Full Coverage

• In the U.S., nearly half a million children are born preterm and it is estimated that 85% of neonatal fatalities are a result of preterm birth and the complications that arise thereof. Effective prevention and management of high-risk pregnancies have been identified as a viable solution to reduce neonatal mortality, which can only be made possible by comprehensive maternal care coverage.
• Neonatal Intensive Care Units are among the most expensive healthcare services given in hospitals, thus it is imperative that its full coverage is included in the maternal health plans women choose.
• Medicaid, for instance, covers nearly half of U.S. pregnancies, with many of those being high-risk. High risk neonatal care is receiving more funding from this federal insurance plan, as Medicaid is used in most states as an "essential cover" for babies born with complications. This is an important consideration for women, especially those with a history or potential for high-risk pregnancies.

Quality of Care and Facility

• Further research identified that longer coverage alone cannot reduce neonatal mortality from high-risk pregnancies, but it must be accompanied by improved quality of care. Reputation for care has been cited by women as a top contender for why they choose facilities and the plans that cover them.
• Women say that they are more likely to choose a hospital with access to a pediatrician and neonatal intensive care units (NICU) than those without, even if it means traveling out of their locale. Access to quality neonatal care services is an important consideration for women when looking for maternal coverage. Research shows that there are improved outcomes for high-risk births who are born in facilities equipped with NICU.
• Excellent in-network care is also a consideration for women looking for maternal care. Research cites that quality of care and communication, as well as bedside manners of staff, are environmental support factors that mothers expect in an NICU, thus these factors heavily dictate which facilities they will use, and conversely what healthcare plan they will choose.

Length of Coverage

• Women would like to determine the length of their stay in hospital after birth. Thus, the length of maternal coverage, especially that given to neonatal care, is a top consideration in choosing healthcare plans.
• Neonatal admission has increased from 64 to 79 per 1000 live births, and the average days spent by a newborn in NICU is 13.2 days for infants born between 39-41 weeks and 46.2 days among infants born with a gestation period below 32 weeks.
• Medicaid, which offers essential coverage for babies born with complications, offers a 60-day coverage for the mother, and once born, the child is eligible for Medicaid coverage until the first year of their life.
• Most insurance plans give parents a 30-day window after their child's birth to add them to their insurance for adequate cover. Those with marketplace coverage have until 60 days to enroll their newborns.

Research Strategy

Women's health services plan selection for perimenopause services

• According to CDC data, 63% of women in the US have insurance through an employer, 16.9% of women are covered by Medicaid, and 14.9% of women purchase their own healthcare insurance.
• According to an AARP poll on women aged 50 and above, women are the main deciders when it comes to healthcare and are more often than not the chief healthcare officer of the household.
•  57% of women over the age of 50 say they prioritize the health of their family over their own while 58% state they are the sole health care decision-maker in their household.
•  1 in 4 women over the age of 50 stated they skipped a perimenopause treatment because it was too expensive while 14% say they went ahead with the treatment only to end up with debt due to high health care costs.
•  Plans that excel at diagnosing chronic conditions early, have programs to help women manage their condition, and apply the newest evidence-based treatments are the most popular with women in their 40s and 50s. Additionally, women with families look for healthcare plans which enable them manage the care of the whole family under a single healthcare policy.
• Research estimates that women going through menopause who also experience Vasomotor Symptoms (VMS), including hot flashes and night sweats, had 121% higher utilization of healthcare plans. It is estimated that 75% of women in the US experience VMS.
• Perimenopause services that women are actively seeking as part of their plans include consultations provided as a small out-of-pocket expense, curated content that includes nutrition and lifestyle recommendations, feminine care products specific to perimenopause, and over-the-counter medication for hot flashes, vaginal dryness, sleep and loss of eyelashes.
• Women in the United States are estimated to be "more likely to be covered by health insurance as a dependent (24% of women aged 19 to 64 years) than men", which puts women at a bigger risk for losing coverage if their husband dies, or if their spouse loses their job. When getting insurance as a dependent, women do not choose their plans based on services offered, meaning 1/4 of the American female population does not look into perimenopause services whilst deciding on their healthcare plan.
• For menopausal symptoms such as vaginal dryness, many insurers do not cover OTC medication such as a drug called Addyi that was approved in the US to treat low sexual desire disorder in perimenopausal women. For around 40% of women who experience vaginal dryness during perimenopause, insurers that cover medication such as Addyi are a go-to choice.

Research methodology

• The Centers for Disease Control and Prevention states that more women are having children in their 30s than in their 20s. This means that more women need to seek infertility treatments or in vitro fertilization (IVF) since fertility in women declines steadily with age.
• According to FertilityIQ, a "digital database for information about fertility benefits and treatments," the costs of IVF are now over $20,000 per cycle. Furthermore, a survey of more than 10,000 verified, U.S.-based IVF patients showed that the average patient undergoes over two cycles during treatment. As a result, they end up paying about $51,000 in total.
• Despite the high costs of IVF treatment, insurance coverage is still limited in the United States with only 10 states having an "IVF insurance mandate" and 16 states that require some type of reproductive health coverage, but not necessarily IVF. There are also loopholes as small employers are often exempt, as well as large corporations that self-insure their insurance plans.
• FertilityIQ estimates that there will be over 400,000 IVF procedures in 2020, only 19% of employees and patients have complete coverage and 19% receiving no coverage at all. To put this into perspective, only about 500 employers in the U.S. offered "some sort of fertility benefit" in 2019.
• Based on the statistics above, about 80% of U.S. women cover IVF expenses out-of-pocket with 52% using their credit cards and 25% taking out personal loans. Student Loan Hero reports that 14% tap their 401 (k), 8% take out home equity loans, and 1% use 'other' means of payment.
• FertilityIQ reports that of the 19% of IVF patients with complete coverage in 2017, 70% received the benefits through their employers. About 30% received their IVF benefits through their partners' employers.
• However, the survey showed that complete coverage did not influence the decision on the number of embryos transferred among 86% of IVF patients. About 8% and 6% were influenced to transfer fewer and more embryos, respectively. FertilityIQ states that "many employers cover IVF with the understanding that assuaging an employee’s cost concerns will prompt that employee to transfer fewer embryos simultaneously, thus mitigating the risk of costly, multiple-birth deliveries, which often run employers $120,000 — $400,000."

RESEARCH STRATEGY

How Women Choose a Maternal Health Plan

•  60% of adult women not eligible for Medicare (ages 19-64) choose private sector insurance plans. 8% purchase individual plans directly through marketplaces, 17% are insured through Medicaid, 3% are covered in another way, and 11% are uninsured. Employers, individual marketplaces, and Medicaid each offer multiple plans that can be compared based on cost (in premiums and deductibles) and variety of services covered.
• Beginning in 2014, the Affordable Care Act required all qualified health plans to provide women with maternity care and childbirth. Benefits considered essential include outpatient visits, hospitalization, newborn care, and lactation counseling, though genetic testing is not considered essential.
• Cost barriers often influence whether a woman decides to get health insurance. When the Affordable Care Act expanded Medicaid and added new subsidies in 2014, the percentage of uninsured women declined sharply in all ages and income brackets.
• Women on Medicaid are more likely to put off or avoid prenatal care than women with private health insurance.
• Not many women choose insurance plans based on complete information: only 26.7% of women surveyed in 2016 had heard of all models of care that might be covered by an insurance plan.

Factors Women Use to Compare Health Insurance Plans

•  73.2% of women surveyed in a 2017 study said that their choice of obstetrician-gynecologist or midwife was more important to them than their choice of hospital. In general, women tend not to incorporate a hospital's quality ratings into the decision regarding where to give birth.
• Women who have not yet given birth are highly loyal to their OB-gyns. 80% of mothers-to-be under 35 planned to see their current OB-gyn for maternal care, and 79% of mothers-to-be over 35 stated the same.
• Women who choose an OB-gyn at the time they become pregnant are more likely to rely on the opinions of friends and family than referrals from physicians.
• Woman who have given birth in the past place a higher value on having a private postpartum room, their baby sleeping in the room with them, having friendly doctors and nurses, and delivering close to their homes.
•  22% of women prefer giving birth with the help of a midwife, though research also suggests that women only prefer a midwife as a primary caregiver when a birth unit led by nurses and doctors is attached.

U.S. Women's attitudes toward maternal care

• A 2015 study showed that 66% of women put off doctor's appointments when sick, and that 82% of women put off preventative care.
• Women place a high value on choice and personal involvement with decisions about their maternal care.

Research strategy

Selection Criteria

• The Affordable Care Act of 2010 made provisions for the federal contraceptive coverage guarantee that mandates most private healthcare plans nationwide to cover "18 methods of contraception used by women (including female sterilization), along with related counseling and services." More recently, several states that matched, or even surpassed, the federal requirements.
•  Public funding for family planning services is also available in the United States including the Medicaid program and state-level funding. In 2015, Medicaid accounted for about 75% of non-maternal health expenditures while state-level sources, Title X, and 'other' federal sources accounting for 13%, 10%, and 2%, respectively.
• In 2017, about 75% of U.S. women stated that their contraception care costs were covered fully by insurance plans while about 19% said that insurance covered part of the cost.
• Based on the information provided by a 2019 fact sheet and a 2020 report by the GuttMacher Institute, the choice of non-maternal health services plans among U.S. women is majorly influenced by affordability. Higher income women tend to use private insurance while those with incomes below the federal poverty level are bound to publicly supported services such as Medicaid.
• However, even with insurance coverage, it was found that women with higher incomes (and private insurance) tend to use contraceptives more compared to women with lower incomes (and public coverage). Notably, about 6% of women with employer-sponsored coverage are in faith-based plans that are exempted from providing contraceptive care.

Important Considerations

• In a 2016 study of U.S. women aged between 18 and 44 years, it was found that most women use contraceptives to prevent unplanned pregnancies in order to avoid negative effects to their career, education, mental health, and income. Beyond preventing unwanted pregnancy, contraceptive use was said to reduce stress, to provide health benefits, and to ensure the continued ability to work.
• According to a Kaiser study, about 65% and 16% of sexually active women with private and medicaid plans, respectively, in the United States use contraceptives to prevent pregnancies. Overall, preventing pregnancy is the leading reason for using contraceptives at 59% followed by managing a medical condition (13%) and a combination of preventing pregnancy and managing a medical condition (22%).

What They Value

• Based on the 2020 Guttmacher report, a "woman’s contraceptive needs may vary over her reproductive lifetime" with over 75% having used three or more contraceptive methods by age 44. The desirability of the services is dependent on the woman's specific needs and preferences.
• About 57% of women reported using one contraceptive method while 42% used two or more methods. Between 2017 and 2018, 59% of women who used contraceptives used male condoms, 40% used oral contraceptives, and 24% used an intrauterine device (IUD). Condoms and oral contraceptives are still dominant among younger women at 79% and 60%.
• The Kaiser study also found that the site of care for sexual health services differed by the type of insurance coverage. About 81% of women with private insurance sought non-maternal services at a doctor's offices compared to 59% of those with medicaid coverage. The latter group also showed a preference for public clinics and community health centers.

Advantia Health

•  Advantia Health is a stable, growing full-service women's health plan provider. The company started in 2014 and was a recent beneficiary of a $45 million investment from BlueMountain Capital Management LLC. Its services are primarily for women because it recognizes them as "the chief medical officers of the family."
• In the course of its growth, the company has expanded into clinical research that benefits patients and acquired Heartland Women's Healthcare to have a national spread. In 2019, Advantia Health also acquired Pacify, a tech startup.
• The company has a functional website and offers services in OB-GYN, primary care, mental wellness, and specialist care.
• OB-GYN services entail the delivery of babies and the treatment of diseases of reproductive organs in women. The abbreviation is for obstetrics (obstetrician) and gynecology (gynecologist).
• Its primary care services entail taking preventive treatment measures to forestall debilitating health issues. Advantia Health plays an active role in this regard, ensuring women adapt well to lifestyle changes.
• The mental wellness services of the company entail overall management of the individual's health, particularly in such areas as the treatment of stress. Advantia Health has a team of dedicated professionals to handle mental health issues.
• Its specialist care services entail incorporating the likes of "first-class women’s health specialists including gynecological, oncology, and urogynecologists" to handle specialized cases peculiar to womanhood.
• The overall information on the marketing strategy that Advantia Health is using to engage with women is through a direct-care system that entails "building out networks of women’s health clinics, ramping up the use of technology, and promising a more comprehensive approach to care."
• A campaign example of the company is the 'Pacify App' campaign, which the company executed across various channels and messaging. One channel is the use of a 50-second video with messaging such as 'access to unlimited video consultations with health professionals,' 'no appointment, no waiting,' and 'with Pacify comes peace of mind.' The company also made use of press channels like NPR, Washingtonian, HuffPost, Business Insider, and MedCity News to drive home this campaign.
• The Pacify app offers "on-demand 24/7 lactation support." Through the use of this telemedicine technology, the company delivers a postpartum support system, and "many women call on this service for lactation consulting."

The Tia Clinic

•  Tia Clinic is a stable, growing full-service women's health plan provider. It qualifies itself as "the next generation of women’s healthcare platform bringing empathy and innovation together to help women thrive." The company started in 2016 and was a recent beneficiary of a $2.5 million seed funding and $6 million in capital investment.
• In the course of its growth, the company has established a brick-and-mortar medical center in New York City to merge both its digital and physical offerings and create a one-stop-shop for patients. Tia Clinic is currently scaling for a nationwide spread.
• The company has a functional website and offers services in exams and screening, acute infections, consultations, primary care, gynecological procedures, and wellness services. For these services it offers, some are covered by the company's accepted insurance plans, while some come with cash prices.
• Exams and screening services of Tia Clinic entail a well-woman examination packaging, which encapsulates testing, screening, and treatment of sexually transmitted infections (STI). Acute infection services entail testing and treatment of urinary tract infections (UTI), bacterial vaginosis, and yeast.
• Its consultation services entail consulting in areas such as birth control, endometriosis, fibroid or cysts, autoimmune disease, fertility, infertility, vulvodynia, vaginismus, and others. The primary care services of the company entail medical treatments of strep throat, sinus infection, flu, and flu shot.
• Gynecological procedure services of Tia Clinic cover areas such as IUD insertion, biopsy, IUD removal, ultrasound, and colposcopy. Its wellness services comprise acupuncture and group wellness workshop.
• The overall information on the marketing strategy that the Tia Clinic is using to engage with women is through an integrated and personalized care system that "uses tech and design to build a personalized, soulful relationship-driven care model that helps women make informed decisions about their health."
• A campaign example of the company is the '#AskTia' campaign for its Tia App, which was executed via a 62-second video across social media platforms like Facebook. Messaging for the Tia App campaign include "own your body, own your choices" and various hashtags like '#AskTia,' '#TiaTips,' and '#TiaTalks.' The company also featured the app on platforms such as Forbes, Refinery 29, BRIT+CO, and Mashable to drive home this campaign.
• The Tia App is the "personal, private women’s health advisor," and depending on who is responding, Tia's tone can be clinical, colloquial, serious or sweet & sass. It is a personalized tool aim to get women smart (#TiaTalks) and trustworthy of the company.
• Based on established trust tailored on personalized delivery, memberships for the company's plan sold out within the first few weeks after it opened the NYC medical center, while the waitlist accounts for many more.

Research Strategy

Using a 2017 Post