New Health Care Model Cut Costs and Reduced Need for Medical Services for Pregnant Women and Newborns Essay

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LAS VEGAS (Jan. 23, 2017)—In a study to be presented Friday, Jan. 27, in the oral concurrent session at 1:15 p.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, researchers will present their findings for a study titled, Pregnancy medical home: Outcomes and cost-savings.

The study set out to evaluate the impact of a pregnancy medical home model on the utilization of emergency services and hospital days in a low-income population. Texas Children’s Health Plan and Baylor College of Medicine partnered to create a new health care model in Houston, Texas. The principles of patient-centered care found in a primary care medical home were expanded to include obstetrics and gynecology, creating a pregnancy medical home exclusively for women and children covered by Medicaid and the Children’s Health Insurance Program (Chip).

The medical home integrates obstetrics/gynecology, maternal-fetal medicine, pediatrics, behavioral health, optometry, dentistry, radiology, laboratory and pharmacy—all in one location. The home provides team-based care with midwives and physicians in the clinic and a hospitalist model for inpatient care. Extended hours (66 hours per week for OB and 100 hours per week for pediatrics) and walk-in/same day appointments provide opportunities to avoid unnecessary emergency room visits.

The researchers compared this care model with traditional obstetric care and found that women receiving care at the medical home were significantly less likely to utilize the emergency room and also spent significantly fewer days in the hospital. In addition, their newborns spent significantly fewer days in the hospital and were less likely to utilize the emergency room.

“The decreased need to use these services resulted in an estimated annual savings of over $800,000 for pregnant women and over $1.6 million for newborns,” explained Lisa Hollier, M.D., professor of obstetrics and gynecology for Baylor College of Medicine and one of the researchers of the study to be presented at the SMFM annual meeting.  “We believe this model can readily serve as a national model for improved health care, substantial savings and improved outcomes,” Hollier added.

Abstract #55      Pregnancy medical home: outcomes and cost-savings

ANJU SUHAG1 , Ritu Dutta1 , Heidi L. Schwarzwald1,2 , Tangula Taylor2 , Lisa Hollier1,2 1 Baylor College of Medicine, Houston, TX, 2 Texas Children’s Health Plan, Houston, TX

OBJECTIVE: To evaluate the impact of a pregnancy medical home model on utilization of emergency services and length of stay for hospitalization in a low income population.

STUDY DESIGN: A pregnancy medical home (PMH) model was developed for pregnant women members of Texas Children’s Health Plan (TCHP) enrolled in Medicaid and Chip Perinate. Obstetric care is provided by physicians and midwives integrated with pediatrics, behavioral health, dental, optometry, pharmacy and laboratory. MFM service is embedded in the clinic. The PMH offers extended hours, allows walk-ins, has 24 hour nurse availability for triage, and a laborist model for hospital coverage. Women enrolled in TCHP are prospectively assigned to the Medical Home using an algorithm based on their address. Assigned members who select the PMH for their care comprise the study cohort. Women assigned but choosing another provider serve as the comparison. Utilization rates for emergency care and hospital admissions were compared between the two groups over a one year period April 2015 – March 2016 using the Fisher exact test. A p-value of<0.05 was considered significant.

RESULTS: A total of 37,275 member months accrued to women assigned to the PMH. Of these, 5,282 months were for patients in the PMH model. The number of emergency room visits per 1000 members was significantly less among pregnant women with at least one visit to the PMH (897 vs. 1969 per 1000, p<0.01). The number of inpatient hospital days per 1000 members was also significantly reduced among pregnant women with at least one visit to the PMH (2939 vs. 4279 per 1000, p<0.01). The PMH has generated $330,161 in annual ER savings within its member panel and $494,313 in annual savings related to inpatient days.

CONCLUSION: The pregnancy medical home model effectively reduced healthcare utilization and cost for participating pregnant members.

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