Pregnant woman When fertilitybenefits are not properly managed, employers face a host ofproblems that seriously impact employee productivity. (Photo:Shutterstock)

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The American family is evolving, signaling cultural and economicshifts that are here to stay. American's are delaying marriage, waiting longer to havechildren and having fewer children. As Millennials prioritizeeducation and career, more and more of them are finding themselvesin need of fertility assistance when they finally decide to have afamily. Although once considered a rare employee benefit,employer-covered fertility benefits and other family-buildingbenefits such as adoption and surrogacy are now becoming anecessity in the workplace.

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From a workplace perspective, the subject of infertilitypresents employers with both an opportunity and a challenge. Theopportunity: attract and retain the best talent in an increasinglycompetitive marketplace by offering all-inclusive fertilitycoverage to employees. The challenge: when fertility benefits arenot managed by experts in the space, employers face a host ofproblems that seriously impact employee productivity as well asshort and long-term health care costs.

Managing the family-building benefit will drive savings

Employers offing a fertility benefit can offer an unmanagedbenefit, or a clinically managed benefit. With an unmanagedbenefit, (COE models included) employees navigate their own paththrough a complicated fertility environment, spending theirprecious benefit dollars at their own discretion. This gives anemployee access to company funds without any guidance on the mostefficient and productive way to use those funds, dramaticallyincreasing claims.

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However, a clinically managed solution connects clinical expertsto employees and guides each employee through their own personalfamily-building journey, recommending the most appropriate networkdoctors, medical treatments and drugs, purchased at the lowest unitcost. Managed programs can also include prior authorization,eliminating wasted spend on medications. Each element of a managedfertility journey is tailored to the individual patient.

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Read more: Tech industry shines for fertilitybenefits

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The results from clinically managed benefits are tangible,including more successful outcomes, which means satisfied and loyalemployees, and reduced medical costs on multiple fronts. The directROI of having managed fertility benefits go beyond the desire torecruit and retain top talent. Below are three categories whereorganizations offering a clinically managed fertility benefit seesignificant savings.

Deep maternity cost savings

An employee going through fertility treatment, with an unmanagedbenefit, may opt for IVF and choose to have numerousembryos implanted to increase the chance of pregnancy. This oftenresults in twins, triplets or other high-order multiple gestations.More than 20 percent of twins and 80 percent of triplets are bornprematurely and require NICU care. Research shows that an averageNICU admission can have a 20-day length of stay and cost between$40,000-$80,000, a cost employer groups would certainly want toavoid.

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A managed benefit drives more successful outcomes; specifically,healthy, full-term singleton babies. These outcomes are producedthrough evidence based medical protocols that encourage the mostefficacious treatment, like eSET (Elective Single Embryo Transfer).The clinical oversight that comes with a managed solution drivessafer pregnancies, which means fewer C-sections, pre-term birthsand NICU expenses.

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Beyond the direct medical costs of pregnancy and multiplepre-term births, employers must also contend with issues thatminimize productivity, including absenteeism, the loss ofinstitutional knowledge from retention problems post-pregnancy, andshort-and long-term disability.

Long-term reduced medical costs

Babies that are born prematurely often have lifelong health careconditions such as asthma, cerebral palsy or developmentalproblems. Employers are responsible for the long-term health carecosts of those pre-term babies as they grow, and these areexpensive health issues. Clinically managed fertility solutionsreduce the number of multiple gestations, which reduces pre-termdeliveries, driving long-term health care costs down.

Reduced Rx utilization and unit cost

Pharmacy costs can easily comprise up to half of the overallfertility spend. A program with clinical oversight and priorauthorization ensures the dispensing of only appropriatemedications and quantities. Patient education on pharmacy dosage,storage and medication side effects helps employees maximize theirfertility medication benefit.

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In addition to the immeasurable benefits that come fromsupported, productive and loyal employees, employers who offerclinically managed fertility benefits eliminate wasted benefitdollars, while improving the quality of care and reaffirming acommitment to supporting families. The long-term value of managedfertility benefits results in medically safe and effectivesolutions for the employee, paired with spectrum of cost savings tothe employer.

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Peter Nieves serves as the chief commercialofficer for WINFertility. He is responsible for the profitablegrowth, product strategy and expansion at WIN. Peter has over 25years of experience in the benefits consulting and P&Cindustry.

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