Unintended pregnancies remain a significant problem to be tackled through the input and involvement of purchasers of care, such as self-funded employers. As seen in the current analysis by Dieguez and colleagues, the consistently high estimate of unintended pregnancies that persist today represents a general call to action for those in charge of benefit plan design in terms of the medical and the pharmacy benefits provided to plan members.
The US Centers for Disease Control and Prevention (CDC) Division of Reproductive Health monitors maternal and infant health, including many issues related to the consequences of pregnancy.2 A number of surveillance systems, data, and reports are available to inform benefit decision makers on the CDC’s website about the extent and potential burden of unintended pregnancies in the United States.3
In terms of maternal and fetal medicine, for example, neonatal costs continue to be a significant economic driver for variations in clinical care. The March of Dimes produces an annual scorecard of premature births in each state, with a corresponding letter grade assigned to it.4 In 2014, South Carolina was tied with Florida for the fourth highest rate of preterm births in the country.4 Also in 2014, South Carolina received a “D” grade rating from the March of Dimes.5
The South Carolina Birth Outcomes Initiative, a collaborative effort that focused on population health and engages all healthcare stakeholders, including employers and commercial insurance plans, was launched in July 2011.6 The South Carolina Birth Outcomes Initiative is now a best practices case study for turning the situation around with regard to the elimination of elective inductions for nonmedically indicated deliveries before 39 weeks, unless medically necessary.6
The change in rating in 1 year alone can represent a true quality shift in Leapfrog Hospital Safety scores for participating hospitals, in addition to Medicaid and commercial health insurance benefits, in terms of avoiding maternal or infant complications, as well as preventing increased medical costs.7 The multistakeholder South Carolina Birth Outcomes Initiative illustrates how population health can include the employer as part of the solution, as well as contribute to improving the health of a population.
EMPLOYERS/PROVIDERS/PATIENTS: The article by Dieguez and colleagues can assist employers as purchasers of care, along with providers (ie, medical groups, hospitals, and health systems) and patients (ie, employee plan members) to know all the factors and options related to dealing with value-based decision-making on an important issue such as unintended pregnancies.1 These factors include economics as well as clinical outcomes from various stakeholder perspectives related to today’s shared responsibility of managing healthcare risk.
1. Dieguez G, Pyenson BS, Law AW, et al. The cost of unintended pregnancies for employer-sponsored health insurance plans. Am Health Drug Benefits. 2015;8:83-91.
2. US Centers for Disease Control and Prevention. Maternal and infant health. Updated March 11, 2015. www.cdc.gov/reproductivehealth/MaternalInfantHealth/index.htm. Accessed March 20, 2015.
3. US Centers for Disease Control and Prevention. Reproductive health: data and statistics. Updated February 4, 2015. www.cdc.gov/reproductivehealth/Data_Stats/index.htm. Accessed March 20, 2015.
4. March of Dimes. 2014 Premature birth report cards. www.marchofdimes.org/mission/prematurity-reportcard.aspx. Accessed March 20, 2015.
5. March of Dimes. 2014 Premature birth report card: South Carolina. www.marchofdimes.org/materials/premature-birth-report-card-south-carolina.pdf. Accessed March 20, 2015.
6. South Carolina Healthy Connections. South Carolina Birth Outcomes Initiative. www.scdhhs.gov/organizations/boi. Accessed March 20, 2015.
7. The Leapfrog Group. Early elective deliveries fact sheet. https://leapfroghospitalsurvey.org/web/wp-content/uploads/FSdeliveries.pdf. Accessed March 20, 2015.