Addressing Top Cost Conditions: High-risk Maternity and NICU

Learn how employers can avoid high-risk maternity and NICU costs through programs and initiatives.


April 14, 2021

According to the 2021 Large Employers’ Health Care Strategy and Plan Design Survey, 24% of surveyed employers say high-risk maternity and NICU care are among their top three health care cost trend drivers. This makes sense given that maternity is top reason for hospitalization and that many employees are choosing to have children later in life, sometimes with the support of advanced reproductive technology (ART).

Employers can consider the following strategies to improve the quality of maternity care, starting with preconception to the delivery room, which will help employees avoid high-risk pregnancies and having their newborns stay in the neonatal intensive care unit (NICU).

  • 1 | Offer evidence-based fertility treatment coverage. Differentiating out-of-pocket costs between in- and out-of-network providers can incentivize members to choose fertility providers and treatments with better outcomes. Ensure that eligibility requirements for fertility treatments include single parents by choice and LGBTQ families by expanding beyond clinical definitions of infertility.
  • 2 | Provide fertility, adoption and surrogacy benefits to support all types of paths to parenthood.
  • 3 | Encourage early engagement in maternity case management programs by promoting their availability and incentivizing with enrollment giveaways.
  • 4 | Consider offering a maternity point solution to those trying to conceive, currently expecting or post-partum. Look for programs that have demonstrated clinical outcomes, are easily accessible and integrate with the employees’ medical benefits/network providers, in addition to connecting and coordinating with each employee’s OB/GYN.
  • 5 | For locations with a high concentration of employees, consider offering a Centers of Excellence (COE) program for maternity. Structure a bundled payment reimbursement for high-volume, high-quality centers.

To learn more about these strategies, view the playback video below from the Business Group’s virtual learning series on Addressing Top Cost Conditions, featuring UnitedHealth Group and First Republic Bank. Additionally, more extensive resources can be found to the right.

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