Birth Weight Increased, Costs Cut with Medicaid Care-Coordination Plan

Abstract

This preliminary study evaluates the outcome of case management services in the Baby Love Program over 2 years (1988-89). A comparison was made between 15526 Medicaid eligible women who received the special services and the 34643 Medicaid eligible women who did not. Information was collected on the incidence of low birth weight (LBW) very low birth weight (VLBW) infant mortality (IM) newborn medical care costs and participation in the Special Supplemental Food Program for Women Infants and Children (WIC). Methods for matching Medicaid claims to births are given as well as the description of the nature of the Baby Love Program. The findings were that the rate of LBW was 21% higher and VLBW was 62% higher among those not receiving the special services. LBW was 8.7% for Baby Love mothers and 10.5% for the other mothers. VLBW was 1.2% for Baby Love mothers and 2.0% for other mothers. IM was also reduced in the program group i.e. 9.9/1000 live births for Baby Love mothers and 12.2/10000 live births for other mothers. Prenatal care services were used by 91% of Baby Love mothers and 67% for the other group. Over US $2 million was saved in medical costs for infants within 60 days of birth. Care cost US$1694 in the care coordination group and US$1971 in the other group. Better outcomes are recorded regardless of the nature of the care-giving facility. The ratio saved is just over US$2 for every US$1 spent for care coordination of all medical services beginning within 60 days after birth. The savings per women averages US$140. In the regression analysis of maternal risk factors on LBW and IM the findings were that current pregnancy being under 18 years of age and being black were strong predictors of LBW i.e. odds ratios of 2.14 1.29 and 1.66 respectively. When these risk factors are controlled for as well as education marital status previous infant death or stillbirth smoking prenatal care and receipt of prenatal care other than a public health clinic the findings were that women without special care were 20% more likely to have an LBW 50% more likely to have a VLBW and 20% more likely to have IM. Prenatal care was further analyzed by time involved. Those receiving services for <3 months and were covered for <26% of their maternity care had more LBW and VLBW babies and more IM. The likelihood of receiving postpartum and well-baby care was greater among Baby Love mothers.