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

2. I’m from the insurance company, and I’m here to help you.

3. Our Core Value:
Empowering people to live healthier lives through innovative global coverage, wellness, and care management solutions.

4. 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, (August 2015) | doi: /jp

5. 80% of NAS cases are paid for by Medicaid costs, ranging from $400/ day to $4,000/day

6. 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

7. 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.

8. 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.

9. 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.

10. ABH WV NAS PROGRAM

11. 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.

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

13. 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

14. 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

15. 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.

16. Success Story
NAS Video 2017 Full Cut