Evaluating the ROI of a Virtual Maternity Care Initiative Across Medicaid Plans in a Single State
Author(s)
Adam Kubsh, FSA, Tanya Rudakevych, BS, Lena Bertozzi, BA, Thomas Galeon, MS, MEng, Sarah Kramarz, BA, Shyamali Choudhury, MPP, Ranjani Ahrens, BSE, Ian J. Hooley, BS.
Pomelo Care, New York, NY, USA.
Pomelo Care, New York, NY, USA.
OBJECTIVES: To evaluate the cost impact of a 24/7 virtual maternal-newborn care program on population-level total cost of care across two Medicaid plans within the same state.
METHODS: This retrospective analysis focused on individuals insured by either of two Medicaid plans within a single state, both of which implemented the same virtual maternity program. Mom-baby episodes were indexed to the delivery of a liveborn infant as identified through procedure and professional claims. Episodes were inclusive of costs spanning from initial pregnancy ICD10 code through to 2 months postpartum. Historical episode costs for each plan were defined using 2022-2023 historical data where available, and year-over-year growth (‘trend’) in mean episode cost was calculated. The final trend was determined by combining data from the state Medicaid agency’s rate sheet with the plan-specific historical data. Trend was then applied to 2022-2023 costs to estimate expected 2024 episode costs without the program. Actual 2024 episode costs were calculated, and adjusted upwards to account for for incurred but not reported (IBNR) claims. IBNR percentages were estimated based on 2023 plan data. Actual costs with IBNR were compared to expected costs. Return on investment (ROI) was calculated on a gross basis relative to program fees. An IRB waiver of informed consent was obtained.
RESULTS: Mean historical episode cost for the plans was $17,339 (N=10,098). Year-over-year trend across both was 4%, yielding an expected 2024 episode cost of $18,033. Actual 2024 episode cost was $16,450 after applying IBNR (N=4,207), representing a cost reduction of 8.8%, and a 3.9 ROI relative to program fees.
CONCLUSIONS: The findings suggest that participation in this virtual maternity program is associated with a reduction in total cost of care with a positive return on investment in a Medicaid population. Future research should consider using methods such as randomized trials to further substantiate these outcomes.
METHODS: This retrospective analysis focused on individuals insured by either of two Medicaid plans within a single state, both of which implemented the same virtual maternity program. Mom-baby episodes were indexed to the delivery of a liveborn infant as identified through procedure and professional claims. Episodes were inclusive of costs spanning from initial pregnancy ICD10 code through to 2 months postpartum. Historical episode costs for each plan were defined using 2022-2023 historical data where available, and year-over-year growth (‘trend’) in mean episode cost was calculated. The final trend was determined by combining data from the state Medicaid agency’s rate sheet with the plan-specific historical data. Trend was then applied to 2022-2023 costs to estimate expected 2024 episode costs without the program. Actual 2024 episode costs were calculated, and adjusted upwards to account for for incurred but not reported (IBNR) claims. IBNR percentages were estimated based on 2023 plan data. Actual costs with IBNR were compared to expected costs. Return on investment (ROI) was calculated on a gross basis relative to program fees. An IRB waiver of informed consent was obtained.
RESULTS: Mean historical episode cost for the plans was $17,339 (N=10,098). Year-over-year trend across both was 4%, yielding an expected 2024 episode cost of $18,033. Actual 2024 episode cost was $16,450 after applying IBNR (N=4,207), representing a cost reduction of 8.8%, and a 3.9 ROI relative to program fees.
CONCLUSIONS: The findings suggest that participation in this virtual maternity program is associated with a reduction in total cost of care with a positive return on investment in a Medicaid population. Future research should consider using methods such as randomized trials to further substantiate these outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE146
Topic
Economic Evaluation
Disease
SDC: Reproductive & Sexual Health