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Programs aim to reduce at-risk pregnancies and premature births


The costs of delivering a child too early, and with a lifetime of health complications that typically follow, can skyrocket quickly, making pregnancy and baby-related costs among the highest in the insurance arena, experts say.

Dr. Pamela Hymel, medical director for integrated health at San Jose, Calif.-based Cisco Systems Inc., reported that about 50% of the company's medical claims costs in 2006 were related to pregnancy.

That's why experts say it's common for most companies, such as Cisco, to include some form of voluntary pregnancy wellness program as part of their benefits plan, even doling out attractive incentives--from gift certificates and new baby necessities to cash--to entice women into signing up. And more and more, insurance companies are polishing their programs to avoid the hefty costs to employers.

A baby that is born before 37 weeks is considered premature and often suffers a list of ailments due to underdevelopment, leading to lengthy hospital stays and a plethora of tests and monitoring.

Cindy Gates, Baltimore-based vp in clinical consulting for Aon Consulting, has seen tabs run as high as $200,000; others in the field say costs can run well past $500,000.

"The big key (for businesses) is not having a 24-week baby being born and all the costs associated with that," Ms. Gates said. "This can be very costly, and that is just getting them out of the intensive care unit. Typically these children have more problems later on."

According to the March of Dimes, a White Plains, N.Y.-based nonprofit that aims to improve the health of babies, employers pay nearly 15 times more for premature babies in their first year than for babies born full-term at 40 weeks or more.

"Maternity could be the biggest health expense for companies with a lot of employees of childbearing age...All it takes is one premature baby to reach a million in costs," said Helen Darling, president of the Washington-based National Business Group on Health. "I don't know any employer that doesn't have a program that identifies high-risk pregnancies. The programs are so important and have such a huge impact."

The goal, according to experts, is to provide pregnant women with a wealth of information, track pregnancies, look for the red flags that could lead to a premature birth or health complications, and offer preventative solutions and support--all in an effort to produce a healthy child and avoid expensive bills.

Research by and large shows that women who receive adequate prenatal care and monitoring produce healthy babies. One extensive study by Baltimore-based Johns Hopkins Medical Institutions, for example, found that as little as one prenatal visit can decrease the risk of a premature birth.

Citing the studies, most prenatal programs are sponsored by insurance companies as part of overall wellness and disease-management packages that are attached to health care policies. For that reason, it's difficult to break out the cost of the prenatal programs, said Ms. Gates, who estimates that the costs can run 70 cents to $1 per employee per month.

Insurers, meanwhile, declined to elaborate on program prices.

According to Steve Raetzman, an Arlington, Va.-based senior group health consultant with Watson Wyatt Worldwide, employers almost always prefer early pregnancy care.

"There is a much higher willingness for employers and insurers to sponsor these types of services for mothers because the tools...the low costs and the quality are there," Mr. Raetzman said.

So what can pregnant employees expect?

Mr. Raetzman said programs have evolved in the past 10 years from an impersonal prenatal health book or pamphlet mailed to pregnant employees to today's 24-hour nurse hotlines and comprehensive Web sites that provide information on everything from what to eat to how to manage side effects such as morning sickness.

Those who opt to sign up for a program through their insurance provider often participate in a lengthy phone interview with a medical professional trained to identify risk factors, such as whether the mother has existing health concerns or whether she engages in dangerous behavior or work. Participants are referred to specialists as needed.

Technology has also helped enhance programs with at-home monitoring for pregnant women who are identified as high-risk for premature delivery, according to Ms. Darling.

"(These programs) will usually offer whatever is needed to aid the mother," Ms. Darling said. "(Insurers) try to establish a relationship during the pregnancy so they can find out if something is going wrong. There's a lot of mothering going on for new mothers."

Improving offerings

There also are some improvements on the horizon for major insurers.

Bloomfield, Conn.-based CIGNA Healthcare, for example, this year launched an initiative that revamped its longtime pregnancy wellness program into one that covers pregnancy and maternity from preconception to postpartum.

Its program--Healthy Pregnancies, Healthy Babies--offers pregnant employees a wide range of intervention, depending on the mothers' risk factors. For example, a mother who has already had a premature birth or who smokes--two factors that increase the chances of a premature delivery--will have frequent contact with a health counselor or other interventions, said Dr. David Ferris, a medical officer for clinical program development who works in CIGNA's headquarters.

"The goal is to identify risk and work collaboratively with the mother," Dr. Ferris said.

A Hartford, Conn.-based Aetna Inc. spokeswoman said the company is now seeking ways to improve its Moms-to-Babies Maternity Management Program, but declined to describe specific changes.

She said Aetna wants to improve the program, which already offers a laundry list of interventions and counseling, based on further research on preventing unhealthy pregnancies.