Hi all,
Today I had the opportunity to meet with a large group of HMO directors. This
presentation was part of a regular meeting of the HMO's with AAP's NJ chapter
(and nationally involved) practice management committee chair Dr Richard
Lander. I was there to present Breastfeeding as a "health promotion campaign"
I was introduced with the phrase "how they could help" so I turned it
around and
said that I was there to help THEM... My first statement was that we in NJ(or
rather THEY- looking them in the eye) spend over 17.5 MILLION DOLLARS PER year
for the number of children that were never breastfed for just the first
year of
life, and that if our rates were increased from current rates to
healthy people
2010 goals we could save 15.5 million dollars, I told them that I extrapolated
these numbers from.... and I had a handout of various reports- see
below (in NJ
we have 110,000 births in 2003, then take the BF initiation rate and subtract
from 100, that gives you the "never breastfed rate" then multiply that by $400
-yes I rounded up but I also told them that this was an underestimation as it
was only looking at 3 illnesses and just first year and just child where as we
all know about benefits to mom etc.... that gave me the 17.5 mil. then I took
the # births x current exclusive at 6 mo rt and subtracted from the #births x
healthy people 2010 exclusive 6 mo goal and multiplied that difference by $400
to get the 15.5 mil.
I then showed the the evidence behind these economic #'s,
http://www.ers.usda.gov/publications/fanrr13/
http://www.usbreastfeeding.org/Issue-Papers/Economics.pdf
Ball, T. M. and A. L. Wright (1999). "Health Care Costs of Formula-feeding in
the First Year of Life." Pediatrics 103(4): 870-876.
http://pediatrics.aappublications.org/cgi/content/full/103/4/S1/870
printed out the abstract for my hand outs and tables 2 and 3 that show the
monetory breakdown and also "health care utilizatiion"
then current NJ BF rates, thanks to my WIC BF coordinator,
(yes I rounded up the never BF to 40%)
>> New Jersey:
>>
>> # of births: 110,242
>>
>> The Electronic Birth Certificate asks how the infant was fed in the 24
>> hours prior to hospital discharge.***2003
>>
>> Exclusive BF: 38.2%
>> Combination: 29.0%
>> Any BF: 67.2%
>>
>> Here is the link to the Healthy New Jersey website:
>> http://www.state.nj.us/health/chs/hnj2010u05/hnj2010u05c3.pdf#3b
>> Pages 15 and 16 have the breastfeeding objectives
compared to nationwide
http://www.cdc.gov/breastfeeding/data/NIS_data/data_2004.htm
http://www.gao.gov/cgi-bin/getrpt?GAO-06-282
and that we have competition from neighboring states
http://www.fitpregnancy.com/bestcities/
then some PRAM's data on "why women stop BF early"
Then I went through this booklet and made comments
http://www.ahip.org/content/default.aspx?bc=38|65|369|412|424
www.4woman.gov/owh/pub/breastfeeding/
This is a 100-page booklet put out by the AAHP--American Association of
Health Plans--in 2001 as part of their series on women's health issues. It
starts with a message from Surgeon General David Satcher and was sponsored
by DHHS and the Office on Women's Health.
The book spotlights eight health plans that support breastfeeding for their
enrolled members and three that have breastfeeding benefits for their own
employees.
On page 79, Aetna says it had a return on investment of $2.18 for every
dollar they spent on their program for their own employees. On page 61, one
of the Kaiser plans shows a 13% to 23% increase in bf rate at various ages
from 2 weeks to 6 months in the three years since starting to cover
breastfeeding care for their enrolled mothers.
Then listed additional resources for ideas of what they can DO...
http://www.babyfriendlyusa.org/eng/10steps.html
http://www.cdc.gov/breastfeeding/pdf/bluprntbk2.pdf
http://www.cdc.gov/breastfeeding/resources/guide.htm
And the chapter on maternity care practices:
http://www.cdc.gov/breastfeeding/pdf/BF_guide_1.pdf
They actually had a lot of questions for me. One was How many LC's are
there in
the state? Another was how much time does a typical LC visit take-- I said 1-3
hours. The committee chair asked if LC visits in the hospital were paid for,
they would answer but his co chair felt that it was covered under a global
newborn fee. One HMO head really griped about the increasing C/S rates and
wondered if it was linked. I told him that its not so much decreased for
planned c/s but it was certainly a good topic and if he wanted I could put him
in touch with someone from ICAN (I... cesearean awareness network?) We
talked a
bit about reimbursement for the 3-5 day visit and I suggested having a
visiting
RN and they related that a peds visit would be cheaper. I telked a lot about
having non formula company material, one latere mentioned privately that their
Co. uses "Bright Beginings" and one resolution was for me to get them a "copy
ready" article from the "academy" for them to use in their patient healthy
newsletters and they wouldn't mind all using the same letter. I also talked
about pump reimbursement. I can't tell you what's actually going to get done,
but they were taking notes and I gave them all my business cards and a
few said
they would meet with me personally to discuss this further.
I can tell you of one small victory...I was talking of subtle messages and our
culture, and mentioned how one company had on their new baby welcome
certificate only one pic which was of a baby bottle, I had written a letter to
that Co last yr and never heard a reply, well... the guy was there and he said
that they changed that pic as a result of my letter, he was sorry he never got
back to me!!! So, all of you, get out there and write letters!!!
Good luck,
Amy M. Kotler, MD FAAP
Chair Breastfeeding and Nutrition Committee AAP/NJ
Dover Pediatrics
LLLI Breastfeeding Resource Center
Doctors Park 369 W. Blackwell St
Dover NJ 07801
ph 973 328 8300
fx 973 328 8315
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