Study finds Kaiser Permanente Early Start program could save US billions in health costs

(Press-News.org) OAKLAND, Calif. -- A program for women at risk of substance abuse during pregnancy could save nearly $2 billion annually in health care costs if implemented nationwide, according to a Kaiser Permanente study published online in the American College of Obstetricians and Gynecologists' journal, Obstetrics & Gynecology.

The cost-benefit analysis of the Kaiser Permanente Early Start program follows a 2008 Kaiser Permanente study that showed the program helps pregnant women at risk of substance abuse achieve similar health outcomes — for both mothers and their infants — as women who do not use cigarettes, alcohol or drugs.

Kaiser Permanente has proved the program decreases maternal and neonatal morbidity and stillbirths, according to study lead author Nancy C. Goler, MD, of the Department of Obstetrics & Gynecology for The Permanente Medical Group in Vallejo, Calif.

"Now, we're able to show everyone that not only is it the right thing to do, we will save money," Dr. Goler said. "This program is a very low-technology intervention that has an enormous net cost savings."

Given the known risk of substance abuse in pregnancy Kaiser Permanente Northern California screens pregnant women by urine toxicology tests and substance-abuse screening questionnaires. This new study examined 49,261 women comparing the health care costs for pregnant women in four groups and found the Early Start program yields an average net cost benefit of $5.9 million annually.

One group of women at risk for substance abuse in pregnancy participated in full Early Start services, including a one-hour psychosocial assessment and follow-up appointments. The second group of women at risk for substance abuse had limited Early Start services, including a one-hour psychosocial assessment without follow-up. The third group of women at risk for substance abuse did not access Early Start, and the women in the control group tested negative for substance use in pregnancy and were not at risk.

Nearly $2 billion could be saved for every 4 million births each year if the program was implemented nationwide, the study estimated. The Kaiser Permanente researchers presented their cost statistics in 2009 dollars.

A large part of Early Start's success is due to the program's accessibility to patients. The program is located at the same clinic in which pregnant women receive their routine prenatal care, Dr. Goler said, adding that appointments with the woman's prenatal care provider and her Early Start specialist are coordinated. More clinicians should move their substance-abuse prevention programs for pregnant women into prenatal care sites, Dr. Goler noted.

### Launched in 1990, Kaiser Permanente's Early Start program integrates obstetric care with substance-abuse treatment for pregnant women in three ways: all women are screened by questionnaire for drug, cigarette and alcohol use, and by urine toxicology testing with signed consent; a licensed substance-abuse expert works in the OB/GYN department and sees the patients at the same time as their prenatal care appointments; and all providers and patients are educated about the effects of drug, alcohol and cigarette use during pregnancy.

Other authors on the study included: Mary Anne Armstrong, MA, and Yun-Yi Hung, PhD, Division of Research, Kaiser Permanente Northern California, Oakland, Calif.; Veronica M. Osejo, Patient Care Services, Kaiser Foundation Health Plan, Inc., Oakland, Calif.; Monica Haimowitz, LCSW, Patient Care Services, Kaiser Foundation Health Plan, Inc., Oakland, Calif.; and Aaron B. Caughey, MD, PhD, Department of Obstetrics & Gynecology, Center for Women's Health, Oregon Health & Science University in Portland, Ore.

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: http://www.kp.org/newscenter.