When it comes to fertility, family building, and women’s health care, union members often find themselves navigating a complex landscape alone. A general lack of disease awareness, coupled with gaps in access to quality information and care have created an environment where individuals and families suffer in silence and are left to fend for themselves.
These gaps in support aren’t just unfortunate – they can lead to devastating consequences for both families and their plan sponsors.
The high cost of treatment and the isolation from dealing with a stigmatized health issue all too often lead desperate families to make uninformed or cost-based decisions that can have a significant negative impact on their lives and well-being.
From wasting time and money on ineffective treatment to life-threatening medical crises for both the person carrying the pregnancy and the infant, not having access to the right specialized guidance from the start quickly snowballs into high-risk situations that lead to high-cost claims, life-long medical conditions, and increased absenteeism.
Considering 1 in 6 people are impacted globally by infertility, with a third of cases due to male-factor infertility, and the fact that approximately 15 million lives are covered by union-negotiated insurance, labor is in a unique position to make a world of difference for men and women across the workforce. By opening access to comprehensive care that helps them grow their families safely, plan sponsors can empower their members with the right tools to make the right decisions, saving time, money, and lives.
The High Price of Gaps in Fertility and Women’s Health Care
The stigmatized nature of fertility and under-supported women’s health conditions such as menopause creates an environment with limited guidance, minimal coverage options, and fragmented care networks. Without guidance, coverage, or integrated care, members willing to risk anything for the chance to grow their family end up cutting corners to save money – almost always landing themselves in far worse conditions.
Decisions like skipping genetic testing, electing a multiple embryo transfer, or ignoring debilitating symptoms are tempting to patients already facing immense financial pressures. However, any financial gain is meaningless when it leads to less than desirable outcomes, such as high-risk maternity costs, NICU admissions, and severe health conditions.
Life-or-death situations for members aside, the imminent need for high-risk care significantly increases the cost of care to plan sponsors as well, not to mention the economic impact of increased absenteeism.
And yet – years of data has proven that comprehensive care is effective at preventing some of the most common high-cost claims associated with maternal and infant health. In fact, there are organizations that have reduced NICU claims to zero after implementing a comprehensive benefit.
Recognizing the unique needs of members throughout their lifetime, it becomes imperative to seek out a benefit solution that is rooted in comprehensive specialty care. But where does a plan sponsor start?
According to leading clinicians, a comprehensive family building and women’s health benefit will include three critical components – each of which helps drive effective member experiences and outcomes:
- Network Access and Management: A robust network of providers specializing in comprehensive fertility treatment pathways, menopause, and women’s health services is paramount. However, that is just the start. Efficiency comes from consistency, so the best way to ensure effective, quality care is what clinicians call “integrated care management” – active oversight that holds providers accountable to quality standards that are clinically proven to be more effective. This ensures members always receive the best care from trusted professionals without encountering unnecessary barriers or delays.
- Clinically Integrated Education and Advocacy: While empowering members with education and advocacy resources is essential, critical early intervention happens when that support is clinically integrated into the journey. From understanding coverage options to navigating complex medical procedures and symptoms, having an integrated support system can alleviate stress, avoid unnecessary treatment, and empower individuals to make informed decisions about their health care journey.
- Data-Driven, Patient-Centered Care: Personalization is key to addressing the unique needs of members starting a family or navigating menopause and other women’s health conditions. Health journeys vary by individual, so it makes sense that the most effective outcomes happen when patients and their doctors have the flexibility to develop personalized care plans specific to the patient’s unique needs. A benefit solution that prioritizes data-driven, patient-centered care ensures that individuals receive tailored treatments and interventions that are most likely to yield successful outcomes.
By prioritizing these components in their benefit selection process, plan sponsors can become the critical bridge their members need for truly transformative care – boosting retention and recruitment with realized dreams of family, while reducing healthcare costs and delivering the world-class experience the hard workers of America deserve.
To learn more about infertility in the trades, listen to the recent America’s Work Force Union podcast. This podcast features Dr. Janet Choi, a double-board certified reproductive endocrinologist, and Stacey Hofert, GVP of Labor and Trust for Progyny and expert in building effective Taft Hartley Multi-Employer plans.