Cost Analysis of a Maternity Disease Management Program
Background: With over 4 million births annually in the US, pregnancy is a high-volume and high-cost condition for both public and private payers. Although pregnancy is generally considered to be a time of wellness, certain maternal habits and medical conditions place a pregnancy at risk of maternal and/or neonatal complications. Disease management (DM) provides a framework in which to identify and manage pregnancies at risk of expensive adverse outcomes. Objective: To analyze the costs of a maternity DM program in a commercial health plan population. Methods: We conducted an analysis of maternal and newborn data from a commercial health plan collected before utilization of a maternity DM program (baseline period: January-December 2003) and after initiation of the program (operations period: January-December 2004). The maternity DM program consisted of telephonic risk assessment, patient education, and case management of patients identified as being at high risk for adverse pregnancy outcomes. The average costs per high-risk case and high-risk condition were compared between the baseline and operational periods. Results: A baseline population of 8704 pregnant women in a delivery window of 1 January 2003-31 December 2003 was compared with 7770 pregnant women enrolled for maternity DM in the operations window of 1 January 2004-31 December 2004. In the baseline period, 4756 high-risk conditions were found in 3626 of the 8704 women who experienced a pregnancy (41.7% of patients; a mean of 1.3 conditions per affected pregnancy), while in the operational period, 4377 high-risk conditions were found in 3352 of the 7770 women who experienced a pregnancy (43.1% of patients; a mean of 1.3 conditions). The most common high-risk condition in both study windows was preterm labor (22.8% baseline vs 23.6% operational). The largest average cost per high-risk case in both periods was for multiple-gestation pregnancies ($US23_171 vs $US28_148; year 2004 values). The cost per mother-baby pair was $US9686 in the baseline period compared with $US9116 in the operations period ($US478 per net savings per mother-baby pair). The net return on investment for maternity DM services was 5.2___1 (DM costs to payer of $US713_220). Conclusion: This analysis demonstrates that maternity DM in a commercial population is cost saving.
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