South Carolina Medicaid, Blues Partnership on Birth Outcomes Initiative Yields Promising Results, Reports AIS Newsletter

The December issue of The AIS Report on Blue Cross and Blue Shield Plans* takes a look at the early outcomes of South Carolina’s Birth Outcomes Initiative (BOI), featuring interviews with officials from the South Carolina Blues plan and South Carolina’s Medicaid program.

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Washington, DC (PRWEB) December 18, 2013

In an unprecedented public-private effort to save babies and money, South Carolina Medicaid stopped paying for early, elective deliveries as of Jan. 1, 2013, and so did BlueCross BlueShield of South Carolina. The December issue of The AIS Report on Blue Cross and Blue Shield Plans* takes a look at the early outcomes of South Carolina’s Birth Outcomes Initiative (BOI), featuring interviews with officials from the South Carolina Blues plan and South Carolina’s Medicaid program. Results are so dramatic that the lead state official tells The AIS Report that 16 states and six national entities are looking at the BOI and its work to reduce early births as a model for implementation.

The statewide initiative is a joint effort by the South Carolina Blues plan, Dept. of Health and Human Services (DHHS), state hospital association and March of Dimes aimed at reducing the number of elective early births. Babies born before 39 weeks generally have lower birth weights and higher rates of complications and infant mortality. (March of Dimes says the cost of an early birth averages $32,000, compared with a $3,000 average cost for a full-term birth.)

Already South Carolina’s BOI has exceeded the state’s annual cost-savings projection of $7 million. In the first three months of 2013 alone, the effort reduced unwarranted early-elective inductions before 39 weeks by 50%, decreased NICU admissions, and saved Medicaid more than $6 million, state officials say. That is a significant savings figure for an initiative started in 2011 because of South Carolina’s struggles with its rising Medicaid budget, they add. South Carolina’s DHHS, which anticipated spending $55 million on Medicaid delivery and NICU payments in the first quarter of 2013, instead spent $49 million. Second-quarter data are expected by late December.

Melanie Giese, director of the BOI for South Carolina’s Medicaid program, tells The AIS Report that state Medicaid officials were “surprised” the $6 million first-quarter 2013 cost savings figure “was that robust.” But she says the state “doesn’t want to hang its hat” on that figure or anticipate it will end up as $24 million in annual savings. “We’re hoping to see something similar [in subsequent quarterly savings],” she says, “but don’t know for sure.”

Laura Long, M.D., chief medical officer and vice president of clinical innovation for the South Carolina Blues plan, tells The AIS Report that the South Carolina Blues plan will have a better sense of cost savings when full-year 2013 data is available next spring. “We don’t have access to quite as much 39-week data [as does the state], but we’ve seen a reduction in NICU days in 2012 and 2013,” she says. “In 2012, we were working collaboratively [with network providers] to reduce early elective deliveries and avoided 22 NICU stays, which we were pretty pleased with…for an estimated savings of $1 million,” Long added. “I can’t directly tie [the reduction] to this [initiative], but historically our NICU rates haven’t declined” — and the rate is continuing to decline this year.

Visit http://aishealth.com/archive/nblu1213-02 to read the article in its entirety.

About The AIS Report on Blue Cross and Blue Shield Plans*
The AIS Report on Blue Cross and Blue Shield Plans delivers timely news and insightful analysis of new products, market share, strategies, conversions, financing, profitability and strategic alliances of Blue Cross and Blue Shield plans, which are major players in every U.S. health insurance market. The 12-page monthly newsletter is must-reading for plan managers and others who consider BCBS plans to be partners or competitors. Visit http://aishealth.com/marketplace/ais-report-blue-cross-and-blue-shield-plans for more information.

*A thoroughly objective publication, The AIS Report on Blue Cross and Blue Shield Plans is published independently by AIS and is not affiliated with or sponsored, endorsed or approved by the Blue Cross Blue Shield Association or any of the independent Blue Cross and Blue Shield companies.

About Atlantic Information Services
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