As the number of women of childbearing age entering the workforce continues to increase, employers are experiencing the impact of pregnancy at the Worksite. At the same time, expenses related to childbirth are often the single largest component of health care costs, ranging from 10% to 49% of all expenses. The emotional and financial impact on employees, families and employers have prompted the need to provide resources and intervention to address this issue.
Program Description
Narrative Description of Program
As the number of women of childbearing age entering the workforce continues to increase, employers are experiencing the impact of pregnancy at the Worksite. At the same time, expenses related to childbirth are often the single largest component of health care costs, ranging from 10% to 49% of all expenses. The emotional and financial impact on employees, families and employers have prompted the need to provide resources and intervention to address this issue.
The encouraging and exciting aspect of prenatal cost management is that many of the complications and expenses can be modified through education and intervention. Health Management Corporation's Baby Benefits program is an effective way to improve the outcome of pregnancy thus benefiting the employee, family and employer.
Baby Benefits was introduced in 1989 as the first commercial prenatal program in the United States with the mission of helping to produce the best possible pregnancy outcomes. In order to accomplish this goal, Baby Benefits centers around several key components:
- Promotion: to recruit and encourage participation
- Risk Assessment: to identify those participants with potential for complications
- Education: to provide awareness and skills to participants so they may play a more active role in ensuring a health pregnancy
- Support: to support the physician's plan of treatment and make available to the participant all existing resources that will impact positively on the pregnancy outcome
- Intervention: to provide maternity and benefits management to those individuals whose risk levels can be impacted.
The Baby Benefits program has resulted in improved pregnancy outcomes for mothers and babies as well as documented reductions in the costs associated with avoidable preterm deliveries.
Program Description
Baby Benefits was introduced in August of 1989 as the first commercially available prenatal risk management program in the United States. The program is founded upon extensive research conducted by Health Management Corporation and focuses on improving the health of both mothers and their babies.
Baby Benefits addresses many of the Healthy 2000 objectives, especially those related to maternal and infant health. These objectives include the reduction of infant mortality rates, reduction of low birthweight babies, reduced cesarean delivery rates, alcohol, tobacco and drug abstinence and an increase in the number of women receiving proper prenatal care.
Baby Benefits goals and objectives are reached through a process of participant assessment, education and intervention delivered through the worksite, medicare or health plans. Through ongoing cost/benefit analysis, HMC has identified those prenatal issues which relate to increased costs and has incorporated education and intervention to address them.
The confidential program is staffed by nurses, each with over five years experience in obstetrical/perinatal care with obstetrical specialty certification and or a degree. They are required to participate in continuing education classes and conferences.
Baby Benefits is available in Spanish and low-literacy versions.
Contact Summary
| General Information | |
|---|---|
| Program Name | Baby Benefits - Prenatal Risk Management |
| Company Name and Address | Health Management CorporationP.O. Box 26016Richmond, VA 23260 |
| Contact Person | Robin Foust, Director,Market and Product Development(804) 354-4089 |
| Program Information | |
| Program Category | Innovator/Vendor |
| Year begun | 1989 |
| Total number of individual participants | 30,000 |
| Number of currently actively enrolled | 4,582 |
| Number of companies/groups involved | 16,000 |
| Access to Program | Marketed broadly, replicated |
| Cost per participant per year | Varies |
| Estimated cost savings per participant per year | Varies |
| Data available to external reviewers or investigators | Yes |
| Program targeted at Healthy People 2000 goals |
Yes |
| Program goals (in priority order) | (1) Health outcome improvement(2) Cost-benefit(3) Risk Factor Reduction
(4) Cost-effectiveness |
Evaluation Summary
Summary of Findings
Participation: Participation in the program tends to vary by group size and ranges from 43% for groups with more than 1,000 employees to 55% for groups with less than 500 employees.
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.
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.
Summary of Findings
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).
Evaluation Documentation
Critique
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.