Critique 

Health Management Corporation - Baby Benefits, Prenatal Risk Management

The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.

Evaluation: Health Management Corporation's "Baby Benefits" program, provided Sarah Lee a 10 percent reduction in in-patient obstetric charges, a 33 percent reduction in in-patient charges and $699,000 savings related to prematurity, or $2.50 per $1 invested. "Trigon Blue Cross Blue Shield's" use of the "Baby Benefits" program, saved 20.1 percent on prematurity/low birth weight claims on over 30,000 contracts from fewer pre-term births and lower costs.

Supports Healthy People 2000 goals and objectives. Program model includes intervention strategies which support behavior change and risk reduction. Program data demonstrates strong evidence for cost-savings based on direct claims analysis. Uses lifestyle assessment and addresses all of the critical behaviors for mothers and babies. This is considered a very strong prenatal program. There is a company commitment to well baby/mother care. Cost-benefit analysis indicates an excellent return on investment of $250 saved for each dollar invested.

Participation rates are low. Description of the program is not sufficient to understand all aspects. What has happened after 1993? Program evaluation holds that the program saves money because claims related to pre-term birth or infant pre-maturity decreased as a percent of total claims. The partial inappropriateness of this measure is indicated by the fact that these costs actually increased. A more appropriate measure would be the change in the prevalence rate or the cost per person among the target population. Despite this, attachment two indicates that the incidence of pre-maturity was 1.2 percent in participants and 1.8 percent among non-participants and that cost per infant was $10,000 among participants and $24,000 among non-participants, which is impressive.