Health plans cheered along with other players in the managed care industry when the Leapfrog Group recently announced that there has been a dramatic decline in early elective deliveries of babies. “The national average of 4.6% in 2013 stands in sharp contrast to the national average of 17% in 2010,” Leapfrog says in a prepared statement.
Founded by the Business Roundtable in fall 2000, Leapfrog is a consortium of Fortune 500 businesses that seeks to mobilize employer purchasing power to improve the safety and value of health care.
As we reported last year (http://tinyurl.com/preterm-story), health plans are very much a part of the effort to reduce elective preterm deliveries. Patricia Stephenson, MD, a senior medical director at Cigna, is glad that the effort is finally paying off, noting that the American College of Obstetricians and Gynecologists has been promoting the 5% level for 30 years.
Patients and physicians need to understand the dangers of preterm deliveries, says Patricia Stephenson, MD, a senior medical director at Cigna.
“It’s not a new message,” says Stephenson. “But the practice of obstetrics evolved over the years and it just got to a place where physicians and patients were doing this more out of convenience. They’ve come to recognize the pitfalls of what they were doing.”
The risks of being born preterm include respiratory distress, infection, sepsis, and develop mental problems.
Cigna is a member on Leapfrog’s maternity safety committee. “We were very involved with the decision to go forward with this,” says Stephenson. The insurer promoted the benchmarks to network physicians and provided links to Internet videos to increase awareness. It also educated beneficiaries “so that if their provider suggested an early delivery, they would be prepared to question that and say, Do I have a medical indication for why you’re suggesting it?”
Not that she’s blaming providers. “Nobody did this intentionally,” says Stephenson. “I just think that folks didn’t really understand that it really was an issue. You might deliver 50 babies a month and one of them you deliver a little earlier and, sure, it goes to the NICU [neonatal intensive care unit] for a couple of days with breathing problems but ultimately, for the few days that you see it, it’s fine. I don’t know that you would recognize that as contributing to a national problem.”
Cigna measures hospital performance in this area through its Neonatal Case Management Program (NCMP), which is run by three medical directors.
When an infant is admitted to an NICU at a hospital that Cigna contracts with, NCMP nurses swing into action, collecting as much data as possible on the baby. “We have pediatric specialists who work with those case management nurses to make sure that the treatment plan is appropriate and the right services are available,” says Stephenson. “And then they will make recommendations and if necessary our medical directors will speak to the providers at the facilities to either discuss the treatment plan or to coordinate transfer or whatever’s necessary, again, to optimize the outcomes for those infants.
“When it comes close to the time when those infants will be discharged from the nurseries, a lot of them require home health services, follow-up, and coordination of services.”
The idea is to not wait until labor to identify the members who are at risk, Stephenson says. “Cigna identifies mothers who are at high risk and we want to make sure that they are receiving services from a facility that’s ultimately going to be able to meet the needs for the ones that we can predict.”