Medicaid and Private Payer Implement Nonpayment Policy for Early Elective Births, Improving Outcomes for Newborns and Reducing Costs | AHRQ Health Care Innovations Exchange

Medicaid and Private Payer Implement Nonpayment Policy for Early Elective Births, Improving Outcomes for Newborns and Reducing Costs | AHRQ Health Care Innovations Exchange

AHRQ’s Health Care Innovations Exchange Focuses on Innovative Approaches to Improving Birth Outcomes

The latest issue of AHRQ’s Health Care Innovations Exchangefeatures three programs that used innovative approaches to improve outcomes for newborns and pregnant women. One profile describes a policy to deny insurance payment for hospital and physician charges associated with early births (prior to 39 weeks gestational age) involving elective inductions or nonmedically indicated deliveries. This policy, implemented jointly by the South Carolina Department of Health and Human Services and BlueCross BlueShield of South Carolina, followed a voluntary effort by providers that led to declines in early, elective inductions and deliveries. The nonpayment policy, which was officially launched on January 1, 2013, was implemented in stages, beginning in July 2012. During the first three months after ramp-up began (July 2012 through September 2012), admissions of newborns to neonatal intensive care units and total birth-related costs came in below projections based on claims data, suggesting the policy has generated further improvements in health outcomes and cost reductions.