The inability to conceive a baby is a complex and deeply emotional experience for members and their families. As a highly specialized area of care, fertility treatment is a significant cost driver for health plans and employers.
Leveraging highly experienced fertility clinicians, adhering to evidence-based clinical practices associated with achieving healthy pregnancies, and educating members about treatment options can help achieve quality outcomes and lower costs.
Optum Fertility Solutions is a case management program that supports effective treatment decisions and guides members to highly qualified providers. To quantify the benefit of the program, we conducted a study of commercial plan members.
The case study
Optum analyzed a treatment group and a control group of female members over a 41-month period.
- The treatment group (16,496 members) — were those who had claims for fertility treatments covered by their employers’ plan, and had access to Optum Fertility Solutions case management.
- The control group (16,255 members) — were those who had claims for fertility treatments covered by their employers’ plan, but had no access to Optum Fertility Solutions case management.
Optum Fertility Solutions
- Supports and educates members about treatment decisions and finding quality providers
- Leverages expertise of board-certified reproductive endocrinologists, fertility nurses and social workers
- Navigates to other relevant health management programs available to them
The results: lower costs, better outcomes
- Higher Center of Excellence utilization: The treatment group used Centers of Excellence (COE) facilities at a higher rate (72.9%) than females without access to Fertility Solutions (55.6%).
- 5% fewer cesarean deliveries: Treatment group members (48.4%) had five percent lower cesarean delivery rates than control group members (50.7%).
- Lower fertility treatment costs: Treatment group members incurred lower in-vitro fertilization (IVF) treatment costs. Average cost per treatment cycle for IVF was $7,964 for the treatment group compared to $9,605 for the control group, a savings of $1,641 per treated member.
- 8% more successful pregnancies: Members in the treatment group (56.9%) getting IVF treatments were eight percent more likely to achieve a successful pregnancy and delivery than the control group (52.6%).
- Shorter days to pregnancy: Members in the treatment group (170.8) achieved a successful pregnancy eight days sooner than the control group (178.8)
- 1.2% higher singleton rate: Treatment group members seeking care in a COE had a higher singleton baby rate (90.4%) than non-COE users (89.2%)
- Healthier maternal outcomes: Mothers in the treatment group (10.17 days) had a 0.49 day reduction NICU length-of-stay. Overall, there was a 2% savings in pregnancy, delivery and newborn costs for mothers in the treatment group compared to those in the control group (10.66 days).