Delivering on the promise of fertility care

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).

Study conclusion

This study indicates that the Optum Fertility Solutions program helps connect members to treatment that facilitates higher successful pregnancies, faster time to delivery, better outcomes and lower fertility costs. In addition to fertility program savings, the study demonstrated program savings for pregnancy, delivery and NICU cost savings.