Neonatal Abstinence Syndrome (NAS) Program Overview October 12, 2017

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Neonatal Abstinence Syndrome (NAS) The proportion of babies born with NAS from 2000 to 2012 increased five-fold One baby suffering from opiate withdrawal is born every 25 minutes Average NAS LOS 16.9 days vs 2.1 days Cost hospitals an estimated $1.5 billion 81% were paid by state Medicaid programs Patrick et. Al., Journal of Perinatology 35, 650-655 (August 2015) | doi:10.1038/jp.2015.36

80% of NAS cases are paid for by Medicaid costs, ranging from $400/ day to $4,000/day

Aetna’s Response to the Opioid Epidemic Leveraging our data analytic capabilities, deep clinical insights and innovative collaborations to meaningfully impact opioid epidemic. Prevent Treat Support Prevention of Opioid Misuse and Abuse Identify and intervene at-risk behavior Enhance Access to Evidence Based Treatments Promote non-opioid pain management Innovative formulary design Deter inappropriate prescribing habits Identify at-risk member behavior Increase access to naloxone Promote “Medication Assisted Therapy” Partner to address social stigma associated with substance abuse Increase access to behavioral health and substance abuse support

Prevention Aetna helps providers and members to manage and end opioid use by: Working to increase the availability of alternatives for pain relief, such as: Physical Therapy, Chiropractic / osteopathic manipulative treatment, acupuncture, massage, cognitive behavioral therapy, and others. Standard provider and member newsletter guides on pain management, prescription management, and MAT for regular distribution in all Aetna Medicaid markets. Providing education for providers and members on proper opioid prescribing and pain management.

Intervention Care management nurses, and plan Medical Directors have mandated substance use disorder recognition and treatment training though an external expert organization. Training also includes the use of trauma screening, such as: Adverse Childhood Events, as it critical for members’ comprehensive integrated care. Aetna has endorsed the use of SBIRT (Screening, Brief Intervention, Referral Treatment), and are working to promote reimbursement of SIBRT in all states.

Treatment Members whose dosing is >120 MEDD is reviewed by a team of physicians, pharmacist, and case managers. Sign a pain contract Restricted to a single pharmacy, single provider Prior to the carve out of pharmacy benefits Aetna had a program in place that resulted in 30% reduction in utilization in the last year.

ABH WV NAS PROGRAM

Aim, Goals and Objectives 1)Identify pregnant woman with Substance Use disorder(SUD) and refer for treatment. 2) Reduce the incidence of NAS by providing treatment for SUD during pregnancy. 3) Reduce NICU admission , Readmissions and LOS for NAS. 4) Start Care Management for the infant while hospitalized, to improve discharge planning and parent/guardian training during the infant’s hospital stay. 5) Support mother’s adherence with Substance Abuse Treatment prenatally and after delivery.

ABHWV NAS Program 1,100 members have been enrolled since March 2014 111 members currently enrolled 81 members have graduated from the NAS program

Value Added Services Pack and Play, or Baby Carrier Upon successful completion of NAS program at delivery Educational Toy Upon successful completion of NAS program at 1 year of life for the baby

Regionalized Case Managers Staff are now regionalized throughout the state, and working with members with in that region. We have embedded Case Managers at: Cabell Marshall Obstetrics and Gynecology CAMC – Women’s Medicine Center Our embedded nurses have a background in OB nursing and see our members face to face. They focus on education, resources, and can deliver value added services directly to the member We also partner with Lily’s Place in Huntington and our nurse from Cabell does face to face visits with moms

Journey Through Case Management Our Case managers are with the member throughout their entire journey. They follow them from pregnancy, and into the baby’s first year of life. Throughout the members journey the Case Manager is with them during inpatient stays, and therapies; offering support and education.

Success Story NAS Video 2017 Full Cut