Program tackling growing problem of newborns exposed to drugs
As opioid addiction and the amount of money spent on health care both climb in Massachusetts, a new program looks to tackle both issues with a focus on pregnant women and their newborns that have been exposed to drugs.
Rates of neonatal abstinence syndrome -- a diagnosis that results from a baby's exposure to substances including methadone, opioid painkillers, buprenorphine and heroin while in the womb -- have been rising rapidly nationwide and in Massachusetts, according to the state's Health Policy Commission.
In Massachusetts in 2004, fewer than three hospital births out of every 1,000 involved neonatal abstinence syndrome. In 2013, that number jumped to more than 16 out of every 1,000. By 2014, twenty Bay State hospitals saw rates of neonatal abstinence syndrome that were more than five times the 2012 national average of 3.4 per 1,000.
After a board vote this month gave the green light, the Health Policy Commission will now move forward with a $3.5 million program to help hospitals and health systems throughout the state address the growing number of infants exposed to opioids in utero and to improve addiction treatment for pregnant and postpartum women.
"It really has kind of a full continuum here, from pregnancy all the way to six months after delivery, including that hospital stay," Health Policy Commission executive director David Seltz said. "I think there are multiple different ways that we hope to be able to provide support to women and infants through this period, with the stated goal of reducing the impact of the opioid epidemic."
The efforts will build on work already underway at the Department of Public Health, which received a $3 million federal grant in August for a multidisciplinary approach to support families with substance-exposed newborns.
"These funds help protect some of our smallest and most vulnerable residents," Secretary of Health and Human Services Marylou Sudders said when the grant was announced.
The DPH program involves three hospitals, the UMass Medical Center and two facilities on Cape Cod, Seltz said. He said the commission and the department realized together there was still a need for additional funds in other regions and a more comprehensive approach.0
"We think there is a tremendous amount of unmet need - an opportunity to use these dollars to expand that initiative to more communities," Seltz said.
The commission will use $3 million from its dedicated community hospital investment program to match the federal award.
The new program will also include a quality improvement initiative that will see $500,000 -- money that was appropriated in the fiscal 2016 budget -- go to two hospitals for inpatient treatment related to neonatal abstinence syndrome, between delivery of the baby and discharge from the hospital.
The "delivery to discharge" initiative will look to reduce the total cost of care through the adoption of a variety of standards, including reducing the use of drugs such as morphine, increasing the use of breastfeeding and implementing multidisciplinary approaches that involve specialists in addiction, pediatrics and social work.
According to data presented at Health Policy Commission meetings, aggregate hospital charges for neonatal abstinence syndrome climbed from $720 million in 2009 to $1.5 billion in 2012. The mean hospital charges for infants with the syndrome is $66,700, compared to $3,500 for infants born at term without health complications. For infants with neonatal abstinence syndrome who are treated pharmacologically, with drugs like morphine, the charges jump to $93,400.
"There is strong evidence in some pilots and programs in other states and Canada that we have reviewed and researched in developing this that there are best practices that can be put in place in the hospitals that will reduce the length of stay, reduce the need for intensive services and have resulted in substantial savings," Seltz said.
The commission plans to issue a request for proposals in early January, then start soliciting applications from hospitals and making awards in the spring. Implementation of the program could begin early next year, Seltz said.
Hospitals involved in the initiative will provide the commission with data on babies with neonatal abstinence syndrome, which Seltz said will provide a "real-time window" into what medical centers are facing as part of the opioid crisis. Some of the information collected will be made public, he said.
"I think success will be measured in lives saved, in improved health outcomes and reducing costs to the system, and in identifying best practices and duplicating them so the standard of care is high across the commonwealth," Seltz said.
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