Impact of 17P Usage on NICU Admissions In a Managed Medicaid Population — A Five-Year Review

by
Mary V. Mason, MD, MBA
Senior vice president and chief medical officer, Centene Corp.
Amy Poole-Yaeger, MD
Vice president of medical affairs, Centene Corp.
Cathie R. Krueger, RN, BSN
Manager of clinical policy, Centene Corp.
Kara M. House, MBA
Vice president of business process optimization, Centene Corp.
Brad Lucas, MD, MBA
Vice president of medical affairs, Centene Corp.

Abstract

Objective. 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 recurrent preterm delivery and neonatal intensive care unit (NICU) admissions.

Study design. A 2004–2009 longitudinal review of birth outcomes in 193 singleton pregnant women with a history of spontaneous preterm delivery that were treated with 17P versus a control group.

Methodology. Intervention included offering 17P as a benefit to pregnant women who had a history of spontaneous preterm delivery and who were deemed to be appropriate candidates by their doctor. Members for this study were identified by claims review and obstetrical (OB) case managers in the health plans.

A process of early identification, using a variety of data sources, was established along with an educational program aimed at physicians, their office staff, and plan members in order to increase 17P utilization in appropriate candidates.

Results. Deliveries with a gestational age of less than 35 weeks decreased significantly from 41.67% in the control group to 26.42% in the 17P group when 17P was initiated by 28 weeks of gestation. The NICU admission rate decreased from 45% in the control group to 33.68% in this 17P group, and was nearly significant.

Conclusion. Offering 17P as a benefit does have a positive effect on reducing the rate of recurrent preterm delivery and rate of NICU admission in a managed Medicaid population. There was no decrease in effectiveness with delay in initiation of 17P as long as it was started by 28 weeks of gestation.

Key words: Managed Medicaid, preterm birth, 17P