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Medical Home Cuts Utilization, Costs in Pregnancy

MedPage TodayJanuary 30, 2017Articles

Medicaid patients who received care in a “pregnancy medical home” in Texas seemed to have a significant decrease in hospital utilization, for both emergency department (ED) visits and inpatient hospital stays, researchers said here.

Compared with patients with no visits to the pregnancy medical home, those with at least one visit to the pregnancy medical home had significantly fewer emergency room visits (1,969 versus 897 visits per 1,000 member months, P<0.01), reported Anju Suhag, MD, of Baylor College of Medicine in Houston, and colleagues.

There was also a significant decline in the number of inpatient hospital days among patients who used the pregnancy medical home compared to those who did not (2,939 versus 4,279 per 1,000 member months,P<0.01), they said in a presentation at the Society for Maternal-Fetal Medicine(SMFM) annual meeting.

Moreover, the pregnancy medical home was also linked with significant cost savings for both the ED and the hospital ($330,161 and $494, 313 in annual savings, respectively).

The pregnancy medical home model was a partnership with Texas Children’s Health Plan and Baylor College of Medicine. The Centers for Children and Women is a fully capitated, full risk model that opened their first center in August 2013 and their second center in November 2014.

Suhag explained how the Centers for Children and Women incorporates “a large and broad variety of care providers” — not only ob/gyns, but maternal-fetal medicine specialists, genetic counseling, fetal ultrasound, as well as pediatrics and behavioral health.

One SMFM attendee pointed out that a maternal-fetal medicine specialist was highly unusual, as most medical homes are not in the obstetric specialty.

Suhag said that there are three maternal-fetal medicine specialists in the pregnancy medical home, who provide consultation to high-risk patients, “identifying patients who are safe enough to stay in the community and those who are too complex to care for in a community hospital,” she said.

Erin Clark, MD, of the University of Utah in Salt Lake City, characterized this study as an “innovative strategy” that was a shift away from “our generally dogmatic approach to obstetric care.”

“Novel strategies for providing patient-centered obstetric care that increase value-high quality, high patient satisfaction, and low cost are desperately needed,” she told MedPage Today via email.

“Strategies like the pregnancy medical home, which facilitate cost-effective population management, may be critical for the future success of our healthcare system,” added Clark, who was not involved in the study.

While Suhag said that cost savings were the goal, she added that validation of the pregnancy medical home has had “mixed results.” She cited one example: Community Care of North Carolina, which saw a 6.7% decrease in low birth weight infants from 2011 to 2014.

This retrospective cohort study examined data from 32,275 member months of pregnant women and their newborns who had insurance coverage through the Texas Children’s Health Plan from April 2015 to March 2016. Of these, 5,282 months were from patients in the pregnancy medical home.

Overall, similar significant declines in healthcare utilization were seen for newborns. Those newborns who received care in the pregnancy medical home group had significant declines in ED utilization compared to those who did not receive care in the pregnancy medical home (1,652 versus 1,921) and declines in inpatient days (698 versus 1,799, P<0.01 for both) over the same time period.

Suhag credited the “unique features” of the pregnancy medical home for these declines, such as enhanced access, evidence-based protocols, and emphasis on quality and patient experience. She also cited benefits such as after-hours and weekend appointments, as well as walk-in visits. Researchers estimated that 17% of pregnancy medical home visits were same-day appointments and that 40% of pregnant women in the pregnancy medical home started prenatal care in their first trimester.

Study limitations included the fact that it was a non-randomized comparison of healthcare utilization, and that the study time frame was relatively short.

Suhag said her group would like to examine additional pregnancy and newborn outcomes, as well as examining these outcomes over a longer period of time.

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