Optimizing Outcomes and Reducing Costs for Payers and Health Plans

Birth-related conditions (including pregnancy, delivery, and the care of newborns) are the most expensive of all hospital stays for Medicaid, with expenses exceeding $40 billion for birth-related conditions alone, and accounting for 26.1% of their total hospitalization spend. Pregnancy and newborn infant hospitalization were also among the most expensive reasons for hospitalization among patients with private insurance, totaling $50 billion, ranking as the two most expensive conditions.

But not all births cost the same. Compared to births without complications, preterm births, cesarean section, and maternal mental health conditions come with a far larger price tag.

The Cost of Preterm Birth

Preterm births (<37 weeks gestation) represent more than 10% of all live births, and can lead to long-term intellectual and developmental disabilities, including cerebral palsy, behavioral disorders, physical development, learning, and communication. Moreover, preterm births are the leading cause of infant death, accounting for more than 1 in 5 child deaths prior to their fifth birthday.

The high prevalence and burden of preterm infants mean they are among the patient populations with the highest medical expenditures. Each preterm birth incurs a medical expenditure between $51,791 and $76,232, which increases around eight-fold to $603,778 for infants born very prematurely(<24 weeks gestation). Consequently, the total medical care cost for premature births in the United States averages approximately $17.1 billion every year.

The Cost of Cesarean Section

32.1% of live births in the United States are delivered via cesarean sections (c-section). While a cesarean section can be a lifesaving surgery, it can put women and babies at unnecessary risk of short and long-term health problems if performed when there is no medical need. C-sections increase the risk of heavy bleeding, infections, breastfeeding delays, and complications with future pregnancies.

C-sections also increase costs for payers. This is due to the higher delivery costs, the greater intensity of care and recovery services, and the associated complications postpartum. Altogether, the healthcare costs of a birth via cesarean average $26,280; 44% higher than the cost of a vaginal delivery ($14,768).

The Cost of Mental Health Conditions

Whether due to miscarriage, drug dependence, postpartum or stress, mothers face a myriad of mental challenges. Maternal mental health conditions (MMHCs), which include depression and anxiety disorders, affect at least 1 in 5 mothers in the United States, almost 20% of whom will experience suicidal thoughts or undertake acts of self-harm.

MMHCs are the highest driver of medical and non-medical costs related to pregnancy in the United States, totaling around $18.1 billion per year. The support that mothers need to cope with these conditions, as well as the risk of health complications when left untreated, contribute to the increased healthcare costs. Currently, the cost of not treating MMHCs is $31,000 per mother-infant pair, and mental health conditions fall within Medicaid’s top 20 most expensive conditions.

The Mother Goose Solution

Mother Goose Health’s maternal care platform provides mothers with a comprehensive fully integrated solution that brings together all parts of the maternity care ecosystem in a single space. This helps them to monitor real-time risk, detect rising risk, identify need for early intervention, and effectively communicate with maternity care coordinators, their obstetrical care provider and other needed services.

In a 2023case-control study by Mother Goose Health, mothers utilizing the platform experienced a preterm birth rate 55% lower than those who did not (4.68% v8.76%). Moreover, the platform achieved a 22% lower rate of cesarean sections versus the national average.

Coordinating all aspects of care for patients in one SaaS and human-enabled environment allows Mother Goose Health to greatly reduce the costs associated with adverse pregnancy outcomes, which would otherwise arise from a lack of early risk detection. By addressing the treatment gap for MMHCs, improving resource utilization, and reducing admissions to hospitals and neonatal intensive care units, Mother Goose Health helps to improve outcomes for mothers and newborns while lowering overall costs and providing significant ROI for payors and health plans.

‍