Opportunities to drive high-value maternal health care in employer-sponsored insurance

Maternal health outcomes are worse in the United States than in any other developed country, and yet one in every six dollars that an employer spends on inpatient health care goes towards maternity services. A single pregnancy episode (prenatal care, childbirth, and postpartum care) in the employer-sponsored insurance (ESI) population costs nearly $25k per pregnancy on average, 14% of which individuals pay out-of-pocket. Despite being a key cost driver for employers, maternal health care is riddled with deeply-rooted inequities that result in poor health outcomes, even for low-risk pregnancies, and a negative patient experience.

The silver lining is that innovation is occurring – from new companies offering innovative care models, to policies that encourage investment in workforce and training. Medicaid, which pays for 42% of births in the U.S. (and over 50% in some states), has led the way in scaling this type of innovation for maternal health care, exploring new payment models and workforce transformations. Perhaps as a result, Medicaid also tends to be a market entry point for many new maternal health care companies.

The commercial insurance sector, however, sees much less innovation and experimentation in maternal health care, despite covering half of women in the U.S. It’s time to ensure maternal health care innovation for this population is on par with Medicaid. To identify the most meaningful opportunities for maternal health care innovation in commercial populations, we must first understand the similarities and differences in the ESI maternal health population relative to Medicaid.

We analyzed 2021-2022 birth certificate data from the Center for Disease Control and Prevention’s National Vital Statistics System and the 2019-2022 National Health Interview Survey (NHIS) data to shed light on the similarities and differences between the Medicaid and ESI populations, and to highlight areas of Medicaid innovation that could be applied to ESI. Here are three key challenges facing birthing individuals with ESI, some of which are unique to ESI while others map to what is seen in Medicaid populations.

1. Birthing individuals on ESI are financially strained: Our findings demonstrate that nearly 13% of all birthing individuals on ESI are receiving WIC, despite the long-held belief that it is designed for the Medicaid population.
2. Birthing individuals receiving ESI are more likely to undergo c-sections for low-risk pregnancies than Medicaid recipients.
3. Self-reported depression and anxiety are equally prevalent in the ESI and Medicaid birthing populations: one-third of individuals struggle with mental health.
    

Download the Maternal Health Care report