Arkansas, a poor and predominately rural state, has failed in the past to provide satisfactory medical care for expectant mothers. For the past 16 years, the state has ranked second worst nationwide in women's health, with 73 of the state's 75 counties designated "medically underserved" areas. Arkansas Medicaid covers only 55 percent of deliveries annually, leaving many of its most vulnerable families unable to afford requisite medical care.
In response to this dire situation, the University of Arkansas for Medical Sciences, Arkansas Medicaid, the Arkansas Medical Society, and physicians across the state teamed up to create the Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS) alliance in 2002. ANGELS uses technology to promote a cost-effective collaboration that incorporates state and federal entities, nonprofit organizations, and physicians to improve adherence to evidence-based guidelines in antenatal and neonatal health care. The program uses a system of high-risk pregnancy consultation and referral to improve birth outcomes and women's health.
The program has three main components. ANGELS provides telemedicine equipment to rural providers at no cost, allowing high-risk pregnant patients to receive real-time ultrasounds and consultation by the leading maternal medicine specialists. The program also established a 24/7 Call Center where obstetrical nurses provide case management, evidence-based telephone consultation, and arrange for maternal transport statewide. Finally, in collaboration with physicians from across the state, ANGELS has developed and distributed 92 evidence-based obstetrical and neonatal guidelines for health care providers across Arkansas.
Because of the ANGELS program, Medicaid beneficiaries who have premature or low birth weight infants are now 42 percent more likely to deliver them in a regional tertiary care center, where specialized perinatal care helps ensure fewer medical complications and higher infant survival rates. In doing so, the program also saves Arkansas Medicaid the millions of dollars associated with the incidence of complications due to lack of adequate care. Initial estimates put the return on investment of the program at between $1.30 and $1.50 for every dollar spent.
Physicians and expectant mothers alike have responded enthusiastically to the introduction of ANGELS. The group conducted over 500 consultations in its inaugural year, and the call center increased its volume from 147 calls in its first month of operation to an average of 2066 calls per month in 2006. Quality has kept pace with quantity, too—on a patient satisfaction survey, ANGELS received an average of 4.79 on a 5-point scale.