One of every eight babies in the United States is born prematurely. While advances in medical technology continue to improve the rate of successful births nationwide, costs associated with complications in pregnancy continue to soar. Based on studies conducted by the March of Dimes, nearly half of hospital charges for premature infants in the United States were billed to employers and other private insurers. The cost: more than $26.2 billion annually, according to the Centers for Disease Control and Prevention.
The good news is that employers can play a role in keeping pregnant employees healthy while helping to reduce the costs associated with a premature pregnancy. By offering a maternity management program in the workplace in which mothers-to-be follow a prenatal care regimen, organizations can help reduce premature births and birth defects, lower pregnancy-related costs and improve health outcomes for the mother and newborn.
Some additional facts:
• Direct health care costs to employers for premature babies during their first year of life averaged $41,610, compared to $2,830 for babies born healthy and full term, according to the March of Dimes. In addition, costs associated with missed work and disability for the first year averaged an incremental $2,766 per premature baby compared to a healthy full-term baby.
• Many pre-existing conditions can lead to costly complications associated with pregnancy.
• Getting mothers to enroll in a best-in-class workplace maternity management program early in their pregnancy is the key to increasing healthy pregnancies and deliveries.
Increase in Premature Births
According to the National Center for Health Statistics (NCHS), the preterm birth rate increased by 14 percent between 1994 and 2004. This increase is so alarming that it has been referred to as a national crisis by the March of Dimes. More recent preterm birth rate figures indicate that the preterm birth rate continues to increase. In 2004, the preterm birth rate in the United States was 12.5 percent of live births, and according to the NCHS, the number from 2006 estimates is about 12.8 percent—meaning that more than a half million babies are born too soon each year.
The costs associated with premature births are bad for employees and employers. With mounting deductibles and co-payments, costly medical services and neonatal intensive-care unit costs increasing by 10 to 13 percent a year, employers and families are hit hard.
Another significant concern regarding preterm babies is the impact of birth defects. According to the NCHS, an estimated 120,000 U.S. babies are born each year with major structural defects; this figure represents approximately 3 percent of live births. These birth defects can be devastating not only for the baby’s health but also for the parents’ and employers’ pocketbooks. According to a report issued by the Agency for Healthcare Research and Quality, hospital costs associated with stays related to birth defects totaled $2.6 billion in 2004.
Prenatal Care Prevents Defects
If mothers-to-be enroll in appropriate prenatal care, many of the complications associated with pregnancy can be avoided. For example, according to the March of Dimes, up to 70 percent of neural tube defects—birth defects of the brain and spinal cord—might be prevented if women consume 400 micrograms of folic acid daily, prior to and during the early weeks of conception. The Journal of the American Medical Association reported that smoking during pregnancy is a significant and modifiable risk factor for low birth weight and preterm delivery. A little education and guidance can go a long way toward helping mothers-to-be experience full-term pregnancies.
If mothers-to-be enroll in prenatal care, many
complications associated with pregnancy
can be avoided.
Getting mothers to enroll in a best-in-class workplace maternity management program early in their pregnancy is the key to increasing healthy pregnancies and deliveries. Programs geared to identify and enroll all mothers—not just those with high-risk conditions—as early in their pregnancies as possible, preferably in the first trimester, demonstrate reduced premature birth rates. In particular, premature births have been shown to be reduced by programs that include:
• A comprehensive assessment, followed by an individualized care plan that addresses the needs of the mother-to-be throughout her entire pregnancy and postpartum.
• A sophisticated medical/pharmacy claims-based tool that identifies and stratifies pregnant employees so they can receive appropriate care.
• Coupling the mother-to-be with a dedicated maternity nurse health coach, with whom she can build a personal relationship and address her concerns, especially those requiring behavioral change to reduce risk factors.
Programs that have physician oversight and consultation provide a higher level of management, which is essential during this period of time.
An Integrated Approach
Progressive maternity management programs that integrate care management across the entire spectrum of health care services—including wellness programs, disease management, case management utilization review and disability management—are able to provide more benefits than stand-alone maternity management programs. The benefits of an integrated program include:
• Providing earlier identification of mothers-to-be, and identifying potential risk factors sooner (i.e., managing preexisting conditions such as diabetes, asthma, hypertension and other chronic conditions that might complicate a pregnancy, so as to mitigate their negative impact).
• Offering a single point of management that reduces stress and is more efficient for the mother-to-be and the employer.
• Delivering more complete information pertaining to the health of the mother-to-be and her expected infant.
Integrated maternity management programs are more effective in managing health and cost, as they allow the clinical staff and maternity nurse health coach to access important clinical information at the most crucial times.
Through an integrated model, preexisting conditions that can cause severe complications with a pregnancy can be identified through a variety of methods, including analysis of medical/pharmacy claims and information recorded through a health-risk assessment or via prior disability information.
Between early identification of a pregnancy and identification of preexisting chronic conditions (e.g., diabetes, hypertension, obesity or asthma), appropriate care plans can be developed by the dedicated nurse health coach to manage and support a mother-to-be during her pregnancy.
The Bottom Line
Many preexisting conditions can lead to costly complications associated with pregnancy. Progressive maternity management of those conditions can mitigate complications during pregnancy and reduce costs greatly. The result: Healthy mothers, healthy babies and a healthy bottom line for pregnancy-related costs.
Calvin “Chris” Wilhide, Ph.D., is director of program development and research for Nationwide Better Health, based in the company’s Hunt Valley, Maryland location. He is responsible for development of clinical programs for disease management.