Maternity and Family Planning video detailed transcript
[INTRO MUSIC]
[Text On Screen – A panel discussion on women’s health. Part 2: Maternity and Family Planning]
[STEPHANIE FEHR AND A PANEL OF SPEAKERS SITTING ON A STUDIO SOUND STAGE, SPEAKING TO THE CAMERA, WITH A WHITE SCREEN DISPLAYING: WOMEN’S HEALTH]
STEPHANIE FEHR: Welcome. We're so excited to be here with you talking about women's health. This is a topic we are all so excited about and passionate about.
[Text On Screen – Stephanie Fehr, Chief People Officer, UnitedHealthcare]
I am Stephanie Fehr, and I am privileged to lead the people teams at UnitedHealthcare and serve as their chief people officer. I'm also so fortunate to work with an esteemed panel today. People who care deeply about this topic and are really experts. So why are we talking about women's health and, really, what is our objective? We are, we have the good fortune of having a lot of data around women's health, and that informs the trends that we see over the course of a woman's health journey. And that also informs the type of products and services that will help women navigate their health journeys. And as we've gone through the last year and a half, I know it's been incredibly rewarding for me, and I think all of you, and we've had some incredible discussions and dialogue in that, honestly, have really informed how we want to service our customers and our own employees. And that's what we're going to talk to you about today. Let's talk about maternity and family planning. I'm going to turn it over to Craig, who will share some data, and then we'll have some dialogue with all of you once more. Craig.
CRAIG KURTZWEIL: Thanks, Stephanie.
[Text On Screen – Craig Kurtzweil, Chief Data & Analytics Officer UnitedHealthcare Employer & Individual]
I'm going to take a look at our book of business to see what we're seeing in the data when it comes to, specifically, maternity and family planning data.
[Text On Screen – (Slide 21) Women’s health: By the numbers
192k deliveries, 4,206 hysterectomies, 9,539 with fertility treatment
*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All rights reserved]
As you can see in this view, we have a lot of data when it comes to maternity related events. Almost 200,000 deliveries in the past 12 months, over 4,00 hysterectomies and 9,500 individuals that are going through fertility treatments. I'm going to dive into that data and in a few different ways to show you what we're seeing behind the numbers.
[Text On Screen – (Slide 22) Maternal mortality (Map of the United States and a chart by region)
- Maternal mortality in the U.S. continued to increase in 2021, up to 32.9 deaths per 100,000 live births (1,205 deaths)*1
- COVID-19 was a contributing factor in 34% of the 2021 maternal deaths, which accounts for much of the increase*2
- Disparities in maternal. Mortality rates are seen among different ethnicities, with rates for Black women significantly higher than rates for white or Hispanic women*1
Region, Deaths per 100,000 live births*3
- Northeast 28.8
- Southeast 50.5
- Central 34.7
- West 18.7
Ethnicity, Deaths per 100,000 live births*1
- White 26.6
- Black 69.8
- Hispanic 28.0
*1 http://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#fig1. Assessed July 6, 2023
*2 https://www.gao.gov/products/gao-23-105871. Assessed July 6, 2023
*3 Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed March 24, 2023, ©2024 United HealthCare Services, Inc. All Rights Reserved.]
First of all, when you think about maternity, it's really important to think about maternal mortality and the wide discrepancies we see across the United States. Mortality rates, you can see on the left hand side, when you look at the map, wide variances. When you see what's happening in the northern parts of the states, in Wisconsin, in Minnesota, in Michigan, and so on, how that compares to what we see across the south, specifically in states like Alabama, Louisiana, and even in New Mexico, we see much higher rates of mortality related to maternity. And on the right hand side in that chart, you can see a couple numbers that are really troubling and really big discrepancies we see across the population, specifically looking at the splits by ethnicity, the Black population seeing dramatic increases and higher rates of mortalities associated with maternity visits.
[Text On Screen – (Slide 23) Racial and ethnic disparities persist in maternal mortality (graphs)
US pregnancy-related mortality ratio by race/ethnicity*1 CDC, 2009-2016
US maternal. Mortality rate by race/ethnicity*2 CDC, 2018-2021
*1 CDC pregnancy-related mortality ratio: number of pregnancy-related deaths per 100,000 live births.
*2 CDC maternal mortality rate: number of maternal deaths per 100,000 live births.
©2024 Advisory Board, All rights reserved, advisory.com]
Go a little bit further, you can see that change, that difference that we see across the different ethnic groups is not a one year blip. This has been a historical pattern. We've seen the Black population being much higher year after year and, if anything, that discrepancy is even widening and the gap is getting even further discrepancy between the other ethnic groups.
[Text On Screen – (Slide 24) Infertility prevalence
- Infertility diagnosis and treatment peaks in women ages 30-30, with nearly 85% seeking non-advanced treatments such as fertility drug injections
- Higher prevalence in both advanced and non-advanced fertility treatments are seen among Asian women
Fertility Prevalence by Age Range, Claimants per 1,000 (graphs)
Fertility Prevalence by Ethnicity, Claimants per 1,000 (graphs)
Note: Fertility treatment prevalence includes any member that incurred a claim with N970, N971, N972, or N979 in diagnosis code 1, 3, or 3. Advanced Treatment members includes members with procedure codes related to Artificial Insemination (AI) or Assistive Reproductive Technology (ART).
Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2021 – Sept. 20, 2022, and paid through Nov. 30, 2022.
©2024 United HealthCare Services, Inc. All Rights Reserved.]
If we look into infertility or fertility related services, you can see on the left hand side, as you split this by age, obviously skewed into the 20 to 40 year old population, much higher prevalence associated with the fertility-based services in that population. And on the right hand side, interesting to note, when you split that data by ethnicity, you see some consistencies across the white, Hispanic, and Black populations, but the Asian population really jumps out as utilizing those types of services at a much higher rate.
[Text On Screen – Maternity story, Surest maternity benefit provides ease, affordability, and predictability:
- 47% lower out-of-pocket expenses for maternity delivery care compared to a large market book of business*1
- Surest attracts members planning to have babies. The Surest ASCSO book of business had 20% more births in 2022 compared to a large market book of business*2
- Members who have received maternity care renew at a higher rate than the general population*3
- 99.9% of births on the Surest plan had claims evidence of receiving prenatal care*1, 4
- Surest subsidized 87% of birth expenses – lowering member out-of-pocket costs*1
- Members can shop around for the lowest cost, highest value providers in the broad network when choosing maternity care
- Members know what their out-of-pocket cost will be prior to having a baby, bringing predictability and the ability to budget of the expense
- Members get one bill for their entire birth experience
*1 Surest claims database and a large market national health insurance company claims database incurred Jan 2023 – December 2023 paid through January 2024.
*2 Surest ASO book of business 2022 compared to a non-Surest 2022 commercial norm.
*3 Surest claims database 2023. Members with a maternity episode in 2023 at an 80% rate compared to members without a maternity episode at 72%.
*4 Members who joined Surest within one month of delivery were excluded due to lack of prenatal care claims.]
Surest, ©Bind Benefits, Inc., d/b/a Surest. All rights reserved.]
And then finally, as you think about more maternity, specifically within the Surest population, you see some differences that are very distinct, two things, in particular. One, is that the average cost of these services for those members is almost 50 percent less for members that are going through a maternity experience within Surest. And the other piece that you commonly hear and see and feedback within mothers, expecting mothers that are in Surest, is that the known quantity of what they're going to experience, to be able to know up front, as they're planning for delivery, where they’re going to go and what the cost is going to be, up front, is just a very big difference to what they see under traditional insurance plans. With that, I'll kick it back to you, Stephanie.
STEPHANIE FEHR: Awesome, Craig. Thank you so much. Super interesting. Okay, let's kick off with Lisa and Will on this first question. It sometimes feels like we're going backwards around maternal mortality, especially in the state of Alabama, where they have the highest maternal mortality rate, and they're closing hospitals, putting pregnant women at an even higher risk. Let's start with you, Lisa. Can you talk a little bit more about our home care programs and what we can do about this?
DR. LISA SAUL: Sure. Pregnancy is such an interesting time because it is one where you have two patients, two members, really, a mom and a baby. And you have your clinical aspects of pregnancy, but there's so much social undertone.
[Text On Screen – Dr. Lisa Saul, Chief Medical Officer, Women’s Health UnitedHealthcare]
As you mentioned, we have maternity care deserts that we're looking at and a lot of other social determinants of health that impact on the health of communities. And so our OB home care program is really special in that it brings care to the member and particularly to our high risk members. We are addressing people who are early in pregnancy or having trouble with nausea and vomiting in pregnancy and may be missing work, may not be able to keep anything down. And so we're able to come into the homes and provide them with medication and IV fluid resuscitation, just to maintain. But also when we look at some of our highest risk members, we know that hypertension in pregnancy and diabetes are two of the, two of the diagnoses that really impact, not only the pregnant person, but the birth outcome of that baby. So that's also something that the OB home care program is taking care of, in terms of monitoring blood pressures, monitoring blood sugars, to optimize both of those things during the pregnancy to hopefully affect the most optimal outcome for the birthing person and their baby.
STEPHANIE FEHR: What a great program. Amazing. Thank you. It’s inspiring, actually. Thank you. Will, talk a little bit about the solutions that Maven's offering in this area.
WILL PORTEOUS: I'm going to start with a little bit of a wild statement. Believe it or not, you cannot deliver a baby yet through a phone. I don't want to oversell the digital solution.
[Text On Screen – Will Porteous, Chief Growth Officer, Maven]
STEPHANIE FEHR: Really? Oh, come on.
WILL PORTEOUS: Yet. No, I say that because there is a need for a brick and mortar world, and Maven is really built to supplement that. But when you think about examples like Alabama, or we actually started in the Medicaid space in Arkansas, you have a huge rural population that faces huge disparities in access to all types of care, but one of which being maternal care. I think one of the things that really frustrates me, particularly in learning more about that program, is that often people do have access to great opportunities and care. They just don't know about it, or they don't use it, which always bothered me. And I think one of the great things about Maven, is because it is a digital solution, we can't deliver the baby, we can attract you to use the product. We're typically seeing anywhere from 60 to 80 percent of eligible birthing individuals enroll into Maven and heavily utilize the platform, which does a couple things. One, it provides them access to care providers that you don't actually need to see in a brick and mortar community. They can help you learn. And because it's virtual, we can connect you to someone anywhere across the U.S., which means you have a higher likelihood of finding someone again that looks like you, sounds like you, believes like you. And when you think about things like doulas, there's a dearth of doulas in general. Much less if you wanted to try and find one that fits someone like you. So that's one, it’s providing a much heightened degree of access to care. Again, we have 1,500 providers across 35 different specialties. Two, it's making them aware of these amazing programs that they have.
STEPHANIE FEHR: I was just going to say, so many people don't even think about doulas, right?
WILL PORTEOUS: Because, again, I can't do a lot of this through Maven, but we can connect them to the amazing resources available to them. We've learned what's available to members, how great it is, and we refer them into it on a regular basis, and you see higher utilization and better health outcomes.
STEPHANIE FEHR: It’s a true system. That's fantastic. Great example. Thank you. Lisa, back to you. Maternal mortality, again, it's incredibly eye opening when you look at the people of color and their equity disparities. Can you talk about what's being done to impact that? It's really sad and troubling.
DR. LISA SAUL: We see rates of maternal mortality three times out of – in African American women three times that of their white counterparts, which in 2024, as an African American woman, is very startling. I think that a lot of it does have to do with the interactions that we see in the clinical space and the feelings of being dismissed and unheard, as we've talked about. But it also has to do with what, Will, you've been talking about, is what is the support that is needed? Oftentimes, that's not going to come from the OBGYN or the midwife or the family medicine doctor. It's going to come from the doula, from the care management program, from Maven. It's going to be those questions that you just don't want to ask your doctor because you think it's not a great question or you forgot it, or those things. So I think that a lot of getting into that digital space, making care more convenient, bringing care to where people are, again, so that you're not looking at those disparities of, I have to take off work. I might lose my job if I go to my doctor's appointment. I think adding more telehealth availability, and of course support, in whatever form. I think doulas are great, but just encouraging that support is needed, I think is a really important thing that can help to bridge the gap between what we're seeing currently and the clinical outcomes that we're seeing so that we can improve the overall.
STEPHANIE FEHR: That's great and incredibly encouraging. Please, Will, go ahead.
WILL PORTEOUS: You just reminded me though, I said you can't deliver a baby through a screen, but there are so many things people think you can't do with a phone.
STEPHANIE FEHR: That's very true. There's so many things you can do.
WILL PORTEOUS: Exactly. We actually did a study recently where members who had an in-person doula compared to those with a virtual doula had the same, if not better, member experience virtually and the same outcomes.
STEPHANIE FEHR: How fantastic.
WILL PORTEOUS: It is a changing of a mindset.
STEPHANIE FEHR: So much of it is education. That's a great point. Very good. Okay. Will, I'm going to go to you for the next one. And this is about inclusive family, women's and family health care, specifically inclusive family building support, given half of LGBTQ millennials are actively trying to grow their families. Also, the World Health Organization released a report, and this is always surprising to me, that one in six people, globally, suffer from infertility, and in America, it’s one in five. How has UHC evolved its solutions to meet the needs of these folks?
WILL PORTEOUS: I guess if we're starting with shocking statements, I'll also say I'm also a millennial, believe it or not, apparently, technically, and a member of the LGBT community who has gone through surrogacy. I think one piece of that is an acknowledgment that there are many paths to parenthood. It's kind of new to acknowledge that. And it's been really powerful for me in working with UHC as an earlier adopter, an acknowledgement of that. And honestly, one of the things they did was partner with Maven, because a lot of that falls outside of traditionally medically covered services. And so by having an offering like Maven, you're able to help guide members through these journeys regardless of what they are. So I think one of the cool things we've done, and I'll actually probably let you, Lisa, speak to it, but with UHC and Optum's Fertility Solutions Program, they actually partnered with us to develop an enhanced version of that, called Fertility Solutions Plus. And it's taking what's amazing within United, and what's amazing within Maven, and pairing it all together to deliver something even more meaningful.
DR. LISA SAUL: It allows us to really help our members navigate the complexities of family building. We’re taking the infertility piece out of it and really creating a family building solution, where we can help people navigate, not only what's happening from a reproductive endocrinology standpoint and IVF and that, but as Will said, adoption and surrogacy, as well as egg preservation so that people have options.
STEPHANIE FEHR: There’s the clinical piece of it that you're talking about, Lisa, but there's also the emotional piece of it. It's a very emotional piece. And thank you for sharing your story, Will. Every time you share it, I think, that's an amazing thing that you're willing to share that. For many other people, I'm sure they appreciate it, so thank you.
DR. LISA SAUL: I think the beauty of it, too, in presenting choices, is that some people choose not to go down a path that they came into the arrangement thinking that they were going to go down. And I think there's beauty in that, too, in changing your mind and going down a different path. And I think that's what these solutions are really good at, as well.
STEPHANIE FEHR: Giving people the knowledge to make the choice. That’s right.
WILL PORTEOUS: To piggyback on that, I think an interesting thing for Maven, when we see members enroll into the fertility program, for those who think they need assisted reproductive support, because of the holistic nature and how we help manage that patient's journey, we're actually helping them go through other opportunities to get them pregnant naturally, prior to seeking that treatment. And 30 percent of our members who think they need IVF end up getting pregnant naturally.
STEPHANIE FEHR: That's quite high.
WILL PORTEOUS: But there's so much more you can do. And, oftentimes, with your limited mindset, you're only going to go the path you think of least resistance.
STEPHANIE FEHR: Great point. Yeah. Thank you very much. That's helpful. Awesome. Alison, headed to your way. There are so many resources available to women, which is a great thing we've talked about, but we've also talked about it can be overwhelming, can be super overwhelming for people. How can women advocate for their own health within the entire system and really understand how to navigate it?
ALISON RICHARDS: I think you've heard a lot of the sources and the resources we have available, just some great programs we've just talked about.
[Text On Screen – Alison Richards, Chief Executive Officer, Surest]
And I think part of that, and when I think about how we advocate for ourselves is, again, understanding what's available to you. What path do you want to take, out of the words you just used. I think part of that is the affordability and the predictability of the cost aspect of all of this. If you marry up all of these programs to what I would call a plan benefit design that allows you to predict some of those affordability and predictability of the cost side, you're able to start thinking about the holistic picture. When you look at the holistic picture, I have choices. I know where I want to go. I know how much it's going to cost, but I have resources that are surrounding me, whether it's for maternal, just the easy way we do things, or if it's because I need something that's a little bit different, they're all out there making different choices for me, as an individual, to make those choices. So I would look at it. But one of the things we have seen on the Surest plan is it is a celebrated feature of the plan as having that maternity benefit because of that affordability and the predictability of the cost. And you saw the statistics that Craig talked about, but that's one of the highest rating satisfaction factors, like when we talk about NPS, that we hear women raving about, is the maternity benefit that we have out there. So I would say, how do you advocate for yourself? You have to do your research, just like we're talking about and everything else, but do your research and know you have so much available for you, with all of the programs you have here today.
STEPHANIE FEHR: I love that. You're taking a lot of the ambiguity out of a very ambiguous situation, which creates less stress for people. All right. Thanks, Alison. We're going to wrap up with a fire round of advice. What would you tell folks listening who want to take action, based on our discussion today? I'll start with you, Dr. Saul.
DR. LISA SAUL: I would double down on how we can make things easy. I think that especially in pregnancy, there's already so much that is complex and complicated. If we can identify ways to make it easier for people to navigate pregnancy, that's what I would focus in on.
STEPHANIE FEHR: Great advice. Thank you.
WILL PORTEOUS: I would say don't think about in-person care and digital as two separate opportunities. Think about them, truly, as supplemental opportunities to further touch and engage a member to do things that will better influence their health. You should use every angle possible.
STEPHANIE FEHR: Love that. That's great.
ALISON RICHARDS: I love that because it talks to our, both of our things. I think about health plan selections and the area that we're in and being specific to your needs. As a mother of three, I look at this, we're all in different phases of our health care, of what we need and what we need at any given time. So adjust, stop often, evaluate. You might have different needs at different times. So know what your future need might be might not be the same today as tomorrow. So adjust your needs at the time and the place that you need them.
[OUTRO MUSIC]
STEPHANIE FEHR: Excellent advice. Thank you very much. It's been a pleasure. Thanks so much guys. Talk soon.
[LOGO: UNITEDHEALTHCARE]
[Text On Screen – UnitedHealthcare, There for what matters™, Insurance coverage for fully insured plans is provided by All Savers Insurance Company (for FL, GA, OH, UT, and VA), by UnitedHealthcare Insurance Company of IL (for IL), by United Healthcare of Kentucky, Ltd. (for KY), or by UnitedHealthcare Insurance Company (for AL, AR, AZ, CO DC, DE, CA, IA, ID, IN, KS, LA, MI, MN, MO, MS, MT, NC, NE, NH, NV, OK, PA, RI, SC, SD, TN, TX, UT, VA, WV, AND WY). These policies have exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact either your broker or the company. Administrative services for insurance products underwritten by All Savers Insurance Company and UnitedHealthcare Insurance Company, and for self-funded plans, are provided by Bind Benefits, Inc. d/b/a Surest, its affiliate UnitedHealthcare Services, Inc., or by Bind Benefits, Inc. d/b/a Surest Administrators Services, in CA. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Maven and Maven Wallet are products of Maven Clinic Co. Maven is an independent company contracted to provide family-building support including care advocacy, virtual coaching, and education. Maven does not provide medical care and is not intended to replace your in-person health care providers. Use of the services is subject to terms of service and privacy policy. Maven® is a registered trademark of Maven Clinic Co. All rights reserved.]
