Better starts mean better outcomes for South Carolina babies

Published March 2, 2014

The Blue Cross and Blue Shield commitment to the health and wellness of the communities we serve extends beyond the health insurance policies that protect our members. Working to transform our health care system is a critical piece of the BCBS mission, and Plans are seeing exciting, tangible results of these efforts every day.

One such example comes from BlueCross BlueShield of South Carolina, which joined with state government, the South Carolina Hospital Association, local providers and area nonprofits to help decrease the number of early elective deliveries in 2013 by half compared to 2011 levels.

How did this come about?  

In 2011, South Carolina had the fourth highest rate of preterm births in the country. The state earned a “D” on the 2013 March of Dimes annual report card of premature births in each state. The South Carolina Birth Outcomes Initiative was created with the mission to reduce preterm labor, racial disparity, neonatal intensive care unit (NICU) admission rates and average length of stay, and to screen for and treat behavioral health problems – all with a vision to improve the health of mothers and babies.

The problem needed to be tackled through input and involvement by the state’s birthing hospitals, the South Carolina Obstetrical and Gynecological Society and the South Carolina chapter of the March of Dimes. Over the course of a year and a half, the hospitals assigned administrative and clinical leads and providers collaborated to end the practice. In addition, the state’s 43 birthing hospitals signed a letter of commitment to eliminate elective inductions prior to 39 weeks unless medically necessary.

The payors also did their part. In January 2013, representatives held a press conference to announce that the state Medicaid program and S.C. BlueCross– which together pay for 85 percent of births in the state - would no longer cover elective deliveries between 37 and 39 weeks.  South Carolina was the first state to mandate such a policy in the public and private sectors.

This kicked in coverage by media across the state of the initiative, which helped to raise public awareness that a significant number of patients and doctors were scheduling births early for convenience, rather than for medical necessity — and that this practice often led to worse outcomes and higher costs.

A full year’s data won’t be available until spring of 2014, but preliminary data show a significant decline in the number of early elective births by 2013. Before the SC Birth Outcomes collaboration, 11 percent of S.C. BlueCross and Medicaid births combined were early elective births. By the beginning of 2013, the rate had decreased to 5.6 percent. In addition, Medicaid saved $6 million by the end of the first quarter of 2013, which the agency attributed to the results of the Birth Outcomes Initiative.

Lowering the early elective birth rate is expected to help decrease the infant mortality rate, reduce the number of days mothers and babies are in the hospital and reduce the number of babies who end up in neonatal intensive care. Overall, South Carolina babies will get a better, healthier start in life.

Looking forward

In 2014, S.C. BlueCross plans to add coverage for members to attend group sessions offering health assessment, education and support for pregnant women. This includes medical screening and referral for drug/alcohol use, smoking, domestic violence and depression.

“All of this is good news for babies and moms in South Carolina and we’re proud to be in a position to influence such good outcomes,” said S.C. BlueCross Chief Medical Officer and Vice President of Clinical Innovation Dr. Laura Long, M.D., MPH, who has represented S.C. BlueCross from the beginning of the initiative. “We couldn’t have effected real change without getting all the parties on the same page. The hospitals and providers stepped up, along with the March of Dimes, Medicaid and others, so it was a great collaborative effort.”

The United States has one of the highest rates of premature birth (before 37 completed weeks of pregnancy) in the industrialized world. Premature birth costs our nation more than $26 billion annually. It is the leading cause of newborn death, and babies who survive an early birth often face the risk of lifelong health challenges, such as breathing problems, cerebral palsy and learning disabilities.

Some states have voluntary programs addressing the problem, and some state Medicaid programs have stopped covering early elective births. But South Carolina’s comprehensive approach has become a model for the nation. The nonprofit group Catalyst for Payment Reform, in a case study of the effort published in November 2013, summed it up this way: “South Carolina’s many health care stakeholders across the public and private sectors came together to pay providers to deliver care that is best for babies, and not pay them to deliver care that can be harmful.”