17 Alpha-Hydroxyprogesterone Caproate (17P) Usage in a Medicaid Managed Care Plan and Reduction in Neonatal Intensive Care Unit Days

Offering 17P as a benefit to pregnant women enrollees with a history of preterm delivery can reduce NICU days significantly for a Medicaid plan.

Mary V. Mason, MD, MBA
Clinical Assistant Professor of Medicine, Washington University School of Medicine, Chief Medical Director
Kara M. House, BS, MBA
Manager of Quality, HealthCare USA of Missouri, St. Louis
Cathy M. Fuest, RPh
Director of Pharmacy, HealthCare USA of Missouri, St. Louis
Deborah R. Fitzgerald, RN
Manager of Health Services, HealthCare USA of Missouri, St. Louis
Bonnie J. Kitson, MBA
Vice President of Contracting, HealthCare USA of Missouri, St. Louis
Jacqueline A. Inglis, RN, BSN, MM
Vice President of Health Services, HealthCare USA of Missouri, St. Louis

ABSTRACT

Purpose: To evaluate whether providing 17 alpha-hydroxyprogesterone caproate (17P) to high-risk pregnant women who have a history of preterm delivery in a Medicaid managed care population reduces the rate of neonatal intensive care unit (NICU) admissions, NICU length of stay, and associated costs.

Design: A 2004–2005 longitudinal review of birth outcomes in 24 pregnant women with a history of preterm delivery who were treated with 17P versus a control group.

Methodology: Intervention included offering 17P as a benefit to pregnant women who had a history of preterm labor and delivery and who were deemed to be appropriate candidates for this treatment by their physicians. An educational program about 17P was developed that was aimed at physicians, their office staff, and plan members. A process of early identification of potential 17P candidates was also implemented.

Principal findings: NICU admission rates decreased to 14.3 percent in the control group and 8.3 percent in the 17P group. NICU length of stay decreased significantly from 231 days in the control group to 149 days in the 17P group. Overall costs for the control group were $568,462 versus $165, 487 in the treatment group — a significant savings of $402, 975.

Conclusion: Offering 17P as a benefit to pregnant women enrollees with a history of preterm delivery can decrease NICU days significantly for a Medicaid managed care plan.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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