Sexual and Reproductive health is a broad category and relates primarily to what many call Women’s Health. That said, we will intentionally use more inclusive language that encompasses all individuals who deal with issues like pregnancy and pelvic floor disorders.
Sexual and Reproductive Health issues can be significant cost drivers for employers, but self-funding allows employers to build health plans that can help mitigate risk and even improve member lives.
In the sexual and reproductive health arena, not surprisingly, the largest cost drivers relate to pregnancy and delivery. According to research published by the Peterson Center on Healthcare and the Kaiser Family Foundation (KFF), individuals who give birth incur nearly $18,865 in additional healthcare costs compared to women of the same age who did not give birth – this number includes pre- and post-partum care as well.
Peterson-KFF study found that an average vaginal birth incurred $14,768 in total costs. The average cesarean section (C-section) costs $26,280. The increased costs associated with C-sections derive from a variety of factors. C-sections can be necessary to protect the lives of the mother and child, but the procedure, in and of itself, is costlier than a vaginal birth. C-section births also tend to require longer hospital stays and leave the parent and child at risk for surgical complications.
Beyond the routine costs of labor and delivery, pregnancy complications pose further risks to health plans and members alike. Surgical procedures, inpatient hospital stays, and even neonatal ICU stays cost tens of thousands of dollars. It should be noted, however, that these monetary costs pale in comparison to the physical, emotional, and mental impacts that these episodes can have on families and workplaces.
Sexual and Reproductive Health also encompasses pelvic floor disorders that carry additional risks. These issues are all too prevalent, with 1-in-4 American women suffering from pelvic floor issues, such as endometriosis.
Encountering Endometriosis
Endometriosis is when tissue that usually lines the inside of the uterus grows outside of the uterus, resulting in pain, menstrual irregularities, and even infertility. It is a condition that Roundstone’s CSI team regularly encounters.
When looking for savings potential in self-funding, Roundstone’s CSI team analyzed the medical claims of 97 members who have been diagnosed with endometriosis. On average, treatment directly related to endometriosis costs the health plan $5,253 per member per year (not including $403 in average yearly members costs). On the high end of the spectrum, a single procedure costs the member’s plan more than $90,000.
In total, treatment of endometriosis cost 73 health plans a total of $565,730. Members’ costs totaled $37,713.
These costs relate only to the direct costs of treatment. Employers and members must also deal with the downstream behavioral and physical health risks of Sexual and Reproductive Health issues. Not to mention indirect costs like decreased productivity and increased turnover.
What can self-insured employers do to help manage these costs, and also ensure quality of life for members and their families?
Make Preventative Care Accessible in Your Self-Funded Plan
Preventative care for Sexual and Reproductive Health issues is a key component of any efforts to improve clinical outcomes and mitigate financial risks for employers. By removing financial barriers to care, employers can encourage members to utilize these crucial services.
A recent study published in JAMA surveyed 3,509 participants who were pregnant at the time of the study or had just given birth. 24% of the participants reported unmet healthcare needs during their pregnancies, 60% reported healthcare unaffordability. As many as one third of American women have reported skipping necessary medical care due to out of pocket costs. This sobering statistic helps explain why the US has higher maternal mortality rates than any other high-income countries.
Members delaying care due to cost concerns is a major financial risk for employers. Numerous studies have found that a lack of prenatal care increases risks for pregnancy complications, as well as maternal (and infant) mortality. Regular prenatal visits can help providers catch potential issues early, educate families on healthier habits, and helps members deal with other chronic conditions that can affect pregnancies – like diabetes and depression.
Accessible preventative care can also help self-insured members manage the symptoms and outcomes of other Sexual and Reproductive Health conditions. Pelvic floor therapy through Bloom, a digital health solution that addresses female pelvic health, for example, can help members reduce pain associated with menopausal uterine prolapse and even decrease pain during intercourse for members dealing with endometriosis.
Self-funded plan design modifications that limit cost-sharing obligations for prenatal care and other preventative services may help improve outcomes for employers and members alike.
Educate Members on Benefits in a Self-Funded Plan
Even the most hyper-accessible, doula-covering, midwife-incentivizing plan is only successful if members know what’s covered (and what isn’t). Management and HR should work together to advertise self-funded plan benefits to employees and their dependents.
Self-insured employers can also invest in services that relieve some of the HR’s workload. Partnering with a good healthcare concierge service like Rightway Health can help members navigate their benefits at any time. Concierge services (also called healthcare navigation services) connect members with benefits experts who can guide members to in-network providers, help members review claims, and direct them to additional employee benefits.
Good concierge services (like Rightway) also guide members according to provider quality – which plays a key role in improving outcomes for sexual and reproductive health issues.
Address Your Population’s Needs
Sexual and reproductive health issues affect different communities in different ways. Geography and socioeconomic concerns affect the access that individuals have to prenatal care, and other sexual and reproductive health services.
According to research published by the March of Dimes, 35.6% of counties in the US are maternity care deserts, having no hospitals providing obstetric care, no birth centers, no OB/GYN and no certified nurse midwives. This lack of access affects 2.2 million individuals of childbearing age, and almost 150,000 babies.
Racial disparities in access to healthcare services also affect outcomes. Research published by the American Journal of Public Health found that the maternal mortality rate for Black Americans is 3.5 times higher than white Americans. This disparity extends to indigenous communities as well.
Employers should not be expected to single-handedly solve the complex systemic issues that drive racial and geographic disparities in access to sexual and reproductive healthcare, but awareness of these inequalities is an important step to understanding the risks faced by unique employee populations.
If a high proportion of employees live in maternity care deserts, employers can ensure their self-funded plan offers adequate telehealth services to help members connect with providers.
To help tackle racial disparities, self-insured employers can invest in navigation services that allow members to seek providers according to ethnic, gender, or religious preferences. Research suggests that provider demographics can influence clinical outcomes. For example, a study carried out by researchers from Harvard and George Mason University found that Black infant mortality decreased when the family was paired with Black physicians.
Numerous studies have borne out the unfortunate reality that the clinical field is not immune to racial biases. With this in mind, some members of historically marginalized communities are able to better trust clinical guidance from providers who come from their own communities and may share similar experiences.
Sexual and reproductive health issues are complex, but the good news is that self-funded employers have the flexibility to offer employee benefits that can improve the quality of care while mitigating future cost risks. Like many other healthcare issues, accessibility, education, and understanding are key to effective cost containment, and better lives, particularly in a self-insured plan.
This is not clinical advice. Any decisions regarding one’s health should be made with the guidance of a qualified clinical professional.
