Societal Cost and Benefit from Safe Babies Safe Moms Towards Measuring Social Return on Investment
Posted in SBSM What's New
- Authors: Carol Davis, PhD, MBA; Rehman Liaqat, MPP Candidate; Aditi Bhardwaj, MS; Yetong Xu, MPP Candidate; Vika Li, MPP Candidate; Thomas DeLeire, PhD
- Safe Babies Safe Moms Health Economics Research Team, McCourt School of Public Policy, Georgetown University
Introduction:
This study combines findings from several prior research reports prepared during the SBSM research program. We have extended our empirical work on cost-effectiveness into a nascent analysis of the potential societal return on investment in SBSM, by comparing the incremental program costs and savings immediately after delivery alongside the potential benefits from payer or societal view.
Data, Methods and Model Inputs:
Our study used several components to estimate and model the cost and societal impact on SBSM in 2022. Program Costs, Patient Level Costs and Reimbursements, Estimated Number of Adverse Outcomes Reduced within the SBSM cohort and an Estimate of the Costs Avoided (from societal perspective) by those reductions.
The Health Economics team used Health System accounting reports to estimate the annual indirect costs of SBSM for 2022 as the SBSM program costs that would not be easily reflected at the patient level billing records, such as screening for some health-related social needs, care referral management, patient education curriculum to train caregivers, among other services.
In 2022, these expenses totaled $2.3Million.
Empirical Data: SBSM Prenatal and Birthing patients delivered in 2022, covered by Medicaid or Private Insurance; restricted to cases included in MedStar’s sample for the National Perinatal Information Center (NPIC) used to estimate rates of Severe Maternal Morbidity and Preterm Birth.
Statistical Analysis and Model Inputs: Adjusted and expected levels of pregnancy outcomes were calculated using a logistic regression model for binary outcomes and the generalized linear model for continuous ($) outcomes. Both regression models were controlled for demographic and selected patient health and pregnancy characteristics.
For 2022, we estimated preterm birth 4.8% lower than Other MedStar prenatal/birthing patients (p= .00). The differential rate of SMM compared to other MedStar prenatal/ birthing patients was .12% higher, but not statistically significant. We extrapolate those differentials to estimate 58 fewer preterm births and no resulting impact on SMM in 2022. (In 2021, we saw a 1.9% reduction in preterm birth and .6% reduction in SMM). We modelled the long term and non-medical impact of the 58 fewer preterm births at $78.05K (in 2019$) each using analyses of external literature (See References).
After adjusting for medical cost inflation, the net present value of costs avoided over 5 yrs is $5.2M.
Source: HCFI Analysis and Modelling using several references. Notes: Dashes indicate cost data unavailability or inapplicability. Cost data (in 2019$) is extrapolated from O’Neil et al. 2022. * “Other” Conditions include Amniotic Fluid Embolism, Venous Thromboembolism, Renal Disease, and Cardiac Arrest, which are often rare, less frequently documented but clinically significant conditions.
Results:
In 2022, the societal impact of reductions in adverse pregnancy outcomes was a 5yr NPV of $5.2M, compared to program costs of $2.3M.
Health System Level
- Operating Revenues exceed SBSM costs, including the program costs, under the existing prospective payment evenue model, As of 2022, the impact of SBSM is most evident on the incidence of preterm birth.
- Prevailing reimbursement rules offer divergent incentives between Medicaid and Private insurers. Similarly, payment models dictate the scope of program costs that can be integrated into normal patient operations and patient-level accounts, as well as the net financial impact on health system.
Societal Level
- Medical costs for preterm births dominate the societal impact of adverse outcomes (w and w/o co-occurring SMM).
- Productivity losses associated with maternal mental health, dominates the research on non-medical costs over baby’s first five years.
Limitations:
Analysis of SBSM empirical results at the health system level is subject to limited sample size and the complexity and novelty of our analytical approach using mom-baby pairs as the primary unit of analysis.
Our societal impact analysis requires estimating the counterfactual scenario, “but for SBSM”, an inherently subjective exercise. Accordingly, we approach the work conservatively, using only external sources we could analytically replicate. Our analyses exclude costs beyond five years postpartum for policy salience. Our model also could not account for the interactions between different comorbid conditions, readmission costs, and secondary outcomes.
Societal benefit/cost analysis is an emerging area, without methodological consistency. During this formative period, external insights were limited, and were often developed in an international setting.
Conclusion:
Results to-date suggest that the near-term case for sustaining SBSM hinges on demonstrated results in improved preterm birth.
The long-term or non-medical opportunity for significant returns to society, depend on demonstrating results that improve maternal productivity in the years following giving birth. Within the available sample size, SBSM results cannot yet make a compelling case. Consideration of demonstrating improvements in secondary, less sever bur potentially more common disabling outcomes, may be easier to measure and benefit a wider group of birthing patients.
This study illustrates the efficacy of “pregnancy” as the unit of analysis, and of the potential to assemble a picture of the health system ROI and the societal ROI in tandem. However, data limitations, small sample size and limited actionable empirical data on the societal impacts suggests more work ahead in creating a risk-adjusted working definition of outcomes, as well as the scope of impacts to quantify.
References:
Hall, E. S., & Greenberg, J. M. (2016). Estimating community-level costs of preterm birth. Public Health, 141, 222–228
Luca D. L., et al.(2020) Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States. Am J Public Health. 110(6)
O’Neil, S. S., et al. (2022). Societal cost of nine selected maternal morbidities in the United States. PloS One, 17(10)
White, R. S., et al. (2022). Economic burden of maternal mortality in the USA, 2018–2020. Journal of Comparative Effectiveness Research, 11(13)