Having a baby isn't just expensive for parents. Insurance companies spend $18,329 on the average natural birth in the U.S., and that cost goes up for Caesarian sections, multiple births, pre-term deliveries, or complications.
Parents and insurers share an interest in healthy pregnancies and lower medical costs, and early interventions can reduce the risk of complications. There's just one problem: Insurance companies don't know when women conceive. Medical claims for prenatal visits don't reach them until late in pregnancy or even after delivery. “We might not know a woman is pregnant until three months after she’s given birth,” says Leah O’Donnell, a managing director at Zaffre Investments, the venture capital arm of Blue Cross Blue Shield of Massachusetts.
To change that, some companies are trying to reach women sooner, using smartphone apps that track fertility cycles and pregnancy milestones. Since February, the Massachusetts Blue Cross plan has been sending information to members who use fertility and pregnancy apps from a company called Ovuline. Zaffre led a $3.25 million investment in Boston-based Ovuline on May 22. Blue Cross members who use the app can get personalized notices about their health plan's benefits and information about diet, exercise, or other factors that affect maternal health.
Ovuline is part of a class of self-tracking apps for expectant moms and couples trying to conceive. Users enter data on everything from the timing of menstrual cycles to how often they feel babies kick. Another app, called Due Date Plus, is working with health plans, including Aetna and the Wyoming state Medicaid program. The startup behind Due Date Plus signed a deal this month to market the app to Medicaid agencies across the country through Xerox, which has health-information technology contracts with 38 states. And Text4baby, supported by governments and private insurers, sends women text messages throughout their terms. The free service has been used by more than 850,000 women since 2010.
Insurers want to use app data to increase the odds of healthy deliveries because the stakes are so high: "Having a baby in a NICU for a month can be a million-dollar hospital bill," O'Donnell says. Health plans have tried additional ways to learn when their members get pregnant, such as working with obstetricians and gynecologists, says Rebecca Owen, a health actuary at the Society of Actuaries. The apps are new within the past few years, and insurers are interested, even if it's still unclear how effective they are. No one has done a rigorous medical trial to determine whether the apps actually lead to healthier pregnancies or reduced medical costs. "The judgement is still out on it,” Owen says. "We just don’t know yet how well they work."
Women opt into Ovuline's program by identifying Blue Cross of Massachusetts as their insurance company on one of the apps. The apps collect about 400 data points for each user, says Chief Executive Officer Paris Wallace. Ovuline doesn’t share users’ data directly with insurers. Instead, the app contains information about the health plan's benefits, as well as customized responses based on the data women record on their phones. If pregnant women report back or shoulder pain, for example, Ovuline might tell them that their health plan covers pre-natal massages. Wallace says the system can also lower the risk of costly problems. If a woman reports rising blood pressure, dark urine, and a headache, the app recognizes the pattern as a sign of preeclampsia, a potentially serious complication. Ovuline doesn’t make a diagnosis, but the app prompts users to alert their medical providers about symptoms.
Wallace says Ovuline has sent out 100,000 such alerts. “We’re basically able to do massive triage on millions of people at the same time,” he says. The apps, called Ovia Fertility and Ovia Pregnancy, launched in 2012 and 2013, respectively. Combined, they've had about 2 million users.
State Medicaid plans are watching Due Date Plus' deployment in Wyoming carefully, says Brett Jakovac, managing director of Xerox's government healthcare business. "We’re getting an incredible amount of interest and we’re expecting we’re going to see a number signing up," he says. Maternity care is a top cost for Medicaid programs. In Wyoming, Due Date Plus connects Medicaid patients with nurses or care managers who may visit them at home. Users who report smoking can be connected to a counselor or enroll in an online smoking-cessation program. According to Wildflower Health CEO Leah Sparks, even generally healthy women may benefit from the app. “There are things that come up in pregnancy that even the most savvy, high-tech, motivated Silicon Valley mom may not be aware of,” she says.