Insurance company Passport Health Plan is using a new technology in an attempt to reduce the percentage of premature babies born to its Medicaid members.
Passport Chief Medical Officer Stephen Houghland said the technology — which uses artificial intelligence to analyze various risk factors — is helping the company identify pregnant women as early as the first trimester. He said that will connect women who may be at-risk of delivering preterm babies to prenatal care appointments and other resources.
“For the health care system, it is a significant source of increased cost,” Houghland said. “Then there’s also downstream effects, especially for those children that are born severely premature that are low birth weight. They are more likely to develop more chronic health care conditions, and as a result, incur more cost to the system.”
Carol Brees, an assistant professor and gynecologist at the University of Louisville, said making sure women get prenatal care can also ward off other conditions babies may develop.
“Part of prenatal care is a lot of preventive stuff. We screen for hepatitis, screen for Group B strep, which is one of the big infections that used to kill a lot more babies in the nursery than it does now,” Brees said.
Brees also said that getting women into prenatal care can prevent big costs for both patients and insurance companies.
“A baby that’s born at 28 weeks, they’ll tell you to expect for that baby to stay in the intensive care unit until the due date,” Brees said. “That can be several weeks of very intensive care and that can be very expensive.”
The Technology
Insurance companies usually find out a member is pregnant once the insurance claim is processed from a gynecologist appointment, which Houghland said can take 30 to 90 days.
That means if there are interventions that could reduce the likelihood of a preterm birth, the insurance company isn’t able to deploy that intervention until well past the first trimester.
But Passport’s new technology — from Kentucky-based Lucina Health — speeds that process up. Rather than waiting for the claim to go through a lengthy billing process, the technology identifies the claims from a gynecology appointment immediately, according to Lucina CEO Kevin Bramer.
“We find 85 percent of [pregnant women] in the second trimester. Nobody’s ever done that,” Bramer said.
But identifying a pregnant woman is only the first step. Lucina’s technology then goes through thousands of data points collected by the insurance company that could indicate a woman is at risk of giving birth prematurely. Bramer said those data points could come from things like pharmacy claims and socio-economic factors like neighborhood ZIP code.
“Mom probably didn’t tell you that she may have been a previous substance abuse user, she may have a history of domestic violence in the family and there may be quite a bit of other issues that are in the claims — historical claims that the doctor doesn’t know anything about,” Bramer said.
Depending on the information the insurer has about a patient, this means an insurance company could potentially be more helpful in predicting a problem than a doctor’s office.
Houghland from Passport said after a potential problem is identified, the company connects the patient with a case manager.
“We will follow them a lot differently and help to make sure that their engagement and prenatal services is as complete as possible,” Houghland said. “If there’s an issue with the home and they need to have heat in the winter, we try to help make those connections for women. If they have transportation needs, we try to help meet those needs.”
When Passport tried Lucina’s technology in 2017, they identified about 85 percent of pregnant mothers in the first two trimesters. About 700 of those women went into case management because they were at risk of prematurely giving birth. The technology has resulted in a 13 percent reduction in preterm births for women compared to the previous six months without the technology.
Houghland, however, urged caution in interpreting the early results.
“The early returns are very positive, but at the same time it's hard to say that this is going to decrease prematurity by X percent scaled over the entire population of childbearing women,” Houghland said. “We want to start kind of small and expand.”
