473 - Patterns of Medicaid claims for infants born following in utero drug-exposures in Kentucky, 2017-2019

Poster Number: 473
Publication Number: 473.129

Aric Schadler, University of Kentucky College of Medicine, Lexington, KY, United States; Hong Huang, University of Kentucky College of Medicine, Lexington, KY, United States; Brandon Schanbacher, university of kentucky, lexington, KY, United States; Peter J. Giannone, University of Kentucky College of Medicine, Lexington, KY, United States; Mina Hanna, University of Kentucky College of Medicine, Lexington, KY, United States; John Bauer, University of Kentucky College of Medicine, Lexington, KY, United States

Background: Maternal opioid use disorder during pregnancy has significant health risks to the mother and infant and the state of Kentucky has been significantly impacted by this important and costly medical challenge. State-level data of individual Medicaid claims may be useful for better defining patterns of infant outcomes, healthcare utilization, and trends in patient care.

Objective:
Utilize data specifically available by Kentucky Cabinet for Family Health and Services and investigate trends in Neonatal Abstinence Syndrome (NAS) Medicaid claims for years 2017-2019. 

Design/Methods:
A total of 8 million individual Medicaid claims including birth outcomes and postnatal medical care for 104,000 infants were studied. Retrospective data analytic methodologies including geocoding of de-identified infant patient data, ICD10 code links (P96.XX), providers, and per infant costs over the first 2yrs were investigated. Trends from 2017 to 2019 were studied as were regional sites of patient and care provided. Continuous variables were compared using T-tests or ANOVA where appropriate. Categorical variables were compared using Pearson Chi-square or Fisher’s Exact tests as appropriate; p < 0.05 was considered significant.    

Results:
A total of 4232 infants had an at-birth P96.XX ICD10 code associated to Medicaid claims. Residential county for these infants was concentrated to the eastern regions of KY.  There was a significant downward trend in total numbers of NAS cases from 2017-2019 but the average cost per patient to in first 180d increased by 14% per year. The odds-ratio of premature birth was 2.1-fold greater in NAS cases vs. non-NAS cases (20% preterm w NAS  vs 10% preterm without), with both of these groups higher than the national average; medical costs of hospitalization for infants with premature birth and NAS were roughly twice NAS alone. A major driver of medical costs was transport of infants for medical care from rural eastern KY to larger clinical centers, as was NICU hospitalization for specialized care. 
Conclusion(s): Statewide Medicaid claims data can be effectively used to investigate trends in high-risk infant patient care, with related costs, patient care, and outcomes all useful for better understanding of medical challenges such as NAS. In the years studied (pre-pandemic) the costs for these infants were substantial, geographically concentrated, and complicated by prematurity as a driver of morbidities, transport, and hospitalizations. Prospective strategies for improved access to care, perinatal interventions, and cost-managed therapeutic efforts are clearly warranted.