Preterm Birth Toll at $11 Billion

Obstetrical DM Program Demonstrates Significant Savings

Health Enhancement Newsletter
By Gary Stanziano, M.D.
Senior Vice President of Women's and Children's Health
Matria Healthcare
Published October 2004

Continued increases in poor obstetrical and neonatal clinical outcomes and maternity-related costs are approaching catastrophic levels, with families, health plans and employers in the United States paying out more than $11 billion annually, according to the March of Dimes.[1] In addition to the increases in diagnosed chronic diseases, employers now need to be concerned about the rise in preterm labor deliveries and number of infants born at very low birth weights.

Driving the costs are lengthy hospitalizations in neonatal intensive care units (NICUs), which account for 75 percent of charges for pregnancy management. These occur when infants are born with low birth weights of 2,500 grams or less or very low birth weights of 1,500 grams or less. Based on a report by the U.S. Agency for Healthcare Research and Quality, very low birth weight infants end up costing an average of more than $79,000 in medical costs while the charge per discharge of a normal newborn is just a little more than $1,000.[2]

A rise in twin and triplet deliveries, coupled with an increase in the number of women having children later in life, indirectly contributed to a 25 percent increase in preterm deliveries during the 1980s and 1990s, and the rates continue to climb ever higher. The number one way to reduce costs is to prevent extremely early preterm births by lengthening pregnancies and increasing birth weights.

This is where an obstetrical disease management and wellness program can make the difference. Disease management programs manage the care of women at risk for delivering preterm or developing other serious pregnancy complications through intensive training, assessment and education when patients are referred for interventions. Ongoing education and assessments are provided after interventions to improve patient self-care and compliance with the therapy.

Clinicians work with patients to help them improve self-care skills, with the primary goal of preventing prenatal complications that lead to extremely preterm births. Patients are referred to appropriate clinical interventions that can improve clinical outcomes. Statistics show that programs are successful in lengthening pregnancies and increasing birth weights, which reduces the need for lengthy NICU hospitalizations.

For instance, the number of days infants born to women participating in Matria's MaternaLink^® Obstetrical Disease Management Program needed to stay in the NICU in the year 2002 was 37 percent below the national plan average of 1,614 NICU days per 1,000 births. Additionally, the percentage of very low birth weight infants was 0.7 percent, while the national average was 1.1 percent. Likewise, low birth weight infants comprised 4.6 percent of total MaternaLink births, compared to the national average of 6.1 percent. Similar reductions were observed in years 2001 and 2000, translating into a cost savings of $43 million during the three-year period.

Clearly, a disease management model of care, effectively applied to a population of pregnant women, yields improved clinical outcomes, employee productivity and cost savings.

[1] March of Dimes National Prematurity Symposium, Phoenix, Ariz., January 2003

[2] DRG Guidebook: A Comprehensive Resource to the DRG Classification System 2000, 16th editiion, Arita Hart, Sheila Parvis, technical editors, St. Anthony Publishing, 1999