Two years ago, leaders of the Buckeye Community Health Plan decided to take action after noting an increasing number of babies in Ohio being born with symptoms that included seizures, rapid breathing and vomiting. They were suffering from neonatal abstinence syndrome (NAS), caused by their mothers' abuse of narcotics such as heroin, codeine and oxycodone during pregnancy.
The annual NAS hospitalization rate among infants born in Ohio grew sixfold from 14 per 10,000 live births in 2004 to 88 in 2011, and hospital costs totaled nearly $70 million, an elevenfold increase from 2004, according to the Ohio Department of Health. Medicaid was the primary payer.
“It got to the point where you could no longer look at those numbers and say it isn't our responsibility,” said Dr. Brad Lucas, chief medical officer at Buckeye, a subsidiary of Centene Corp., a Medicaid managed-care company.
In 2013, Buckeye launched the Pregnancy Specialty Care Management Program, which identifies pregnant plan members with current or previous alcohol or substance-abuse problems and engages them in education and treatment programs. Since the program was started, the average length of stay in special-care and intensive-care nurseries for the Buckeye babies diagnosed with NAS has dropped steadily, from 13 days to seven and a half over two years.
This is one of many examples across the country of state Medicaid programs and their contracting managed-care plans serving as incubators for innovative solutions addressing healthcare cost, quality and access issues. The innovations include integration of primary care and behavioral health, telemedicine, accountable care, patient-centered medical homes and coordination of medical services with long-term-care services and supports.
Several states, including California, New Jersey, New York and Texas, also have delivery system reform incentive payment (DSRIP) programs, which are federally approved waiver programs in which federal Medicaid funding is used to create financial incentives for providers to pursue delivery-system reforms. Those reforms involve infrastructure development, system redesign and clinical-outcome and population-focused improvements.
While value-based payment and delivery innovations by Medicare and commercial insurers have gotten more media attention, some experts say Medicaid programs have proven more fertile ground for unfettered innovation. “There is a great deal of political pressure to constrain the cost of the programs, and this has encouraged efforts to implement managed care and other innovative programs designed to reduce spending,” said Michael Gusmano, co-director of the Yale-Hastings Program at the Hastings Center, a bioethics research institute.