months post-delivery | 20.9 % | 53.6 % | 11.1 % | 16.3 % | 2.7 % |
| Insulin† in 12 months post-delivery | 1.0 % | 23.1 % | 1.9 % | 2.1 % | 0.0 % |
| Oral diabetes medication† in 12 months post-delivery | 0.6 % | 14.1 % | 1.6 % | 1.3 % | 0.0 % |
| Antihypertensive medication† in 12 months post-delivery | 4.4 % | 16.7 % | 17.1 % | 10.6 % | 0.9 % |
| Utilization of pregnancy and preconception care, % | |||||
| Receipt of early‡ prenatal care | 71.1 % | 77.9 % | 67.2 % | 69.5 % | 66.3 % |
| Emergency room visit | 9.4 % | 14.3 % | 11.8 % | 10.6 % | 8.2 % |
| Insurance coverage ≥ 3 months before delivery§, % | 85.6 % | 92.3 % | 85.2 % | 85.8 % | 81.0 % |
| Primary care visit | 38.6 % | 41.7 % | 43.3 % | 40.8 % | 31.1 % |
| Obstetrician/gynecology visit | 41.2 % | 54.2 % | 40.9 % | 41.8 % | 33.8 % |
| Emergency room visit | 11.0 % | 11.1 % | 13.6 % | 11.3 % | 8.7 % |
BP blood pressure; CPT current procedural terminology; DM pregestational diabetes mellitus (type 1 or 2 DM); GDM gestational diabetes mellitus; HDP hypertensive disorders of pregnancy
*Glucose testing includes any laboratory test with a glucose value (see Supplemental Table A, available online, for listing of included CPT codes)
†Medication use was defined as ≥ 90 days of filled prescriptions
‡Early prenatal care is defined by NCQA HEDIS measure as a prenatal care visit in the first 104 days of pregnancy18
§Insurance coverage in the 3 months prior to conception. Conception date was estimated by assuming a 40 week pregnancy, and was based on the delivery date minus 40 weeks