By Roger Shedlin, JD, MD and CEO of WINFertility
To attract the most qualified employees, hospital systems, health plans and other healthcare businesses are offering robust family-building benefits. Memorial Sloan Kettering, a network of cancer centers in New York and New Jersey, provides fertility benefits to all of its employees. St. Jude Research Children’s Hospital began offering company-wide fertility benefits last year. A survey of the 14 top medical schools in the U.S. published in January found that all but one offers some kind of infertility treatment coverage. The reason behind the trend is clear.
The healthcare sector places critical reliance on employees who are in the years of planning for and raising children. This is especially true for hospitals and health systems, where a high percentage of staff are in their 20s and 30s. For this age cohort, a major job-selection determinant is whether the employer offers attractive benefits and benefits addressing family-building needs in particular.
Furthermore, in light of the “Great Resignation” and hospital staffing shortages resulting from the COVID-19 pandemic, the need to recruit and retain qualified healthcare workers has never been more acute. The healthcare sector has been quick to understand that a managed fertility benefit – a program that provides financial reimbursement plus clinical oversight, education, and counseling for family-building options – is the fiscally sound way to attract and support employees during their years of planning for and raising children. This translates to loyalty and reduced costs from disruptive staff turnover, with the added benefit of operational stability and better service for patients.
The Demographics of Healthcare Institutions Are Suited for a Family-Building Benefit
The family-building years are challenging for employees. They often conflict with the need for longer work hours and career dedication during the same stage of life. This can hold especially true for nurses, doctors and health care executives, given the unique demands of this field. JAMA recently reported the results of a study of 692 women surgeons, 42 percent of whom had experienced a pregnancy loss. That’s more than twice the rate of the general population.
It is likely every health system has productive staff who, together with their partners, are facing infertility; or prized LGBTQ+ clinical professionals who are considering their family options; or a star executive on the fast track who would like to safely delay having a child. These team members will be contemplating expensive, time-consuming and anxiety-provoking choices, which in most cases will not be covered by the routine maternity and pediatric benefits in their group health insurance. In fact, only 19 states currently require employers to offer fertility coverage to their employees, and even mandated coverage is typically limited to individuals with infertility diagnoses.
To help address their needs, health systems and businesses can offer a comprehensive family-building program that provides financial, informational and behavioral supports to employees who require family-building options such as in vitro fertilization (IVF) or other assisted reproductive technologies (ART), reproductive genetic testing, egg freezing, surrogacy, or adoption. Each of these interventions is stressful, and many would-be parents suffer emotionally. Financial burdens also compound the stress. Each IVF cycle can cost $15,000 to $35,000, including medical and specialty pharmacy. Intended parents could be facing adoption fees that start at $50,000 in the U.S. Costs range from $90,000 to $130,000 for surrogacy, which may include IVF treatment and medical costs for the surrogate, plus legal fees, travel and insurance expenses. In these cases, a family-building benefit can provide financial reimbursement, as well as specialized behavioral counseling and guidance for making complex choices.
The Managed Benefit: The Right Solution
In an unmanaged fertility benefit, employees essentially receive a pool of money to use as they see fit. Employees navigate their own path through a complicated fertility environment and make their own spending decisions. Costs are then reimbursed up to a specified per-event or lifetime limit. Unmanaged plans cost companies more because they offer employees no guidance and put no guardrails around spending.
A better option is the surprisingly cost-effective managed benefit. By fully integrating financial support with clinical oversight, education and counseling, a managed benefit can reduce spending for companies, and provide better support and outcomes for employees. The guidance from clinical experts in managed benefits increases the likelihood of healthy, full-term singleton babies. This reduces C-sections, pre-term births and NICU expenses, which research shows can cost a company between $64,000 and $80,000 per birth ― in some cases costing many hundreds of thousands of dollars.
With an unmanaged benefit, employees get no professional assistance navigating their many family-building choices. Therefore, they more frequently choose treatments that raise the likelihood for twins, triplets or other high-order multiple gestations. This often leads to NICU admissions and long-term healthcare costs for developmental problems, asthma, or cerebral palsy. Not only is this a bad outcome for the parents, it is very costly to an employer whose group health policy will be responsible for increased utilization.
Too frequently pharmacy costs, which account for up to 40 percent of the overall fertility spend, are not properly addressed. This causes both employees and employers to suffer. A fertility benefit program with clinical oversight ensures the dispensing of appropriate medications and quantities. When patients are educated on pharmacy dosage, storage and medication side effects, it helps the employees maximize their fertility medication benefit, which helps health plans and plan sponsors control drug costs.
The bottom line: a managed benefit provides higher success rates with reduced medical costs on multiple fronts. Coupled with the value-add of improved recruitment, retention and productivity, a managed benefit might even pay for itself.
Healthcare Employers Offering Family Building Benefits Can Keep Care Within Their Systems and Networks
As a provider of testing, treatments and pharmacy services, a hospital or health system can also benefit from being a participating provider for well-structured fertility programs. This is, of course, a feature unavailable to employers in other professional fields.
Besides the immeasurable benefits that come from happy, supported, and productive employees, hospital and healthcare employers who offer clinically managed fertility benefits eliminate wasted benefit dollars, while also improving the quality of care and reaffirming a commitment to supporting employees and their families.
Roger Shedlin, M.D., J.D., CEO and founder of WINFertility, the leading fertility benefits management company.