What Prenatal Care Programs Include
- Risk stratification: Identify high-risk pregnancies through claims data and self-referral
- Nurse case management: Dedicated nurse case manager for high-risk pregnancies
- Education: Prenatal education on nutrition, exercise, and warning signs
- Care coordination: Coordination between OB, primary care, and specialists
- Postpartum support: Support for new mothers in the first 90 days after delivery
- NICU support: Case management for NICU admissions
Improving Program Enrollment
Most carrier prenatal care programs have low enrollment because pregnant employees are not aware of them or do not understand the value. Proactive outreach — identifying pregnant employees through claims data and reaching out directly — significantly improves enrollment. Some employers offer incentives (gift cards, reduced cost-sharing) for enrolling in prenatal care programs.
Prenatal Care Program ROI
IQ Insight
Prenatal care programs consistently demonstrate ROI of 3:1 to 5:1. For a plan with 20 deliveries per year, a program that reduces NICU admissions by 25% and preterm births by 20% can save $200,000–$400,000 annually — far more than the cost of the program. The ROI is even higher for plans with high rates of high-risk pregnancies.