Tuesday, December 9, 2014

Mother and ChildA new study from Health Affairs examines the role that state Medicaid programs are playing in reducing the number of early-term elective deliveries.

This study, led by Medicaid Medical Directors in conjunction with AcademyHealth and lead author Tara Trudnak Fowler of Altarum, was published today in Health Affairs.

Reducing early elective deliveries has become a priority for Medicaid medical directors and their state partners. Such deliveries lead to poor health outcomes for newborns and their mothers and generate additional costs for patients, providers, and Medicaid, which pays for up to 48% of all births in the United States each year.

In this study, 22 state Medicaid programs worked with their maternal and child health and vital statistics state colleagues to coordinate quality improvement efforts related to early elective deliveries in the Medicaid population. The study finds that almost 9% of the more than 1.8 million Medicaid births each year are early elective deliveries that result in a higher rate of neonate and neonatal intensive care unit admissions or transfers compared to full-term elective deliveries. Furthermore, these deliveries add to morbidity rates and costs.

The study also finds that early elective delivery rates among Medicaid births are dropping but still need to be reduced. Finally, the study identifies policies implemented in states to reduce the rate of these births, including prior authorization (i.e., patients getting permission from their Medicaid plan to have an early, elective birth) and “hard-stop” policies (i.e., hospitals prohibiting such procedures), as well as education and feedback efforts targeting patients and physicians. The article offers additional evidence and new tools for policymakers pursuing strategies to further reduce the number of such deliveries.

Additional analysis of the 22 states’ data can be found here.

The study was published in the December issue of Health Affairs. Study investigators included Medicaid Medical Directors Jeff Schiff, MD (Minnesota), and Mary S. Applegate, MD (Ohio); Tara Trudnak Fowler, PhD, MPH, from Altarum; and Gerry Fairbrother, PhD, and Katherine Griffith, MHS, from AcademyHealth.

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