Every hour in the United States, an infant is born who is suffering from neonatal abstinence syndrome (NAS) – drug withdrawal due to a mother’s use of opiates during pregnancy. According to the National Institute on Drug Abuse, these babies stay in the hospital nearly five times as long as other newborns. They endure the same withdrawal symptoms an adult would, including tremors, insomnia, convulsions, projectile vomiting and severe diarrhea. Long-term, they may fail to thrive, and may have an increased risk of developmental delays and learning deficits. More than 75 percent of babies suffering from NAS are on Medicaid.
Many states are working hard to reverse this growing and troublesome trend. In West Virginia, state leaders are tackling the issue head-on through a partnership that brings together legislators, state agencies, providers, community partners and managed care for the good of the mother, the baby and West Virginia’s communities.
“West Virginia is committed to finding a way to help drug-addicted mothers give birth to healthy babies and forge a path to overcome their own addiction,” said West Virginia State Delegate Denise Campbell. “Every baby should have a healthy start.”
The state reached out to CoventryCares of West Virginia, an Aetna company that provides managed care plans for the Medicaid population. The local team consulted with Aetna’s national medical experts, and together they created a pilot program designed to help identify pregnant women at risk for giving birth to drug-addicted babies, help the mothers get quick access to specialized care, and follow both mother and baby through the first year of life to provide any additional support.
“Our approach centers on the mobilization of doctors, hospitals, clinics and community organizations across the state. This is the front line for identifying an expectant mother suffering from addiction and needing help.”
Dr. Alonzo White, chief medical officer for Aetna’s Medicaid plans
For the pilot in West Virginia, Aetna relied on the expertise of its local team, which has extensive relationships with providers and community-based organizations across the state. These team members identified substance abuse facilities and doctors who are expert in caring for pregnant women and babies with substance abuse issues. They then conducted a broad education campaign to organizations focused on health and wellness issues, including doctors, hospitals, social workers, clinics, substance abuse counselors, treatment specialists and legislators. The campaign included information about NAS and brochures to educate expectant mothers and fathers. Aetna also added questions to its own prenatal assessment materials for expectant mothers as another way to identify at-risk women.
Pregnant women who are identified as having significant opiate use are educated about the risks their addiction creates for their baby, and they are invited to enroll in a treatment program. Once enrolled, the mother gets rapid access to a treatment facility, ready access to prenatal care with providers who are experts in substance abuse disorder pregnancy and delivery, and a dedicated case manager that follows both mother and baby through pregnancy, delivery and the first year of the baby’s life.
The program went live on March 31, 2014. Within three months, the program had engaged more than two dozen mothers. There has been tremendous support across the state, and substance abuse providers in particular have been heavily engaged in promoting the program to expectant mothers.
“Our practice is partnering with CoventryCares of West Virginia on the NAS program,” said Dr. David Garvin Chaffin, MD. “By assigning a long term central case manager for addicted mothers at the local health plan level, Aetna is overseeing the comprehensive prenatal and postnatal care plans currently available in the marketplace.”
The program is not limited to expectant mothers. When a baby is born with a substance use disorder, and if the mother agrees, Aetna’s local team assigns a case worker to immediately engage with parents and the child to provide access to needed care and support for at least a year after the baby is discharged from the hospital.
“This program is reaching out to identify at-risk mothers, help them overcome their addiction and have a healthy baby,” said Dr. White. “It completely does away with the wait list approach. These moms need treatment as quickly as possible.”
Dr. White notes that the greatest challenge to overcome is gaining the trust of the mother. “Many of the mothers we work with don’t have a great deal of faith that we are there to help them,” he says. “We’re not there to point fingers or pass judgment. We are there to help her and her child get and stay healthy. It’s the right thing to do for both mother and baby.”
“With substance abuse trends escalating in all 50 states, we know it’s important to try to solve this now,” said Dr. White. “We may not know the true impact of this program until these children go to school. But West Virginia is determined to turn this trend around.”