The American family is evolving, signaling cultural and economic shifts that are here to stay. American’s are delaying marriage, waiting longer to have children and having fewer children. As Millennials prioritize education and career, more and more of them are finding themselves in need of fertility assistance when they finally decide to have a family. Although once considered a rare employee benefit, employer-covered fertility benefits and other family-building benefits such as adoption and surrogacy are now becoming a necessity in the workplace.
From a workplace perspective, the subject of infertility presents employers with both an opportunity and a challenge. The opportunity: attract and retain the best talent in an increasingly competitive marketplace by offering all-inclusive fertility coverage to employees. The challenge: when fertility benefits are not managed by experts in the space, employers face a host of problems that seriously impact employee productivity as well as short and long-term health care costs.
Managing the family-building benefit will drive savings
Employers offing a fertility benefit can offer an unmanaged benefit, or a clinically managed benefit. With an unmanaged benefit, (COE models included) employees navigate their own path through a complicated fertility environment, spending their precious benefit dollars at their own discretion. This gives an employee access to company funds without any guidance on the most efficient and productive way to use those funds, dramatically increasing claims.
However, a clinically managed solution connects clinical experts to employees and guides each employee through their own personal family-building journey, recommending the most appropriate network doctors, medical treatments and drugs, purchased at the lowest unit cost. Managed programs can also include prior authorization, eliminating wasted spend on medications. Each element of a managed fertility journey is tailored to the individual patient.
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The results from clinically managed benefits are tangible, including more successful outcomes, which means satisfied and loyal employees, and reduced medical costs on multiple fronts. The direct ROI of having managed fertility benefits go beyond the desire to recruit and retain top talent. Below are three categories where organizations offering a clinically managed fertility benefit see significant savings.
Deep maternity cost savings
An employee going through fertility treatment, with an unmanaged benefit, may opt for IVF and choose to have numerous embryos implanted to increase the chance of pregnancy. This often results in twins, triplets or other high-order multiple gestations. More than 20 percent of twins and 80 percent of triplets are born prematurely and require NICU care. Research shows that an average NICU admission can have a 20-day length of stay and cost between $40,000-$80,000, a cost employer groups would certainly want to avoid.
A managed benefit drives more successful outcomes; specifically, healthy, full-term singleton babies. These outcomes are produced through evidence based medical protocols that encourage the most efficacious treatment, like eSET (Elective Single Embryo Transfer). The clinical oversight that comes with a managed solution drives safer pregnancies, which means fewer C-sections, pre-term births and NICU expenses.
Beyond the direct medical costs of pregnancy and multiple pre-term births, employers must also contend with issues that minimize productivity, including absenteeism, the loss of institutional knowledge from retention problems post-pregnancy, and short-and long-term disability.
Long-term reduced medical costs
Babies that are born prematurely often have lifelong health care conditions such as asthma, cerebral palsy or developmental problems. Employers are responsible for the long-term health care costs of those pre-term babies as they grow, and these are expensive health issues. Clinically managed fertility solutions reduce the number of multiple gestations, which reduces pre-term deliveries, driving long-term health care costs down.
Reduced Rx utilization and unit cost
Pharmacy costs can easily comprise up to half of the overall fertility spend. A program with clinical oversight and prior authorization ensures the dispensing of only appropriate medications and quantities. Patient education on pharmacy dosage, storage and medication side effects helps employees maximize their fertility medication benefit.
In addition to the immeasurable benefits that come from supported, productive and loyal employees, employers who offer clinically managed fertility benefits eliminate wasted benefit dollars, while improving the quality of care and reaffirming a commitment to supporting families. The long-term value of managed fertility benefits results in medically safe and effective solutions for the employee, paired with spectrum of cost savings to the employer.
Peter Nieves serves as the chief commercial officer for WINFertility. He is responsible for the profitable growth, product strategy and expansion at WIN. Peter has over 25 years of experience in the benefits consulting and P&C industry.