142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 9:30 AM - 9:50 AM

Ana Lopez Defede, Ph.D. , Department of Family and Preventive Medicine/SOM, Institute for Families in Society, Columbia, SC
Sarah Gareau, DrPH, MEd, MCHES , Division of Policy and Research on Medicaid and Medicare, University of South Carolina, Institute for Families in Society, Columbia, SC
M. Melanie (BZ) Guise, RN , South Carolina Department of Health & Human Services, Columbia, SC
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.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Provision of health care to the public
Public health administration or related administration

Learning Objectives:
Assess the effectiveness of a statewide program to reimburse for SBIRT for pregnant Medicaid recipients Describe lesson learned from implementing an SBIRT Initiative to help identify and treat pregnant beneficiaries of Medicaid

Keyword(s): Drug Abuse Prevention and Safety, Drug Abuse Treatment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have directed community-based organizations, served as a consultant with programs addressing the needs of at-risk vulnerable populations, worked as an advocate for enhanced health care and educational services for individuals with disabilities, and performed as a university unit administrator. I am presently a standing member of the AHRQ, Health Services and Systems Research Review Panel a federal appointment authorized by the US HHS Secretary.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.