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Custom Reporting Predicts At-Risk Pregnancies, Saving Lives and Money

December 13, 2018

VPHP-Baby-Quote-500px The issue of opioid addiction has become a public health crisis impacting people of all ages, genders and races. It has become such an issue with women of child-bearing age that every 25 minutes, a baby is born suffering from opioid withdrawal.[1] Called neonatal abstinence syndrome, or NAS, this condition occurs in newborns exposed to addictive illegal or prescription drugs while in the mother’s womb. Babies born with NAS often have lower birth weight, jaundice and may need medication to help with addiction withdrawal. On average, a NAS baby endures a 17-day hospital stay, which costs more than $66K, whereas healthy newborns leave the hospital after just two days, at a cost of only $3,500.[1]

According to the Centers for Disease Control and Prevention (CDC), in the United States, the incidence of NAS increased 383% from 2000 to 2012, and an estimated 80% of hospital charges for NAS are covered by state Medicaid programs.[2] Standards of care for screening and treating NAS are still evolving, however, it is clear that early intervention can mitigate and lessen the occurrence.

For Virginia Premier Health Plan (VPHP), a managed care organization serving a vulnerable population of 200,000 members, NAS is a major concern. In Virginia, the total number of NAS hospitalizations increased nearly 11% from 2016 to 2017. The rising number of babies diagnosed with NAS has an impact on state finances; on average, three out of four NAS infants in the Commonwealth of Virginia are covered by Medicaid.[3]

While already complying with state-mandated opioid rules, VPHP still wanted to have some insight into at-risk pregnancies to provide intervention sooner. The EnvisionRx clinical team along with the business intelligence team created over 30 custom reports for VPHP to get a better visualization of its members. Through these reports, it is possible to identify trends, reveal drug price changes, find safety issues and proactively identify areas for improvement.

With the reports generated for VPHP, the health plan is now able to identify potential ‘at-risk’ pregnancies, and provide clinical programs to help decrease NAS. These interventions can significantly reduce the number of NAS babies born to members.

Our flexibility to create and deliver highly customized reports, in partnership with VPHP, is just one of the ways EnvisionRx acts as a critical partner for the plan and helps them meet their objectives. EnvisionRx has helped VPHP save $42 million in pharmacy costs over three years as a result of the partnership. EnvisionRx’s transparent operations, pass-through pricing model and unique approaches to unexpected manufacturer drug pricing changes are helping VPHP navigate the complex pharmacy environment, reduce costs and deliver a better pharmacy care experience for members.

[1] National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
[2] Patrick, et al. (2016). Incidence of Neonatal Abstinence Syndrome—28 states, 1999-2013. MMWR Morb Mortal Wkly Rep 2016;65:799-802.
[3] Virginia Hospital & Healthcare Association (2018).


Download the full case study to see how VPHP improved member care and saved money at the same time.

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