Think Younger . . . Much Younger

When looking to reduce long-term healthcare costs, health plans usually look to the chronically ill and implement programs in hopes of improving outcomes. Health plans should additionally look to a much younger set—infants and their mothers.

The cost of preterm births was at least $26.2 billion, or $51,600 for each preterm infant in 2005. The length of stay for premature children is 13 days, compared to 1.5 days for a term infant. In a preterm child's first year alone, the average medical cost, including inpatient and outpatient care was about 10 times greater than for term infants, according to the March of Dimes.

But health plans should not just analyze the first year of a preterm infant's life. Preterm babies can suffer long-time (sometimes lifelong) health issues.

With this information in mind, health plans are beginning to implement programs geared to help women with high-risk pregnancies. Matria Healthcare has an outpatient management program for women with preterm labor, and a study found the program saved money through fewer ER visits, averted antenatal hospitalizations for the mother, and fewer neonatal ICU admissions for the newborn.

The Marietta, GA-based health plan found a 3:1 ROI when comparing the outpatient program to a control group. Overall, the study researchers reported Matria saved $12,597 per pregnancy during the study period.

"The ROI is one piece of it, but with these types of pregnancies, it's the impact of not just the cost of hospitalization of the mom and the immediate costs for hospitalization of the baby in a NICU, but there is also the long-term and disability costs that have to be borne by our healthcare system," says Gary Stanziano, MD, senior vice president at Matria. There are many reasons that a woman could have a high-risk pregnancy. One that might not come to mind immediately is alcohol or drug use. Kaiser Permanente's Early Start program is an obstetric clinic-based prenatal substance abuse treatment program that tests all expectant mothers for drug use and connects those in danger to a licensed substance abuse expert in the OB/GYN department of its 40 outpatient obstetric clinics.

A study recently published online on the Journal of Perinatology found that the Early Start program improved outcomes for expectant mothers using alcohol or drugs. The expectant mothers with substance abuse issues who were not enrolled in the program had significantly worse outcomes, including preterm delivery and placental abruption.

In addition to the licensed substance abuse expert, called the Early Start specialist, the program includes universal screening of all women for drugs and alcohol by questionnaire, and by urine toxicology testing (with signed consent). And the program educates providers and patients about the effects of drugs, alcohol, and cigarette use in pregnancy.

Nancy C. Goler, MD, regional medical director of the Early Start program for Northern California at Kaiser Permanente Medical Group, in Vallejo, CA, says a key to the program is universal testing, which removes any prejudices. She says testing for drug use should be as routine as treating diabetes.

"[Testing] needs to be universal, and as non-judgmental and non-punitive as possible," says Goler, who was also a co-author of the study.

ROI wasn't part of the study, but the researchers wrote that an internal business care cost analysis for Early Start resulted in a 30% cost savings.

These ROI numbers alone should serve as a wakeup call to health plans without high-risk pregnancy programs. But be forewarned: a high-risk pregnancy program might not see savings immediately.

Instead, expect to invest money in the front end with the understanding that longer pregnancies, and averted hospitalizations and ER visits, will save money in the long run.