114: Impact of an obstetrical case management initiative on NICU costs in a medicaid-funded population


      To analyze the impact on NICU costs of a regional perinatal case management initiative to reduce preterm birth (PTB) in a Medicaid-funded population.

      Study Design

      A grant from the state of South Carolina funded a public/private partnership to reduce PTB and associated costs in Medicaid recipients in an 8 county perinatal region. The program consisted of provider education on the program, PTB risks, and PTB reduction strategies; multiple methods to enroll women for telephonic risk assessment as early as possible; general and targeted healthy pregnancy information and 24/7 nurse access for all enrollees; and ongoing patient-centered case management for women meeting predefined high risk triggers (age < 18; multiples; PTL; bleeding > 14 weeks; barriers to care; history of PTB, LBW, or perinatal death). Medicaid claims, birth certificate, and program data were used to compare neonatal outcomes and costs for the intervention (2006) and a control (2004) year. Data on costs, reimbursements, and inflation were obtained from the Medicaid office and the regional perinatal tertiary care center.


      There were 6,356 Medicaid deliveries in the region in 2006; 2,111 were referred for telephonic risk assessment; 317 women had high risk triggers and consented to case management. Total Medicaid neonatal costs for the region were $21,395,161; NICU care accounted for $16,246,472 (76%) of this. We previously reported the impact of this initiative to reduce both the frequency and duration of NICU care and unchanged NICU utilization in an adjacent and demographically similar region without the program. The resulting 1824 fewer NICU days in 2006 v. 2004 represent a $2,739,878 reduction in NICU expenditures. Accounting for grant, delivery, and prenatal care costs, the total savings for the year is estimated to be $2,483,674, or $391 per Medicaid delivery in our region.


      A coordinated program of telephonic risk assessment and case management used to decrease or delay early PTB can significantly reduce NICU utilization and decrease the overall cost of perinatal care.