High-Risk Maternity Management is Just Half the Story
When I speak with Health Plan Executives or Medicaid Directors about managing the NICU population, their first response is often to share what they are doing to engage high-risk moms or to reduce early elective C-Sections. Certainly, any baby who is carried to full term and avoids the NICU is a “win” for all. Yet, solely focusing on reducing NICU admissions through prenatal programs misses a significant opportunity to help the costly vulnerable NICU population after birth with continuity of care. Prenatal programs do not address a key cost driver, which is variations in medical management, nor the health literacy needs of young families. The best approach to turning the NICU risk into opportunity is with a focused program that involves experienced professionals in NICU care.
High-risk maternity case management programs only move the needle by preventing 1-2% of NICU admissions. While high-risk pregnancy programs, such as the use of the progesterone medicine 17P, succeed in advancing gestational age, in many cases they do not fully prevent premature births that end up as NICU admissions. Identified high-risk moms only account for about half the NICU admissions. Often prenatal programs don’t continue to support the mom after delivery when she assumes the new and challenging role of caring for a medically complex newborn. Across the nation 11.4% of babies are born preterm. Add to that the number of full term babies with complications or drug-addiction and we consistently see NICU admission >12% of all births. These fragile babies cost payers 10 times more than normal newborns and are often born to families who benefit greatly from skilled support in order to get off to a healthy start.
There is a real opportunity to advance the fiscal and quality outcomes for the more than 450,000 babies who start life in the NICU. From the very start, sharing inpatient best practices, encouraging breastfeeding, explaining and reinforcing transition plans of care enables babies to go home sooner and healthier, while reducing the inpatient per capita cost of care. Case Management social assessments, encouraging PCP visits, early intervention referrals and ongoing parental support reduce readmissions and have a measureable impact on the baby’s outcomes during those pivotal first days, weeks and months. When member engagement is high, families respond favorably to the Care Management benefits from their health plan. While prenatal programs are well defined and frequently available, let’s not lose sight of the importance of post-natal family care management. With 1 in every 8 pregnancies resulting in a NICU admission, payers and members alike share in the Care Management benefits for this very special population of infants. What are you doing to effectively manage your NICU population?