Reducing Medicaid Spending and Health Care Utilization for High-Risk Infants

By Yiyan (Echo) Liu

Preterm birth, when an infant is born within the first 37 weeks of pregnancy, is a pressing public health problem both abroad and in the United States. At birth, preterm infants are not yet fully developed and usually are classified as having low birth weight, meaning they weigh less than 5.5 pounds (about 2,500 grams). Preterm infants, and infants born with low birth weight, are at increased risk for death and disability, including visual and hearing impairment, developmental delays, and behavioral challenges. In 2015, almost 10% of infants born in the United States were classified as preterm and 8% had low birth weight.

The financial burden associated with medical care for preterm babies is estimated at $26 billion annually, and because of racial, ethnic, and socioeconomic disparities often associated with preterm births, about half of these births are covered by Medicaid—a joint federal-state program to help pay for health care for low-income Americans. Researchers, including myself, have been studying interventions that can help address these issues and promote better health outcomes.

One promising program, led by Betty R. Vohr, MD, uses a multidisciplinary family care team to offer education and support to parents of high-risk infants born at the Women & Infants Hospital of Rhode Island. In October 2012, Dr. Vohr started the Transition Home Plus program for all preterm infants who spent at least 5 days in the neonatal intensive care unit (NICU) of the Women & Infants Hospital, and the program was later expanded to include all infants cared for in the NICU. This program was funded through a $3.2-million Health Care Innovation Award from the Centers for Medicare & Medicaid Services (CMS).

The Transition Home Plus program took a collaborative approach to care by bringing together a team of providers from across the hospital, including physicians, nurse practitioners, social workers, and trained family resource specialists. A unique aspect of the program was their family resource specialists—parents who had their own infant previously cared for in the NICU and now help parents currently in the Transition Home Plus program. The family resource specialists were trained and worked under the supervision of licensed social workers, and they were matched with families of similar backgrounds to provide both pre- and post-discharge family care in the form of regular meetings, calls, home visits, and clinical assessments.

As the CMS evaluation contractor, RTI used data from the Rhode Island Medicaid program to study the impact of the program on Medicaid spending and use of health care services. I led the Medicaid claims analyses for Women & Infants Hospital and worked with Dr. Vohr’s team along with my RTI colleagues to identify a group of intervention infants cared for in the NICU, as well as a group of comparison infants born and admitted to the same NICU prior to the full program launch.

Our published results indicate that infants who participated in the Transition Home Plus program had significantly lower total Medicaid spending, fewer Emergency Department visits, and fewer readmissions than a comparable group of infants who did not participate in the program. On average, the program decreased Medicaid spending by more than $18,000 per infant per year, primarily through reductions in Emergency Department visits and readmissions.

Programs like Transition Home Plus that provide comprehensive support services as infants transition from hospitals to their homes show potential for decreasing Medicaid spending, readmissions, and Emergency Department visits for preterm infants by providing education, transitional services, and navigation support to families. It is feasible that the Transition Home Plus approach to recruiting and training family resource specialists and incorporating them into the NICU care team could be adopted by NICUs in other hospitals with high-risk populations, offering clinicians and policy makers an effective approach to better addressing the psychosocial and socioeconomic needs of families in caring for high-risk infants.