Posted March 29, 2016 by Cindy Hutter

Wyoming is improving its birth outcomes one downloader at a time. An interactive mobile app—Due Date Plus—that the state Medicaid office developed for pregnant women is redefining prenatal education and transforming how Medicaid meets the needs of its pregnant population.

“Due Date Plus is very important to us because we want to find various ways to get women much more engaged earlier in pregnancy in our health management programs,” says Wyoming Medicaid Medical Director James Bush, MD. “Traditional approaches like webpages and flyers were not working well. Our younger patients have smart phones and are always on them so it made sense to investigate an app.”

Due Date Plus maps out important pregnancy milestones and offers personalized health advice, a weight gain calculator and custom reminders. The app version for Wyoming Medicaid participants is further configured to link to state programs and benefits, Medicaid guidelines and resources such as breastfeeding support, vaccine schedules and a free nurse-staffed 24/7 call center.

Since introducing Due Date Plus in 2014, the state has seen a 35 percent decrease in neonatal intensive care unit admissions, 83 percent decrease in low birth weight children, 22 percent decrease in cesarean section rates and a 105 percent increase in prenatal visits greater than 6 months prior to delivery date in those women engaged with Due Date Plus as compared to the rest of the Medicaid population. Of total users, 19 percent were identified as probably high risk pregnancies, and 59 percent were active users of state health benefits and resources.

“We’re able to track clicks and are getting information we didn’t have before, like what mother’s concerns are and compare pregnancy outcomes across populations,” says Bush. “All that information can help shape the services we offer.”

The state is also hosting “baby showers” in different counties that bring all the local public health, Medicaid and early child-related programs together in one place for pregnant mothers to discover.

“Unlike a health fair, the baby showers are targeted to woman thinking about reproduction and they are a great way to get information out,” says Bush. “Our goal with Due Date Plus is to get pregnant women to identify early, before they see their physician, so the baby shower is one way we’re sharing the app.”

Connecting Multiple Initiatives
The Due Date Plus initiative is one of several efforts tied to Wyoming’s participation in the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN). The state team is focused on three key areas for reducing infant mortality:

1. Tobacco cessation among pregnant women
   
2. Prevention of early and pre-term birth
   
3. Delivery of high-risk babies at appropriate facilities
   

Education available on Due Date Plus is helping with tobacco cessation and preventing early and pre-term births. However, one significant challenge to improving infant mortality rates in the state related to offering quality perinatal care is how sparsely populated the large the state is. In parts of Wyoming, families can live 10 miles from their closest neighbor and hundreds of miles from the smallest critical care hospital. That means even if services were available in the hospital, families might not be able to get to it.

The state is looking closely at telehealth, an option that could bring risk-appropriate care to patients without them having to travel. For example, in very rural areas where women are typically cared for by physician assistants in a small center, telemedicine would make it possible for staff at the centers to confer electronically in real time with a neonatologist.

“For many of these babies that are born out on the frontier, the care givers are capable of implementing therapies, they just don’t know what therapies to implement,” explains Shelly Springer, MD, MBA, MSc, JD, FAAP, the state’s only neonatologist. “Telehealth would be similar to how nurses get plans from a doctor to implement.”

Bush hopes to establish a high-risk pregnancy ECHO program in the state, with a goal that once a high-risk pregnancy is identified, telehealth prenatal visits could be arranged and a proper delivery site identified. Regardless of approach, both Bush and Springer agree, keeping high-risk babies in state to receive appropriate care, instead of being sent off to critical access hospitals in Denver or Salt Lake City, is a huge step forward for babies and families in Wyoming.