World Prematurity Day (WPD) is recognized each year on November 17. It has been eleven years since it’s initiation by the European Foundation for the Care of Newborn Infants (EFCNI). Designed to act as a reminder of the human and financial costs of premature births around the world, the theme this year is one that is often the goal of medical quality improvement experts, health care administrators, payers, and medical professionals throughout the United States: “Born Too Soon - Providing the right care, at the right time, in the right place.”
Worldwide, over 15 million infants are born prematurely (less than 37 weeks gestational age) each year, with over a million deaths per year in this population -- almost 7% of those born.1 According to the March of Dimes (MoD), somewhere between 1 in 9 to 1 in 10 infants are premature, both in the US and worldwide, although the US has one of the highest preterm rates among first world countries. In fact, the rate of premature births has risen each of the last four years in the US.2 In addition, premature birth complications are the leading cause of death for children under the age of five.3 These infants also have increased rates of developmental delays, potentially needing additional resources during their school years.
The direct costs of medical care for prematurity are significant in terms of hospital expenses for stays in the Neonatal Intensive Care Unit (NICU), with such charges often accounting for 7 out of 10 of the most costly hospital procedures billed to insurers, according to the MoD.4 Those data also suggest that insurers can pay over 12 times as much for the care of premature and low birth weight infants as they do for babies with no complications. To underscore those costs, the MoD estimates that if 1 in 9 infants is premature, that single premature child’s care costs more than the other eight combined.
Here’s the good news: more of these babies are surviving, even in extremely premature births, and are going home sooner. But often, the indirect costs of extended NICU stays to parents, employers, and society at-large are overlooked.
A 2016 paper authored in Europe detailed the many impacts a premature birth has on families, from the maternal medical issues that often necessitate an early birth to resolve significant threats to both mother and baby’s health, to the psychological trauma and post-traumatic stress type symptoms that parents suffer from having such dramatic disruptions to their world. 5 Traveling to the hospital to visit their infant; not being able to hold their baby right away to give the skin to skin contact that aids infant development; time away from other family members; missing work or being less productive while thinking of their struggling infant; and feelings of having no control over the situation leading to anxiety, depression, guilt and anger -- all are psychological burdens that result from having a child in the NICU.
The financial costs of the absenteeism and presenteeism to the employer, in addition to the billions in medical costs, cannot be ignored either. While current data are not readily available, the MoD quotes a 2007 Institute of Medicine report indicating that annual costs for people unable to work while caring for their NICU infants exceeded $5.7 billion, a figure which is likely to be at least twice that much in 2019 dollars.6
If you’re a leader at a large company, you’ll likely find many employees who’ve been touched by premature births. And if you truly consider your workforce to be family, you can prove it during these stressful life events. ProgenyHealth’s comprehensive, physician-developed program can help reduce these very expensive NICU claims costs while facilitating a productive return to work for impacted employees at the appropriate point.
Our utilization management programs, aided by state-of-the-art decision support tools and highly skilled, experienced NICU clinicians, help ensure delivery of the right care, at the right time, in the right place, without excess cost to the payer or adverse outcomes for the infants. Our case management staff get in touch early in the NICU stay, and stay in touch throughout the first crucial months of life, to provide education, emotional support, and resources to the mom, caregivers, and family in order to reduce their stress and empower them to meet their infant’s needs post-discharge. Our experience serving this population for over 15 years has demonstrated that NICU infants need highly specialized clinical care coordination and the broader support of an extended “family”. By partnering with ProgenyHealth, employers have a real opportunity to make that happen, and help these vulnerable newborns achieve healthy outcomes.
Steven Richardson, MD, MS, is Chief Medical Officer at ProgenyHealth.
4 – March of Dimes website, accessed 11/5/2019
5 - Ionio C., Colombo C., et al. Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress. Eur J Psychol. 2016 Nov; 12(4): 604-621.