If pregnant and achieve high vitamin D, we propose 400 dollar insurance rebate

Pregnancies are expensive to health insurance companies,
    especially pregnancies having low vitamin D

Propose increasing vitamin D levels and use a portion of the insurance company savings to reward the mother for having reduced medical costs of pregnancy and birth

Costs and net savings to insurance company

• $ 400 rebate/reward given to women for achieving > 40ng level of vitamin D while pregnant
     Note: most of the reasons for poor response to vitamin D will be covered in the brochure
• $ 600 estimated costs includes: vitamin D tests, vitamin D, Omega-3, education, analysis, management, etc.
• $ 4,000 estimated savings of per pregnancy & birth versus having low vitamin D
  high risk for low Vitamin D, dark skin, high BM, high latitude, stay indoors a lot, excessive clothing, night shift,
  have a disease associated with low vitamin D such as: MS, some cancers, diabetes, depression
• $ 3,000 net savings (profit) for health insurance company (such as Aetna, Blue Cross Blue Shield)

Why it will work

Vitamin D reduces medical costs of pregnancy with low vitamin D by average of $4,000

• 97 % of pregnancies have < 40 ng of Vitamin D (high risk: dark skin, obese, etc)
• Intervention trials in hospitals, adding vitamin D have proven $2,570 savings average by reducing preterm births
• 440+ studies of Vitamin D and pregnancy at VitaminDWiki.com

Vitamin D helps with much more than pregnancy

• Less Vitamin D = big recent increases in 30+ health problems
• Vitamin D proven to treat/prevent 78 health problems

Incentives are proven to increase healthy behavior

• Smoking decreased 2.6 times when economic incentives were given
• Economic interventions to improve health – review 2016

8 wins, no losses for this proposal

1) Insurance company increases profit
2) Mother becomes healthier - less time off from work, both before and after birth
3) Mother might have less-than-maximum annual deductibles
4) Mother gets a rebate on her health insurance
5) Infant is healthier (leave hospital sooner, far lower medical costs)
6) Insurance Co. increases # of customers as people become aware of increased health, rebates
7) Hospitals get a reduction in malpractice costs.
8) Pregnancy doctors will be less overworked

Reward is based on number of pregnancy days achieving > 40ng of vitamin D

Give a reward/rebate of $2 for every day pregnant with > 40 nanogram of vitamin D (assuming a 39 week pregnancy)

• $ 476 If loading dose 1 month after becoming pregnant (34weeks x 7 x $2)
• $ 346 if maintenance dose 1 month after pregnant ( 26weeks x 7 x $2)

Additional documented profits to Health Insurance from added Vitamin D

• Reduces Miscarriage 2.5 times (not much cost savings, but mother is much happier)
• Reduces Pre-eclampsia 2 times
• Reduces Gestational Diabetes 2 times RCT
• Reduces Vaginosis 5 times RCT'
• Reduces C-section - unplanned by 1.6 times (C-section adds $20,000 cost to a pregnancy)

Probable sequence from the woman's point of view

1. After her first prenancy visit her Insurance Company says it will pay her up to $476
      if she has low vitamin D and she supplements while pregnant
2. Woman requests that rebate details be sent to her (email or mail, English or Spanish)
3. Woman tells insurance company that she is interested in healthy pregnancy and signs up
4. Woman requests free Vitamin D test via Health Insurance company (Amazon fulfillment)
5. Woman places one drop of her blood onto test paper and mails it in
6. Woman receives brochure describing how much vitamin D, Omega-3 to supplement
7. Woman gets test results one week after maling it in (via email or mail)
8. Woman can then:
   Read the previously recieved brochure
   Discuss the brochure on the phone
   Talk with her doctor
9. Some women go ahead with supplementation (anticipate 50% will do so)
10. Woman requests free Vitamin D and Omega-3 supplements for a healthier pregnancy
    Via Insurance company with Amazon delivery to her home
    Package includes a second home Vitamin D test
    Package includes a $25 thank-you gift certificate as an immediate reward
11. Woman starts supplements and takes second test 10 or 80 days later
       quick loading dose vs maintenance dose
12. Second vitamin D test results are sent both to her and her health insurance company
    expected to show > 90% of the women will have achieved an optimal level of vitamin D
    if among the 10% with low response she can try other form of vitamin D (gut) , Magnesium, stop smoking (which reduces Vitamin D by 9 mg)
13. Rebate check of $346 to $546 is sent to her – perhaps immediately after good test results

Future areas where vitamin D supplementation should be cost effective

Include pregnancies which are not at high risk of being vitamin D deficient (many whites, etc)
Higher reward if their achieved vitamin D level is > 50 nanograms
Cost savings go to large employers (>90% are self-insured)

See also Cost savings with Vitamin D which include the following

• Vitamin D once during pregnancy reduced infant health care costs (300 times ROI) – RCT Dec 2015
• 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016 RCT
• Costs of Pregnancy much reduced by Vitamin D
• Increasing the vitamin D level of all Canadians to 40 ng would save 6 to 18 billion dollars a year – Grant Nov 2016
• Omega-3 supplementation during pregnancy reduce early preterm births (save 1500 USD per child) – Aug 2016
• Heart Attack ICU costs reduced $37,000 per person by $5 of Vitamin D
• Preterm births are VERY costly – Feb 2017
  includes cost-effectiveness estimates for Vitamin D, Omega-3,Vitamin D and Iodine

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