Maternity costs in the U.S. are shockingly high — higher than in any other industrialized nation. But, even with all of this spending, U.S. women face the highest maternal death rate among high-income countries. Much of this is because we fail to identify risks and institute preventative care in time.
And maternity care may continue to become more expensive. Women in the U.S. have some of the highest rates of multiple chronic conditions in the world and the highest rate of mental health needs. For many, adding the cost of prenatal care is just too much, so they skip or delay routine health visits. This can lead to more dangerous, expensive health issues later.
This broken system also impacts the bottom line for health plans and employers: the annual total healthcare expenditures for people with female-specific health conditions is estimated to be more than $108 billion.
Preventable pregnancy-related health issues make up a notable percentage of these costs. For example, in the U.S.:
- Preterm births cost more than $25 billion per year.
- Gestational diabetes costs $636 million per year.
- Preeclampsia costs $1.03 billion per year.
The good news is that there are lots of things payers can do to lower costs and improve pregnancy outcomes. One of the most important is to reach people early in their pregnancies with care, screenings, and education to help them lower their risks and stay healthy.
There are three important steps healthcare plans and employers can take to make this change:
- Identify pregnant members earlier.
- Use data to understand risks for pregnant members as early as possible.
- Personalize care for each member based on their specific risks. This includes targeted education, symptom tracking, and tools for behavior change.
The trick to discovering pregnancy — and risks — early so you can improve health outcomes
Catching risks early is especially difficult when it comes to pregnancy because most health plans don’t know a member is pregnant early enough. Oftentimes, they aren’t aware until they receive a claim for a member’s 12-week ultrasound, the second-trimester anatomy scan, or even later. But data shows that addressing risks earlier is the key to improving pregnancy outcomes. The first trimester is critical for fetal development, and it’s the time when people make decisions about their prenatal care.
First-trimester interventions can help members:
- Understand their risks and how to lower them.
- Advocate for the care they need, such as cervical measurement, to help catch health issues early.
- Begin taking prenatal vitamins and other preventatives if needed (such as low-dose aspirin to reduce the risk of preeclampsia, or progesterone to lower the risk of preterm birth).
- Adopt an exercise plan and understand healthy weight gain during pregnancy.
- Choose a high-quality hospital to help reduce the risk of unnecessary C-section.
Lots of health plans include these steps in their maternity care programs, but if you don’t know a member is pregnant, you can’t reach them in time to lower risks and help them adopt the behaviors that lead to healthier outcomes.
That’s where a good digital health partner comes in — one that can engage members at the very beginning of a pregnancy (or even before conception) and see them through the whole process with personalized risk assessments, education, and support.
Want a digital health partner to help your members have safer birth outcomes? Look for these 5 things
If you’re looking for a digital health partner who can help you reach members early and guide them toward healthy behaviors and preventive care, here are the five most important qualities to look for:
1. A program with a large user base and a proven track record of early adoption and regular use.
Over the last 10 years, Ovia has served more than 18 million family journeys. 83 percent of them enrolled during their first trimester or earlier (Ovia also offers fertility support). On average, Ovia members engage with our program daily.
2. A history of motivating members toward healthy behavior change, and an ROI to prove it.
On average, Ovia clients see a 4:1 ROI. Our solution is backed by more than a decade of claims data that shows reductions in costly health outcomes from conception through birth, along with greater adoption of risk-reducing behaviors. For example:
- 33 percent of members identified as subfertile went on to conceive on their own, without ART (assisted reproductive technology). This helped reduce dangerous multiple births, increasing singleton pregnancies by 30 percent.
- 28 percent reduction in preterm delivery and NICU stays.
- 34 percent reduction in C-section rates.
- 18 percent reduction in preeclampsia.
- 91 percent breastfeeding initiation rate.
- 31 percent increase in perinatal mental health treatment.
3. Products and programs built on clinical evidence.
Ovia’s algorithms continuously evaluate more than 70 risk factors based on the latest obstetric and gynecological guidelines. This helps identify risks well before claims data is available. Using what we’ve learned about risks and outcomes over the past decade, we’ve developed more than 50 clinical pathways so that we can address each member’s specific risks and needs.
Ovia is also the only women’s and family health solution with its own dedicated research branch. Our team has partnered with more than 40 academic institutions (including University of Arizona, University of Wisconsin, and Harvard’s TH Chan School of Public Health) to study women’s health. And we’ve published more than 50 peer-reviewed clinical papers in leading journals.
4. A proactive, personalized approach.
Ovia personalizes each member’s experience based on a comprehensive assessment (95 percent of members who begin our assessment complete it) and daily data inputs by members. We monitor data to provide predictive interventions, reaching out directly to members when a sign or symptom requires action. We recommend visits to a primary care doctor or obstetrician when needed.
5. Data-sharing capabilities so you can integrate with your existing nurse care management system.
Ovia is designed to integrate a member-level data feed with health plan partners. We can also integrate and augment existing maternity care management programs to create a seamless experience for your members.
Want to know more about Ovia? We offer comprehensive women’s and family health programs that include 1:1 coaching, physician-developed clinical programs, and personalized health and wellness education. Visit www.oviahealth.com to discover more.
1. Kaiser Family Foundation (KFF): https://www.kff.org/slideshow/health-spending-in-the-u-s-as-compared-to-other-countries-slideshow/
2. The Commonwealth Fund: https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age
3. The Commonwealth Fund: https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age
4. The Commonwealth Fund: https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age
5. Women’s Health Issues: https://pubmed.ncbi.nlm.nih.gov/17321943/
6. March of Dimes: https://www.marchofdimes.org/peristats/data?reg=99&top=3&stop=362&lev=1&slev=1&obj=1
7. Population Health Management: https://www.liebertpub.com/doi/pdf/10.1089/pop.2009.12303#:~:text=Our%20national%20estimate%20of%20%24636,by%20an%20average%20of%20%243%2C305
8. American Journal of Obstetrics and Gynecology: https://pubmed.ncbi.nlm.nih.gov/28708975/#:~:text=Overall%2C%20the%20total%20cost%20burden,at%2036%20weeks%20gestational%20age
9. Maternal and Child Health Journal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269518/