Friday, September 25, 2009

Check the Evidence First

One of the strategies I’ve been talking about to cut health care costs is using evidence-based medicine for care management and reimbursement policies. Evidence-based medicine is the use of real-world evidence to determine what practices and treatments work best for any given medical condition.

I’ve run across a poignant example of how using evidence-based medicine cuts cost while also raising the quality of care. It turns out that 48% of all newborns admitted to NICU were delivered by scheduled caesarian (C-section) births, many taking place before the 39 weeks that physicians and almost everyone else knows is the full term during which a fetus typically grows before birth.

Medical research shows the greatest growth in the use of C-sections has been among women and their physicians opting for elective procedures, many before the 39 weeks’ gestation period ends. Why do people opt for elective caesarians? Sometimes they do it so the mother is not in the hospital on a major holiday; sometimes it’s to accommodate a vacation.

But whatever the reason that women have elective C-sections before full term, it’s bad for the baby. A growing body of recent research reveals that newborns delivered prior to 39 weeks are two-times more likely to end up in the NICU than babies born at 39 to 42 weeks. No wonder that the American College of Obstetricians and Gynecologists (ACOG) discourage C-Sections to deliver babies before full-term.

When UnitedHealthcare shared this startling data about C-sections and health problems in newborns with a pilot group of physicians and hospitals, they significantly reduced the number of elective C-sections. The result: there was a 46% decline of NICU admissions in three months, a decline that has held stable for more than a year. That’s almost half the numbers of newborns with health problems, almost half the number of distraught parents, almost half the number of potential tragedies. The cost savings to these hospitals, the parents and the health care system are enormous.

We have now launched similar communications programs with all the OB/GYN doctors and 4,800 hospitals in our national network of health care providers. And we’re also putting more about the dangers of elective C-Sections in our Healthy Pregnancy Owner’s Manual that we give to expectant parents and also on our healthy pregnancy website.

UnitedHealthcare is calling for hospitals and obstetricians everywhere to end scheduling elective C-sections unless they are positive that the procedure won’t take place until after the baby has reached full term. Note I said “elective,” because sometimes there are pressing medical reasons for a premature C-Section.

As it turns out, for many conditions there is a great variance in how different physicians treat their patients. If health care insurance companies and medical caregivers work together, we can identify from real-world evidence the best practices for a wide variety of medical conditions. As we can see in the case of elective C-Sections, using evidence-based guidelines in medical care will lead to healthier outcomes for patients.

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