A Kaiser Permanente program for women at risk of substance abuse during their pregnancy could save $2 billion each year if applied on a national basis, according to a new study published recently in the peer-reviewed journal Obstetrics & Gynecology.
The findings come from a 2008 study by Kaiser Permanente that showed its Early Start program helped pregnant women at risk of substance abuse achieve similar health outcomes – for both the mother and child – as those of women who do not use tobacco, alcohol or drugs.
"Now, we're able to show everyone that not only is it the right thing to do, we will save money," said Nancy C. Goler, MD, of the Department of Obstetrics & Gynecology for The Permanente Medical Group in Vallejo, Calif. "This program is a very low-technology intervention that has an enormous net cost savings."
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The program is based on reducing the well-known risks of tobacco, alcohol and drug use during pregnancy. To identify those to enroll in the program, Kaiser Permanente of Northern California routinely screens pregnant women via both a urine toxicology test and a substance-abuse screening questionnaire.
To study the potential cost benefit of the program, Kaiser compared the overall healthcare costs from at-risk women in four distinct groups. The first group participated in full Early Start services, including a one-hour psychosocial assessment and follow-up appointments. The second group had limited Early Start services, including a one-hour psychosocial assessment without follow-up. The third group did not access Early Start, and the women in the control group tested negative for substance use in pregnancy and were not at risk.
In all, the study examined 49,261 women within the four groups and found that women who participated in the Early Start program provided an average net cost benefit of $5.9 million annually. Based on the savings within the Kaiser population, the study estimated that nearly $2 billion could be saved nationally for every 4 million live births annually.
Goler noted that a large measure of the success of the program was the high level of care coordination the women in the Early Start program received. The program is located at the same clinic where pregnant women receive their routine prenatal care and appointments with the woman's prenatal care provider and her Early Start specialist are coordinated.
Kaiser Permanente's Early Start program, launched in 1990, integrates obstetric care with substance-abuse treatment for pregnant women in three ways: all women are screened by questionnaire for drug, cigarette and alcohol use, and by urine toxicology testing with signed consent; a licensed substance-abuse expert works in the OB/GYN department and sees the patients at the same time as their prenatal care appointments; and all providers and patients are educated about the effects of drug, alcohol and cigarette use during pregnancy.