Lessons learned by a state Medicaid agency after reimbursement of SBIRT for pregnant clients

Issues. Exploratory research of South Carolina Medicaid claims data revealed that approximately 1 of every 4 women of child bearing age had at least one opioid prescription.  Of these, 4% (5,543) had opioids prescriptions intermittently through three-years of Medicaid eligibility, and approximately 13% of women with neonatal abstinence deliveries had continuous prescriptions.     

Description. In response, the South Carolina Department of Health & Human Services, in partnership with other state agencies, implemented the Screening, Brief Intervention and Referral to Treatment (SBIRT) program, which provides tools and reimbursement to perform standardized screening and referrals to more than 30,000 pregnant women each your through Medicaid obstetric providers.  By June, 2013, 46.81% of women of reproductive age had received an SBIRT screening, as compared to only 2.92% at the start of the Initiative (August, 2011).  Of these, 41.14% received a screening, 10.38% a brief intervention, and 2.00% a referral.

Lessons Learned. (1) Requiring a physician to complete the universal screening tool, rather than other frontline providers, decreased completion rates.  (2) Increasing efficacy by training obstetric providers on the core clinical components of SBIRT is important.  (3) Following patients after they left the obstetric clinic to ensure follow-through with referral and treatment was challenging. 

Recommendations. As reimbursement is a driving force in encouraging providers to screen pregnant women, allowing providers to bill for each component of SBIRT may encourage sustained treatment.  With a relatively low investment by state agencies, the high costs associated with opioid abuse and other risk factors during pregnancy may be abated.