Experts urge statewide perinatal quality collaborative, propose biomarker screening pilot to cut preterm births
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Summary
A maternal-fetal medicine specialist told Nevada lawmakers a mandatory statewide Perinatal Quality Collaborative (PQC) plus targeted biomarker screening for Medicaid patients could reduce preterm births and neonatal morbidity; he outlined estimated start-up costs and a payer-funded delivery fee to sustain the program.
Dr. Brian Herrier, a maternal-fetal medicine specialist, urged the Joint Interim Standing Committee on Health and Human Services to establish a statewide Perinatal Quality Collaborative, saying Nevada is an outlier without a PQC and ranks poorly on maternal and neonatal outcomes.
The physician told the committee that PQCs provide statewide leadership, shared data infrastructure and implementation support for evidence-based bundles. He provided a first-year start-up estimate of roughly $1.1 million and ongoing annual operating costs near $900,000, and proposed a $40 per-delivery fee paid by Medicaid and commercial payers to cover recurring costs. "This scales with volume and savings," he said, arguing payers would recoup the investment through reduced severe maternal morbidity and NICU use.
Herrier also described a large recent multicenter randomized trial of a proteomic blood test plus a low-cost intervention bundle (low-dose aspirin, vaginal progesterone when indicated, and weekly nursing follow-up). He said the trial was stopped early by its data and safety monitoring board for benefit: among enrollees, the intervention reduced neonatal morbidity and mortality (ratio ~0.8) and showed a 56% reduction in births before 32 weeks in the highest-risk subgroup. He recommended piloting biomarker screening first in the Medicaid population, citing higher baseline risk and early payer pilots by Molina and SilverSummit.
Herrier framed the PQC and biomarker testing as complementary: the PQC would standardize care, collect data and coach implementation across hospitals; the biomarker pilot would identify higher-risk patients for targeted interventions. He cautioned that implementation requires paid personnel (director, program coordinator, data analyst) and training, but said PQCs in other states produced measurable returns on investment.
The committee asked for additional state examples of the proposed delivery-fee funding model and for more granular cost and savings data; Herrier offered to provide the supporting analyses. The committee did not take a formal vote; members indicated interest in further briefings and potential legislative options next session.
The committee closed the item and noted follow-up would include more detailed cost modeling and discussions with payers and pilot sites.
