Abstract
Background/Aims Recent estimates indicate 10–15% of all babies born in the U.S. are admitted to the neonatal intensive care unit (NICU) which along with evidence that coordinated prenatal care is positively correlated with better birth outcomes (fewer low birth weight and premature babies, and fewer infants transferred to NICU’s) suggest the potential for improvement in perinatal care quality and cost. The aim of this analysis is to examine the economic impact of an evidence- and guideline-based standardized coordinated perinatal care and electronic health record measurement process (Geisinger Health System (GHS) Perinatal ProvenCare® (PPC)) for both the mother and infant implemented in a large integrated U.S. healthcare delivery system to test whether it reduces the total cost of care.
Methods GHS PPC applies to care over the entire gestational period (antepartum, intrapartum and postpartum) using a single standardized pathway with 103 best practice measures grouped in five clinically relevant bundles and automated reporting for all patients across 22 practice sites and four hospitals. Geisinger Health Plan claims data from 2007 to 2010 for 3,369 mother-infant combinations were used to calculate total costs of care per live birth for mothers and infants for PPC and control groups. A difference-in-difference method was used to estimate the cost impact accounting for baseline differences between groups and the secular trend in the control group. A set of multivariate regression models was developed to calculate regression-adjusted cost estimates.
Results Average total cost of care per live birth in the PPC group was approximately 26% (P = 0.001) lower compared to the control group. Much of this cost savings was attributable to reductions in the cost associated with infant care, including lower utilization of expensive NICU services.
Conclusions This study demonstrates the potential for reduction in medical care costs of a standardized perinatal care delivery process based on Geisinger’s experience. The findings suggest that cost savings are attributable to prevention of adverse patient outcomes. If applied more broadly, including to state Medicaid programs which cover almost half of U.S. births, similarly implemented standardized processes could result in better health outcomes and significant cost savings.
