Long Range Quality and Cost Outcomes of a Comprehensive Pregnancy Partner Program

Long Range Quality and Cost Outcomes of a Comprehensive Pregnancy Partner Program Karen Bray, PhD, RN, CDE, Nancy Jallo, PhD, FNP, RN, Lisa Specter-Dunaway MPA, Laura Darling MPA, Janis Sabol, BA, RRT, Sharon Lewis, RN, Rebecca Gregory, RN, Rhonda Peebles-Holland, RN Purpose: This study investigated the effects of a comprehensive case management program on quality and financial outcomes in high-risk pregnant women and their infants. Significance: Women who experience a high- risk pregnancy are at increased risk of delivering infants with potential for increased morbidity. It follows that sub-optimal outcomes for mother or infant translate into a higher cost of care. A comprehensive case management program is effective in improving outcomes for these women and their infants with a reduction in associated costs. Methods: This longitudinal study used a two group, quasi-experimental design. The target population was identified from high- risk pregnant women enrolled in Optima Health Plan, a Managed Care Organization. Women were offered participation in the Partners in Pregnancy (PnP) case management program. Two representative groups were identified. The intervention group received program services, the control group did not due to refusal of participation or inability to contact. Both groups were from the same service area experiencing above average pre-term births. The intervention consisted of multiple home visits and telephonic contact throughout the pregnancy by experienced obstetrical nurses and community-based outreach workers. The program focused on encouraging healthy behaviors and prenatal care. Service and cost data were calculated for mothers and babies of each group. Cost data were calculated Per Member Per Month (PMPM) for both groups in defined categories: Emergency Department, Home Care, Inpatient Admissions, Outpatient, Office Visits, and Pharmacy. Mothers were followed for the duration of their pregnancy, infants were followed for one year following birth. Findings: Intervention mothers (n = 84) PMPM cost was higher for ED, Home Health, outpatient and office visits. They had a lower cost than Control mothers (n = 60) in pharmacy and inpatient admissions ($175.78 PMPM compared to $184.75 PMPM). The data are most significant for the Intervention babies (n=84), where the PMPM cost for all indicators was lower than the Control babies (n=60), except for ED cost. Most notable was the difference in inpatient cost ($238.63 PMPM for Intervention babies, $538.84 PMPM for Control babies). Intervention babies spent less time in the hospital, with 4,584 hospital days/1000 as compared to 5,444 hospital days/1000 for Control babies. Healthy behaviors were also impacted by participation, with a 55% decrease in smoking, a 100% decrease in alcohol use and a 70% decrease in stress, as reported by the member. Discussion: Frequent contact and education are key components to improving birth outcomes in a high-risk pregnant population. Through reinforcement of prenatal needs and encouragement to maintain a healthier lifestyle during pregnancy, the babies born to participating members spent less time in the hospital and represented less health care cost than babies born to mothers who did not participate in the program.