Evaluation Summary

Baby Benefits Program Evaluation 

Summary of Findings

Timing of Registration: Most participants register for the program early in their pregnancies. In fact, 59% of all participants register in their first trimester, 32% in their second trimester and 9% in their third trimester.

Risk Assessment: Approximately 79% of all participants are assessed for risk of premature birth. Of those assessed, 23% have been identified to be at increased risk for premature birth. The primary risk factors for the high risk participants include hypertension, pregnancy-induced-hypertension, multiple gestation, diabetes, gestational diabetes, symptoms of preterm labor, bleeding or placental complications. In addition, approximately one in four high risk participants indicated behavioral and/or demographic risk factors.

Delivery Outcomes: Program participants deliver fewer premature infants than average, even though their risk levels are higher than average:

Birth Weight	Participants	U.S. Average	Va. Average
Normal (>=2,500g)	94.8%	91.6%	92.6%
Low (<2,500g)	5.2%	8.4%	7.4%
Very Low (<1,500g)	0.8%	1.3%	1.5%

Inpatient Hospital Claims Analysis: Obstetric claims indicate that although the average maternity charge is lower for non-participants than participants, non-participants deliver proportionately more infants requiring hospitalization related to prematurity than participants, and their infants incur more prematurity -related claims than those born to participants. NICU days/1,000 deliveries are also 35% higher for infants born to non-participants than those born to participants, and claims related to preterm birth and infant prematurity represent a larger portion of non-participant obstetric claims than participant obstetric claims. When claims are reviewed by major risk factors for premature birth, such as multiple gestation and hypertension, participant and non-participant variances are even greater. This indicates that participants have healthier and less costly delivery outcomes than non-participants, even though they are at greater risk for complications.

	Participants	Non-participants	Variance
Average Cost per Mother	$3,732	$3,240	-13.1%
% Infacts w/Prematurity Claims	2.3%	2.6%	+0.3%
Avg Cost per Prem. Infant	$29,591	$33,132	+12.0%
% of Claims Spent on Prematurity	20.6%	25.2%	+4.6%
NICU Days/1000: Inf. w/Prem. Claims	184	248	+34.8%

Cost Savings: The reduced incidence of low birth weight infants among program participants translates to less frequent and less severe prematurity claims. This reduction in prematurity claims is almost three times more than the cost of the program. In fact, based on the above findings, cost savings total $3.63 for every dollar invested in the program.

II. Evaluation Description

Baby Benefits has documented the following results: 

• Reduction in maternity claims: Savings are estimated at 20-40% of all prematurity/low birth weight claims and 4-8 % of all obstetric claims. 
• An actuarial study conducted by Trigon Blue Cross Blue Shield (Blue Cross and Blue Shield of Virginia) documents various program successes 
• The Sara Lee financial impact study documents a $2.50 return on every $1.00 invested.

Following are highlights of the Baby Benefits Financial Impact study conducted for Sara Lee Corporation:

Participation: Sara Lee Corporation implemented the Baby Benefits program in July, 1992. Currently, participation levels are estimated to be at approximately 51%. (1)

Incidence and Severity of Prematurity: Both the incidence and severity of prematurity cases decreased after program implementation. The percentage of infants who incurred prematurity claims decreased from 3.5 % of all cases in the first period to 3.1% of all cases in the second period, and the average infant prematurity charge decreased from $21,890 per infant in the first period to $18,922 per infant in the second period, a 14% reduction in average infant prematurity charges.

Impact of Program on Obstetric Claims: Claims related to preterm birth or infant prematurity totalled $1,225,383 during the first period and $1,322,761 during the second period. When calculated as a percentage of total claims, the percentage of total claims related to prematurity decreased from 30% in Period 1 to 22% in Period 2.

Participant Satisfaction: To date, program participants have expressed high levels of satisfaction with the program's services. In fact, 95% of the 370 respondents rated the program as excellent (66%) or good (29%), and 96% indicated that they would recommend the program to others. In addition, more than two thirds of the respondents noted that they had improved their health habits as a result of information they received from the program.

Cost Savings: The Baby Benefits program had a significant impact on Sara Lee's obstetric claims. The reduction of incidence and severity of prematurity cases that resulted from program utilization generated substantial savings, as was seen by the decrease in prematurity charges as a percentage of total charges. A conservative estimate of cost savings related to program implementation and utilization is $699,277 per year or $2.50 for every dollar invested in the program (see Attachment 3). Cost savings, when computed as a percentage of total claims and total prematurity charges, were equivalent to approximately 10% of all obstetric charges or 33% of all prematurity charges for the first year of the program. (2)

Notes: (1) Due to the time lag between the time a participant registers for the program and when she delivers, the percentage of total women who incurred obstetric admissions that participated in the program was less than 5 1%. It is estimated that approximately 32% of all women who incurred obstetric admissions during the second period were program participants.

(2) Similar savings estimates related to the utilization of the Baby Benefits program were identified in a study conducted by Blue Cross and Blue Shield of Virginia's Actuarial department. The study concluded that, with a participation rate of 32.7%, savings related to program utilization totalled 3.2 % of all obstetric claims or 20.1% of all claims related to prematurity. The variance between the savings estimates identified in the actuarial study and those identified for Sara Lee are due, in part, to differences in participation rates and the risk levels of program participants (a higher percentage of participants were identified to be at increased risk for the Sara Lee population than for the study group) and a difference in the types of claims that were reviewed by the actuarial department. The impact study for Sara Lee incorporated a more limited list of ICD9 codes than that of the Actuarial study (i.e. physician charges, well baby charges and infant charges not related to prematurity were not included in tie impact study for Sara Lee).