Presentation (CTI)

OBJECTIVES: To estimate health plan cost savings based on published reductions in preterm birth (PTB) associated with engagement in a virtual maternity care program.
METHODS: We developed a cost-savings model using medical claims data from nationwide Medicaid and commercially insured deliveries (N=30,786) between September 2024 and December 2025. We calculated baseline distributions of preterm and term deliveries and corresponding episode costs, including pregnancy-related care, inpatient delivery, neonatal intensive care unit (NICU) utilization, and maternal and infant healthcare expenditures during the first year following delivery. A published 24.4% relative reduction in PTB associated with engagement in a virtual maternity care program was applied to the baseline delivery distribution. To account for program-associated improvements in gestational age within preterm and term births not captured by the binary PTB endpoint, we applied a conservative 7.3% within-category cost reduction informed by regression sensitivity analyses estimating lower adjusted episode costs among program-engaged preterm deliveries. Average episode costs were then recalculated under the revised delivery distribution to estimate savings per delivery.
RESULTS: The PTB rate decreased from 11.1% to 8.4% among Medicaid deliveries and from 9.5% to 7.2% among commercially insured deliveries. Baseline mean episode costs were $70,636 versus $18,787 for preterm and term Medicaid deliveries and $129,145 versus $40,038, respectively, among commercially insured deliveries. The modeled delivery distribution yielded estimated savings of $3,061 per Medicaid delivery and $5,402 per commercially insured delivery. Delivery-related expenditures, including NICU costs, accounted for approximately 80-85% of total estimated savings, while postpartum maternal and infant care contributed an additional 10-15%.
CONCLUSIONS: This analysis provides a framework for projecting health plan cost savings associated with reductions in PTB. These findings suggest that virtual maternity care-associated improvements in birth outcomes may generate meaningful economic value for Medicaid and commercial health plans.