Managed Care - January 2010 - (Page 28)
How Plans Can Improve Outcomes And Cut Costs for Preterm Infant Care Ten percent of newborns are admitted to a neonatal intensive care unit. NICU costs are high but controllable. By Michael Kornhauser, MD, and Roy Schneiderman, MD Alere Women’s and Children’s Health has always been a challenge for managed care organizations, and several factors are converging to make the task even more difficult. For example, increases in maternal age and greater use of in vitro fertilization, combined with remarkable medical advances, are leading not only to increases in preterm births, but also to medical complications and associated costs. The average medical costs through the first year of life are approximately $32,000 for preterm infants vs. $3,000 for a full-term infant. Expenses for preterm infants can be easy to overlook in managed care organizations, as a neonatal intensive care unit (NICU) admission typically occurs for only about 1 of every 1,000 members in a commercial health plan (it’s two to three times as high in Medicaid populations). However, Roy Schneiderman, while NICU patients account for MD approximately 0.15 percent of the U.S. population, they account for about 0.45 percent of the total health care costs. What is more, the per-case cost of NICU care is among the highest that a health plan will face in its membership. O ver the past 25 years, preterm births have increased more than 35 percent. Today, about one preterm infant is born every minute in the United States. The good news is that while preterm births are increasing, so too are medical advances for the care of these tiniest of patients. Infants can now survive at 22 to 23 weeks gestation. While remarkable, such advances have come with a high price tag. According to data from the Institute of Medicine, the overall cost of preterm births in the United States is estimated at $26 billion. Michael Kornhauser, For managed care organiza- MD tions, advances in the care of preterm infants create both opportunities and a wide array of societal, ethical, and financial dilemmas. We must first understand the scope of the challenges faced, the factors influencing costs, the solutions that are possible, and ways to ensure broader access to medical advancements and technologies. Effectively managing the care of preterm infants Mike Kornhauser, MD, is vice president and senior medical director, and Roy Schneiderman, MD, is regional medical director at Alere Women’s and Children’s Health. Both are board certified in neonatal-perinatal medicine. Alere offers patientcentered health management and wellness services to large employers and health plans. Its Women’s and Children’s Health division delivers services in all areas of maternal and newborn care. www.alere.com; 800-304-7866 Length of stay About 30 percent to 35 percent of NICU admissions have a NICU length of stay (LOS) of fewer than four days and often have hospital payments for care bundled with maternity payments. Of critical importance is that the remaining 65 percent to 70 percent of NICU admissions typically have an average LOS of about 20 days. These patients are a source of large expenditures. Therefore, payments for a NICU admission with a LOS greater than four days typically will be $40,000 to $80,000 in a commercial health plan. To help put these expenditures in perspective, MANAGED CARE / JANUARY 2010
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