Transition Home Plus Program Reduces Medicaid Spending and Health Care Utilization for High-Risk Infants

Research Objective: To evaluate the effects of a transition home intervention on total Medicaid spending, emergency department (ED) visits, and unplanned readmissions for preterm infants born at ≤ 36.6 weeks gestational age and high-risk full-term infants.

Study Design: Rhode Island Medicaid claims data was used to study the 321 infants cared for in the neonatal intensive care unit (NICU) for ≥ 5 days, who were enrolled in the transition home plus (THP) program. The THP program incorporated support services both pre- and post-NICU discharge provided by social workers and family resource specialists (FRS) working with the medical team between October 2012 and October 2014. The THP infants were compared with 365 high-risk infants born and admitted to the NICU in 2011 prior to the full launch of the THP program. Intervention and comparison group outcomes were compared in the eight 3-month quarters after the infant’s birth. Propensity score weights were applied in regression models to balance demographic characteristics between groups. Regression analyses with quarterly fixed effects were run to determine the impact of THP on total Medicaid spending, ED visits, and unplanned readmissions.

Population Studied: The THP cohort included prospectively enrolled Rhode Island resident high-risk infants who were born early (< 32 weeks), moderate (32-33 weeks), late preterm (34-36.6 weeks), or full-term (> 36.6 weeks) in terms of gestational age. All the THP infants were on Medicaid (fee-for-service or managed care), and were hospitalized for ≥ 5 days in an 80-bed single room Level 3-4 NICU between October 1, 2012 and September 30, 2014. The comparison group included infants on Medicaid hospitalized in the same NICU for ≥ 5 days in the year prior to the study period.

Principal Findings: Infants in the intervention group had significantly lower total Medicaid spending, fewer ED visits, and fewer readmissions than the comparison group. The Medicaid spending savings for the intervention group were $4,591 per infant per quarter (90% CI: −$8,397, −$785) in our study period. The average quarterly difference estimate for ED visits is a decrease of 334 visits (90% CI: −389, −279) per 1,000 patients relative to the comparison group for the first eight quarters after birth, weighted by the number of intervention patients in the quarter. The intervention group is 7.6 percentage points (90% CI: −12.3, −2.9) less likely to have an unplanned readmission during the first eight quarters after birth. Sensitivity analyses looking at Medicaid claims post discharge, which excludes all the NICU-related health care expenses and utilization, showed the results remained largely the same as the main analyses.

Conclusions: Transition home support services for high-risk infants provided by social workers and family resource specialists working with the medical team can reduce Medicaid spending and health care utilization.

Implications for Policy, Delivery or Practice: Expansion of the medical team to include social workers and FRS could offer a cost-effective approach for clinicians and policy makers to consider in addressing the psychosocial needs of families caring for preterm and high-risk full-term infants.