Disorder and Their Infants in Three State Medicaid Programs in - - PowerPoint PPT Presentation

Lisa Clemans-Copea,*, Victoria Lyncha, Embry Howella, Ian Hilla, Nikhil Hollaa, Justin Morgana, Paul Johnsona, Caitlin Cross-Barnetb, J. Alice Thompsonb

a The Urban Institute, b Center for Medicare and Medicaid Innovation (CMMI), CMS

This work was supported by Center for Medicare and Medicaid Innovation, DHHS, Contract No.: HHSM-500-T0004.

Academy Research Meeting, June 2019

Pregnant Women with Opioid Use Disorder and Their Infants in Three State Medicaid Programs in 2013-2016 2016

Preview of the main finding: Few pregnant women with opioid use disorder are receiving consistent treatment in Medicaid

• Women with OUD who are pregnant and parenting did not

receive consistent treatment when enrolled in Medicaid.

• In a typical month in the year before and year after birth,

most Medicaid-enrolled women with OUD received no addiction-related treatment.

Data and study sample

• We linked maternal/infant Medicaid claims/payment and infant birth records

in 3 states 2013-2016 to examine health care use, treatment, neonatal

• utcomes in the year pre/post birth for mothers with opioid use disorder

(OUD) and other substance abuse disorders (SUDs)

• Sample included women with Medicaid claims data who delivered a live singleton

infant in 2014 or 2015

• Sample size was 37,782 for 2014 (9k, 12k, and 17k across the 3 states) and 34,304

for 2015 (8k, 10k, and 15k across the 3 states).

• Classified women as having an SUD/OUD based on an adaptation of the

EMSANT-W, a population-based SUD identification tool tailored to women

• f reproductive age (Derrington et al., 2015) with ICD-9/ICD-10
• Outcomes: health care utilization, expenditures, SUD treatment by type and

consecutive months of treatment, and neonatal outcomes.

SUD & OUD and treatment among sample mothers in the year pre/post birth

SUD & OUD:

• Most Medicaid enrollees in the sample had no SUD (92%)
• 2% percent of the sample had an opioid use disorder (OUD) diagnosis
• 6% of the sample had a SUD diagnosis other than OUD

Treatment:

• 73% of women with OUD had some type of SUD treatment pre/post birth
• But -- most had no treatment in an average enrolled month
• 9% received methadone treatment in an average enrolled month

Prenatal care & Perinatal outcomes

• Pregnant women with OUD had delayed and lower rates of prenatal care

compared to women with other SUDs.

• Rate of preterm or low birth weight did not differ between infants of

mothers with OUD and those with other SUDs.

• Compared to infants of mothers with other SUDs, infants of mothers with an

OUD had:

• higher rates of admission to NICU
• longer birth hospitalizations
• more infant drug/alcohol diagnosis.

Health care costs in the year pre/post birth for women with OUD and SUD and their infants

• Delivery month/hospitalization costs were $22k for women with OUD, $16k

for those with another SUD, and $11k for those without an SUD.

• Costs for women with an OUD were particularly high in the period after

birth.

• Health care costs before and at delivery were higher for women with

methadone treatment than for women with OUD and no treatment.

• Higher costs may be related to the treatment itself or because these women were

experiencing higher health care needs.

Study limitations

• Administrative health care data; lack of detail in the claims data;
• Not able to observe key treatment characteristics such as medication dose

and any SUD treatment not covered by Medicaid;

• Based just on three states, limits the generalizability of the findings to other

states;

• Data excluded women or infants who died before delivery or at delivery,

precluding examination of mortality outcomes;

• Non-experimental nature of our study design precludes causal

interpretations.

What did we find out about health care use and costs of pregnant women with opioid use disorder and their infants?

• Our analysis of maternal and infant Medicaid claims data and infant birth

records in three states shows low treatment rates, delayed prenatal care, high NICU use, and high health care costs among mothers with OUD and their infants.

• Initiation & support of evidence-based treatment during birth

hospitalization could improve outcomes & cost, but may depend on provider/patient attitudes/knowledge of effective treatment

• There is an urgent need for comprehensive, evidence-based OUD

treatment integrated with maternity care.