Application of Disease Management Principles to Pregnancy and Delivery Don Fetterolf, MD, MBA, Executive Vice President, Health Intelligence And Gary Stanziano,

Application of Disease Management Principles to Pregnancy and Delivery

Don Fetterolf, MD, MBA, Don Fetterolf, MD, MBA, Executive Vice President, Health Intelligence Executive Vice President, Health Intelligence

And And Gary Stanziano, MD Gary Stanziano, MD

Executive Vice President, Women’s and Children’s HealthExecutive Vice President, Women’s and Children’s Health

1

Overview

• OverviewOverview• Why Manage PregnancyWhy Manage Pregnancy• Definitions, Pregnancy Statistics and ImpactDefinitions, Pregnancy Statistics and Impact• Risk versus EtiologyRisk versus Etiology• Poor Birth Outcomes and CostsPoor Birth Outcomes and Costs

• Approaches to a Pregnancy Management ProgramApproaches to a Pregnancy Management Program• Outcomes and InformaticsOutcomes and Informatics• Future Directions and IdeasFuture Directions and Ideas

2

Overview

•Pregnancy and Newborn care among most common and in Pregnancy and Newborn care among most common and in the aggregate most expensive conditions.the aggregate most expensive conditions.

•Historically viewed as episodic, event driven, and not Historically viewed as episodic, event driven, and not continuous so not a candidate for “disease management”.continuous so not a candidate for “disease management”.

•““Wellness,” Case Management models also don’t Wellness,” Case Management models also don’t completely address the issues.completely address the issues.

•Is in fact a unique, high volume condition that benefits Is in fact a unique, high volume condition that benefits from primary and secondary preventive health efforts.from primary and secondary preventive health efforts.

3

Why manage the condition of pregnancy?

4

Estimated Maternity/Newborn Health Expenditures

Maternity/Newborn Cost

Percentages Reflect a Non-Medicaid EnvironmentSource: Washington Business Group on Health

Total Payer's Health Care Expenditures

25 - 40%

An estimated twenty-five to forty percent of payer's total health expenditures are allocated to Maternity/Newborn Cost

5

Health Plan Experiences

• Precertification program for pregnancyPrecertification program for pregnancy• Too costly and too many normal onesToo costly and too many normal ones

• ““Drive through deliveries”Drive through deliveries”• Focused review of C-section and VBAC delivery Focused review of C-section and VBAC delivery

ratesrates• ““unnecessary surgical procedures”unnecessary surgical procedures”

• Medical policy restrictionsMedical policy restrictions• InfertilityInfertility

• Home careHome care

• Home made programsHome made programs

6

Definitions

• Preterm LaborPreterm Labor Regular uterine contractions with cervical change that Regular uterine contractions with cervical change that

occurs between 20 and 37 weeks’ gestationoccurs between 20 and 37 weeks’ gestation

• Preterm BirthPreterm Birth Birth between 20 and 37 completed weeks’ gestationBirth between 20 and 37 completed weeks’ gestation

• Very Preterm BirthVery Preterm Birth Birth before 20 and 32 completed weeks’ gestationBirth before 20 and 32 completed weeks’ gestation

7

Definitions

• Low Birth Weight Birth weight less than 2500 gramsBirth weight less than 2500 grams

(5 pounds, 8 ounces)(5 pounds, 8 ounces)

• Very Low Birth WeightVery Low Birth Weight

Birth weight less than 1500 gramsBirth weight less than 1500 grams (3 pounds, 5 ounces)(3 pounds, 5 ounces)

8

• What is the economic impact of What is the economic impact of pregnancies that don’t go pregnancies that don’t go normally?normally?

9

1. Report by Cigna Corporation by the Center for Risk management and Insurance Research-Georgia State University and the Center for Health Policy Studies, Columbia, Maryland; www.bls.gov/cpi;

2. Data on file 3. CDC Safe Motherhood 4. Society of Actuaries: Large Claim Data Base 1997

Cost of Maternity• Average cost per pregnancy is $15,523Average cost per pregnancy is $15,52311

• Analysis of 2002 data claims sets, covering 7.7 Analysis of 2002 data claims sets, covering 7.7 million lives, averaged $13,056 to $16,419 per million lives, averaged $13,056 to $16,419 per pregnancypregnancy22

• More than More than 1 in 31 in 3 pregnant women develop pregnant women develop complicationscomplications33

• Society of Actuaries Large Claim Data Study, Society of Actuaries Large Claim Data Study, Neonates average $80,000, greatest cost of all Neonates average $80,000, greatest cost of all diagnosesdiagnoses44

10

Pregnancy – An Expensive Condition

• More than 1 in 3 pregnant women develop More than 1 in 3 pregnant women develop complications costing complications costing $1 billion$1 billion annually annually (2 million hospital days).(2 million hospital days).11

• Direct health care costs for a premature baby Direct health care costs for a premature baby average $41,610 – 15 times higher than the $2,830 average $41,610 – 15 times higher than the $2,830 for a healthy full-term delivery.for a healthy full-term delivery.22

• NICU expenditures for preterm birth and NICU expenditures for preterm birth and complications total complications total $6.6 billion.$6.6 billion.22

1. CDC Safe Motherhood2. March of Dimes: www.marchofdimes.com

11

The Impact of Poor Birth Outcomes

• Employer/InsurerEmployer/Insurer Maternal care costsMaternal care costs Loss of productivity, absenteeism, presenteeism Loss of productivity, absenteeism, presenteeism Cost of newborn care (NICU)Cost of newborn care (NICU)

• Community/SocietyCommunity/Society Continued care costsContinued care costs Ongoing/life long disabilities and care requirementsOngoing/life long disabilities and care requirements

• Family Family Emotional pain and suffering/quality of life issuesEmotional pain and suffering/quality of life issues Financial hardshipFinancial hardship

12

Employer Costs for Preterm BirthAdditional Employer Costs Due to Preterm BirthsAdditional Employer Costs Due to Preterm Births

Average Cost DifferentialAverage Cost DifferentialPremature Infant Premature Infant

(first 12 months of life only)(first 12 months of life only)

March of Dimes and Thomson Medstat, The many costs of premature birth, impact on business, 2/06.

Inpatient HospitalInpatient Hospital +$33,824+$33,824

Physician Office VisitsPhysician Office Visits +$ 4,561+$ 4,561

DrugsDrugs +$ 395+$ 395

Productivity/Synergy LossProductivity/Synergy Loss +$ 2,766+$ 2,766

Average additional cost to Average additional cost to employer per premature vs. full employer per premature vs. full term birth (when mother is an term birth (when mother is an employee)employee)

$41,546$41,546

13

• Employee and Family:Disease Process i.e.: InfectionEducation/Knowledge i.e.: Signs-SymptomsPsychosocial i.e.: Fear of “bothering providers”Cultural/Language/CommunicationFamily Support

• Employer/Environment/Community:BenefitsWork Type and ConditionsLiving ConditionsTransportation

• Physician:Education/TrainingPractice PatternsOffice Staff TrainingElective C/Section

• Hospital:Emergency Room ProcessL&D Capacity, L&D Personnel & PolicyNeonatologist Practice Patterns

• Health Plan/Insurance:Case ManagementDirect Prenatal Care AccessCopay/Deductible

Factors that Influence Birth Outcomes

Hospital12.3% Preterm Birth

1,600+NICU days per 1000 births

EmployerEnvironmentCommunity

Member and

Family

PhysicianPhysician

HealthPlan

Insurance

HealthPlan

Insurance

HospitalHospital



Employee Family

Employee Family

14

Etiology Theories

• MaternalMaternal GeneticGenetic Placental AbruptionPlacental Abruption InfectionInfection AnatomicalAnatomical

Incompetent cervixIncompetent cervix Over distentionOver distention

− PolyhydramniosPolyhydramnios− Multiple GestationMultiple Gestation

StressStress Hormonal DysfunctionHormonal Dysfunction

Multifactorial Hypotheses

Psychosocial/BehavioralPsychosocial/Behavioral SmokingSmoking DrugsDrugs AlcoholAlcohol

Pre-existing diseasePre-existing disease Pregnancy diseasesPregnancy diseases

PIH PIH EclampsiaEclampsia

Clotting DisordersClotting Disorders IatrogenicIatrogenic UnknownUnknown

15

Etiology Theories, cont’d

• FetalFetal AnomaliesAnomalies Multiple GestationsMultiple Gestations Blood IncompatibilitiesBlood Incompatibilities Placental Thrombosis/InsufficienciesPlacental Thrombosis/Insufficiencies UnknownUnknown

16

Risk Factors for Preterm Birth

1Norwitz ER, Robinson JN, Challis JR. The control of labor. N Engl J Med. 1999 Aug 26;341(9):660-6.

6

50% 50%

50% of PTB’s = No Identifiable Risk Factors

50% of PTB’s = High Risk Pregnancy Factors •History Of Previous Preterm •Multiple Gestation•Maternal Age•Medical Risk Factors

•High Blood Pressure•Diabetes•Infections

•Current Psychosocial Risk Factors•Lifestyle Factors

•Tobacco•Alcohol•Drugs

•Current Clinical Complications

“Reliance on risk factors alone will fail to identify over 50% of women who will have a preterm delivery.”1

17

18

High-Risk

Specialists(MFM, Geneticist,

etc.)

lobGal Physician Fee

Labs

Ultra

soun

d

Lab

Ultra

soun

d

• Amnio• Cerclage

• Labs• Specialists• Pharmacy• Anesthesia• Disposables• Neonatology• Postpartum complications

• Respiratory • Labs• Pharmacy •

Nutrition• Radiology •

Disposables• Social work• Specialists• Surgical procedures

• AFP• Genetic

testing

• Labs• Pharmacy• Fetal monitoring• Specialist-Rounding

• Ultrasound• Disposables

Infe

rtili

ty

Phar

mac

y

Lab

Proc

edur

es

In-p

atie

nt D

eliv

ery

(Indu

ction,

C-sec

tion)

NIC

UIn-p

atie

nt

(Nau

sea

and

Vomiti

ng)

In-p

atie

nt

(PTL

, Diabe

tes, P

IH)

Repea

t Adm

ission

(Add

’l ER

cha

rges

)

Long

-ter

m

Costs

ER V

isit

ER V

isit

Phar

mac

y

ER V

isit

Phar

mac

y

Preg

nanc

y

Post

partum

Che

ck

Global Physician Fee

Preg

nanc

y

Labs

Phar

mac

y

Ultra

soun

d

Lab

Lab

Ultra

soun

d

Del

iver

y

Nur

sery

• GTT• CBC

• In-patient• Lab• Anesthesia

• Lab• Pharmacy• Disposables• Pediatrician

• Fetal monitoring• Pharmacy• Disposables

Post

partum

Check

NormalMaternity Costs

Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, Deshpande AD, Franks AL. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol 2002 Jul;100(1):94-100.

Antenatal In-patient Hospital Costs

• 46,179 Patients46,179 Patients

• 4,016 (9%) Antenatal Hospitalizations4,016 (9%) Antenatal Hospitalizations

• 15.7% had more than one hospitalization15.7% had more than one hospitalization

• $36 Million Antenatal Costs ($1,550/day)$36 Million Antenatal Costs ($1,550/day)

Diagnosis Incidence Average LOS Costs

PTL 24% 3.4 days $5,642

Hyperemesis 9% 3.0 days $4,167 Hypertensive Disorders

9% 4.6 days $7,145

PPROM 6% 12.6 days $20,753

Diabetes 3% 3.1 days $4,591

19

$0

$50,000

$100,000

$150,000

$200,000

$250,000

25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Gestational Age at Delivery Assuming $3000 per day costs

Average Costs for Infants Admitted to NICUAverage Costs for Infants Admitted to NICU

Ross MG, et al. Prediction by maternal risk factors of neonatal intensive care admission: evaluation of >59,000 women in national managed care programs, Am J Obstet Gynecol 1999;181:835-42.

20

What is Driving NICU Costs?

• Preterm births are increasingPreterm births are increasing• Smaller and earlier infants are survivingSmaller and earlier infants are surviving

Technology/ventilation improvementsTechnology/ventilation improvements SurfactantSurfactant CorticosteroidsCorticosteroids

• NICU ProliferationNICU Proliferation• Infertility and Multiple Gestation IncreasesInfertility and Multiple Gestation Increases

21

US Preterm Birth Rates

Source: National Center for Health Statistics, Final Natality DataPrepared by March of Dimes Perinatal Data Center, 2004

9.410.8

11.9 12.1 12.310.1

7.6

0

4

8

12

1981 1991 2001 2002 2003 March ofDimes2007Goal

SurgeonGeneral

2010Goal

27 Percent Increase 1981-2001Percent of Live Births

* 2004 Preliminary Data = 12.5% PTB

22

23

Frequent Stop Loss Insurance Risk --Cost Impact Categories

• CancerCancer• TransplantsTransplants• Maternal/Fetal medicalMaternal/Fetal medical• Progression of Chronic DiseasesProgression of Chronic Diseases

• CHF, CAD, cardiacCHF, CAD, cardiac• DiabetesDiabetes• ESRDESRD• EtcEtc

• Trauma and acute catastrophesTrauma and acute catastrophes

24

How Disease Management Can Help Stop Loss Insurers

• Theoretically, disease management type interventions can Theoretically, disease management type interventions can help stop loss insurers by either reducing cost or reducing help stop loss insurers by either reducing cost or reducing riskiness of the insured group.riskiness of the insured group.

• Medical management would do this by:Medical management would do this by:• Reducing the number of people hitting the stop loss limit.Reducing the number of people hitting the stop loss limit.• Reducing the total costs at the individual level for those Reducing the total costs at the individual level for those

who did hit the stop loss limit.who did hit the stop loss limit.• Reducing the variation (standard deviation, coefficient of Reducing the variation (standard deviation, coefficient of

variation) of costs at the individual level above the stop variation) of costs at the individual level above the stop loss limit.loss limit.

25

Medical Management: CQI and Shifting Bell Curves

#

PMPM Cost

Improvement =•Shifting the curve•Narrowing the curve•Dropping the tail

Savings = differences in the integrated area under the curves.

26

Effect of DM on Maternity Cost Structure• Study was conducted on a large health plan in our data repository, Study was conducted on a large health plan in our data repository,

having some 1.3 million members. having some 1.3 million members. • Some 6,200 deliveries were represented.Some 6,200 deliveries were represented.• A baseline and 1 year follow-up were evaluated.A baseline and 1 year follow-up were evaluated.• Costs per maternity case were examined and results includedCosts per maternity case were examined and results included

• Number of individuals – decreasedNumber of individuals – decreased• Total costs/case – average cost per case decreased for stop loss Total costs/case – average cost per case decreased for stop loss

cases. Costs/case decreased more for the most expensive cases.cases. Costs/case decreased more for the most expensive cases.• Costs above the stop loss attachment point –decreased for all Costs above the stop loss attachment point –decreased for all

but highest level (which had only 13 cases).but highest level (which had only 13 cases).• Standard deviation of costs above attachment point – increased Standard deviation of costs above attachment point – increased

for this client. Coeff of variation was less for the highest cost for this client. Coeff of variation was less for the highest cost cases.cases.

27

Impact of DM on Maternity Stop Loss

Client/Lives

StopLossAttach Pt

Total OBCases

% Change in Cases Hitting Stop Loss

Stop Loss Cases as % of Total% Change

% Change Average Stop Loss Cost/Case

% Change Average$ AboveStop Loss

% Change SD/CV CostsAbove Stop Loss

D1.3

Million(8,200

deliveries)

$ 75,000$150,000$175,000$200,000

----

-++-

-+++

----

---+

+ +++

•For this client, which has an aging population, the number of deliveries is declining overall.•The average cost per OB case declined in all stop loss attachment point levels.•The amount of cost above the stop loss attachment point declined in all levels.•The variation in stop loss exposure was significant in all levels, but was less at the highest level.

28

Maternity DM and Stop Loss: Percent Change over One Year of Program

Maternity DM Impact

-30.0%

-20.0%

-10.0%

0.0%

10.0%

20.0%

30.0%

40.0%

$75,000 $150,000 $175,000 $200,000

Stop Loss Level

Pc

t C

ha

ng

e

Total OB Cases

OB Cases HittingStop Loss

Average$ per StopLoss Case

Avg$ Above StopLoss Level

Stdev$ Above StopLoss Level

Coef Var$ above StopLoss Level

29

Cost Band Data

Within individual cost bands, average cost per case declines in each band. There seems to be an impact on variation as well.

Removing outliers >$100,000, both cost and variation declined.

So, given all this information, So, given all this information, does medical management as a does medical management as a strategy have anything to offer?strategy have anything to offer?

30

Medical Management

• Comprehensive Approach NeededComprehensive Approach Needed• Pregnancy identification and referralPregnancy identification and referral• Risk stratificationRisk stratification• Risk-specific interventionsRisk-specific interventions• Case managementCase management• NICU Case managementNICU Case management• Outcomes measurementOutcomes measurement

31

Management Programs Should

• Focuses on maintaining the health of Focuses on maintaining the health of the pregnant woman and decreasing the pregnant woman and decreasing risks through education and high-risk risks through education and high-risk obstetrical nurse case managersobstetrical nurse case managers

• Addresses the needs of payers, Addresses the needs of payers, families and employersfamilies and employers

• Reduces poor birth outcomes and Reduces poor birth outcomes and related costsrelated costs

32

33

Management Components• Surveillance and identificationSurveillance and identification - Periodic obstetrical - Periodic obstetrical

assessments assessments

• One-on-one case management One-on-one case management expertise and ongoing expertise and ongoing

support, support,

• Home care in lieu of hospitalization Home care in lieu of hospitalization for high risk for high risk

pregnanciespregnancies

• Focus on high cost NICU causes and readmitsFocus on high cost NICU causes and readmits..

• Timely Education Timely Education - book, web based and newsletters . - book, web based and newsletters .

Multiple channels of communication.Multiple channels of communication.

• Access to maternity nurses 24x7 Access to maternity nurses 24x7 through the call center through the call center

RN/MD consultation.RN/MD consultation.

OB Case Management

NICU Care Management

Outcomes Reporting & Informatics

• IDENTIFY risk factors that may impact healthy birth outcomes and educate families about behavior changes.

OB Homecare Services

Case Identification

34

Implementation

Initial Risk AssessmentEducation e-OB Newsletter

BabyLine Reporting

Case ManagementStratified by Risk

Follow-Up Risk Assessment•Education •e –OB Newsletter

•BabyLine •Reporting

Identification Enrollment

OUTCOMES

Risk Factors

Program Flow

35


• EXTEND the pregnancy and improve birth weight through specialized maternity case management..

Case Identification

OB Case Management



36

Case Management: Proactive Rather than Catastrophic

Level I:Level I:Teenage Pregnancy Maternal age < 18 Teenage Pregnancy Maternal age < 18 Advanced Maternal Age Maternal age > 35Advanced Maternal Age Maternal age > 35Smoking during pregnancySmoking during pregnancyETOH use during pregnancyETOH use during pregnancyRecreational drug use during pregnancy Recreational drug use during pregnancy Barriers to obtaining adequate prenatal careBarriers to obtaining adequate prenatal careDomestic Abuse [urgent notification MD]Domestic Abuse [urgent notification MD] Level IILevel IIHistory of conditionsHistory of conditionsHistory of Recurrent Pregnancy loss History of Recurrent Pregnancy loss History of Preterm LaborHistory of Preterm LaborHistory of Gestational DiabetesHistory of Gestational DiabetesHistory of Pregnancy Induced HypertensionHistory of Pregnancy Induced HypertensionHistory of Neonatal Death or Stillbirth History of Neonatal Death or Stillbirth History of Low Birth Weight baby [less than 5 lbs at birth]History of Low Birth Weight baby [less than 5 lbs at birth]History of Preterm DeliveryHistory of Preterm DeliveryHistory of Post Partum DepressionHistory of Post Partum DepressionHistory of Chronic HypertensionHistory of Chronic HypertensionOther Current Medical ConditionsOther Current Medical ConditionsCardiac condition receiving treatment and/or medicationCardiac condition receiving treatment and/or medicationBlood clotting conditionBlood clotting conditionRenal condition receiving treatment and/or medicationRenal condition receiving treatment and/or medicationDiabetes Mellitus – Type 1Diabetes Mellitus – Type 1Diabetes Mellitus – Type 2Diabetes Mellitus – Type 2Family History of genetic disorder and/or birth defectFamily History of genetic disorder and/or birth defect

Level III Current Pregnancy Conditions Multiple Gestation Non-adherence to prescribed activity restrictions and/or medications Lack of support Hyperemesis Gravidarum receiving treatment and/or medication Pregnancy Induced Hypertension Preterm Labor Preterm Labor receiving treatment and/or medication Preterm Labor no treatment – condition unresolved Preterm Labor unknown resolved condition Preterm Labor cervical change Non-adherence to prescribed activity restrictions and/or medications Lack of support Gestational Diabetes Potential Rupture Membranes [urgent notification MD] Polyhydramnios Oligohydramnios Placenta Previa Placental Abruption

Level IV• Catastrophic • Out of Network• Trauma

37


• MINIMIZE the need for hospitalization through industry-leading homecare services.

OB Case Management



Case Identification

38

OB Homecare Services -Overview

Homecare Service Approaches:Homecare Service Approaches:• Pre-Term Labor Services (some hotly debated!)Pre-Term Labor Services (some hotly debated!)

• Home Uterine Activity MonitoringHome Uterine Activity Monitoring• Subcutaneous Tocolytic Infusion TherapySubcutaneous Tocolytic Infusion Therapy• 17P Administration Services17P Administration Services

• Nausea and Vomiting in Pregnancy Nausea and Vomiting in Pregnancy • Zofran and Reglan Subcutaneous Infusion TherapyZofran and Reglan Subcutaneous Infusion Therapy

• Diabetes in PregnancyDiabetes in Pregnancy• Pregnancy Induced Hypertension ManagementPregnancy Induced Hypertension Management• Anticoagulation TherapyAnticoagulation Therapy

39

• REDUCE NICU admissions and length of stay through proactive prenatal interventions and NICU care management.

OB Case Management




Case Identification

40

Key Factors Driving Newborn Costs

• NICU UtilizationNICU Utilization

• Unnecessary higher level NICU stays for Unnecessary higher level NICU stays for grower/feeder infantsgrower/feeder infants

• Delays in scheduling and provision of Delays in scheduling and provision of NICU servicesNICU services

• Prolonged NICU stays awaiting discharge Prolonged NICU stays awaiting discharge planningplanning

• Unscheduled NICU readmissionsUnscheduled NICU readmissions

41


• DOCUMENT clinical improvements, financial savings and patient satisfaction.

OB Case Management



Case Identification

42

• What types of results can be What types of results can be expected?expected?

43

Economic Impact Potential

• Programs reduce costs and improve outcomes through Programs reduce costs and improve outcomes through

• Decreased length of NICU admissionDecreased length of NICU admission

• Decreased number of ER visitsDecreased number of ER visits

• Reduced number of NICU readmissions within 30 Reduced number of NICU readmissions within 30 daysdays

• Improved coordination of NICU care amongst the Improved coordination of NICU care amongst the multi-disciplinary teammulti-disciplinary team

• Post NICU infant carePost NICU infant care

44

Managed* National Birth Data1

Preterm birth rate, All Preterm birth rate, All birthsbirths

9.0%9.0% 12.1%

Low Birth Weight rateLow Birth Weight rate

SingletonsSingletons 4.7%4.7% 6.1%

TwinsTwins 53.9%53.9% 55.4%

TripletsTriplets 98.1%98.1% 94.4%

Very Low Birth Weight rateVery Low Birth Weight rate

SingletonsSingletons 0.7%0.7% 1.1%

TwinsTwins 5.2%5.2% 10.2%

TripletsTriplets 27.8%27.8% 34.5%

NICU days per 1,000 birthsNICU days per 1,000 births 1,1421,142 1,6142

Medical Management Clinical Results

1. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: Final data for 2002. National vital statistics reports; vol 52 no10. Hyattsville, Maryland: National Center for Health Statistics. 2003.

2. Benchmark NICU data from 7 health plans/employers claims data (1998-2002).

*Results include 11,732 births (Commercial/Medicaid)

45

Managed2 National Birth Data

NICU days per 1,000 birthsNICU days per 1,000 births 1,073 1,6141

Number of NICU Days Number of NICU Days Saved per 1,000 BirthsSaved per 1,000 Births

541

Estimated cost per NICU Estimated cost per NICU DayDay

$2,000

Total Projected Cost Total Projected Cost Savings per 1,000 BirthsSavings per 1,000 Births

$1,082,000

Total Projected Cost Total Projected Cost Savings per BirthSavings per Birth

$1,082

ROIROI 6.3:1

Medical Management Financial Results

1. Benchmark NICU data from 7 health plans/employers dataset (1998-2002)

2. Managed results include 10,467 births (Commercial/Medicaid)46

Managed Financial Results –Commercial vs Medicaid

$0

$1,000

$2,000

$3,000

$4,000

Commercial Medicaid

$3,228 $3,228

$1,980 $1,620

National Average Managed

38.7%

49.8%

National Average based on benchmark of NICU data from 7 health plans/employers claims data (1998-2002).REDUCTION IN TOTAL NICU COSTS PER DELIVERING MEMBER

47

Near Term Industry Movement

• Preconception ProgramPreconception Program

• Web enabled interactions with high risk Web enabled interactions with high risk membersmembers

• Inter-conception Management of High Risk Inter-conception Management of High Risk PregnancyPregnancy

• Post Partum Depression ProgramPost Partum Depression Program

• Pediatric First Year of LifePediatric First Year of Life

48

Future Emerging TechnologiesInitiatives (Future)

• Infant and Pediatric HealthInfant and Pediatric Health

• Women’s Health Specific WellnessWomen’s Health Specific Wellness

• New Emergent Diagnostics or DrugsNew Emergent Diagnostics or Drugs

• Genetic Screening - Trimester Screens + Genetic Screening - Trimester Screens + Nuchal Cord UltrasoundNuchal Cord Ultrasound

• Cord Blood Genetic Analysis/ScreeningCord Blood Genetic Analysis/Screening

49

Thank You!

50

Look for: Fetterolf, Stanziano. “Application of Disease Management Principles to Pregnancy and Delivery”. Disease Management. Fall/Winter 2008. In press.

Documents

Application of Disease Management Principles to Pregnancy and Delivery Don Fetterolf, MD, MBA, Executive Vice President, Health Intelligence And Gary Stanziano,