Pregnancy management program saves millions in NICU cost

Case managers are notified of at-risk patients early on

A program that identifies high-risk pregnancies early on and notifies payer case managers has yielded significant improvements in pregnancy outcomes for health plans and employers, Matria Healthcare Inc. reports.

The Atlanta-based company’s MaternaLink disease management program generated neo-natal intensive care unit (NICU) cost savings of nearly $45 million for the more than 121,000 births it managed during a four year period.

NICU days per 1,000 births dropped from 1,194 days in 1997 to 1,013 days in 2000 for participating health plans, well below the national average of 1,200 to 1,500 NICU days per 1,000 births, says Gary J. Stanziano, MD, medical director for Matria.

The decrease was more dramatic for plans that participated in the program for three years, dropping to 970 days per 1,000 births in 2000.

When patients who are members of participating health plans visit their physician for their first pregnancy visit, the program automatically identifies them and asks them to participate in the program by filling out a risk assessment questionnaire. The screening questionnaire is available by mail, by fax, telephone call to a Matria customer services representative, or over the Internet.

About 85% of patients choose to participate, according to James Reichmann, president of Matria’s Women’s Health Division.

The program identifies early on the 10% to 20% of pregnant women who have high risk pregnancies. "The participation rate with pregnant patients is very high. Most patients are very interested and motivated to have a good outcome," Reichmann adds.

All patients who participate in the program receive a customized newsletter from Matria. Those who are at risk receive educational material tailored to their specific condition or risk factor.

The program immediately identifies pregnant women who are likely to have high cost pregnancies, either because of hospitalization throughout the pregnancy or adverse outcomes. For instance, patients with multiple gestation, a history of pre-term labor, or diabetes in pregnancy are among the high risk patients.

The immediate notification allows the health plan’s case managers to begin to manage the pregnancy. "We rapidly identify patients who will get the most benefit from case management services that are available to the patient," Reichmann says.

A common problem is that the plan doesn’t know a patient is pregnant until they are hospitalized. "The program notifies the health plans of patients who need to be case managed before they have any additional expenses so the case managers can intervene early in the pregnancy," Reichmann adds.

Pregnant patients are asked to fill out a second risk questionnaire at around 28 weeks to further identify patients who may have high risk conditions in their current pregnancy.

"We chose the mid-gestational time because of conditions that appear later on in the pregnancy, such as pregnancy-induced hypertension and gestational diabetes," Stanziano, adds.

The MaternaLink program doesn’t replace any internal pregnancy management programs the health plans may have, Reichmann says.

"We do front end risk assessment and send out customized educational material. We quickly cull out the population that will benefit most from case management and allow the case manager to move the patient to [the most] appropriate and least expensive medical management opportunity. It could be home care services or behavior modification programs such as smoking cessation or drug and alcohol abuse counseling," Reichmann says.

Once a patient delivers, Matria collects patient outcomes and puts together an outcome report for the payer.

Here are some of the outcomes for 2000:

The pre-term birthrate for participating plans was 8.6%, compared with the national benchmark of 11.8%.

The low birth weight rate was 6.2% compared with the national average of 7.6%.

Among MaternaLink participants, only .9% of births were at less than 32 weeks, compared with the national average of 1.96%.