Infertility case management: improving both short-term and long-term outcomes while reducing costs.

Purpose/objectives: Infertility is a growing medical condition as more women are desirous of having children at an older age. It is estimated to be a $3 billion business, and, while infertility treatment is a for-profit commercial endeavor, the product is noncommercial (baby or babies). The treatment process may be complicated with overutilization, drug wastage, and adverse outcomes. High-order multiple gestations may result in preterm births, chronic adult diseases, and lifelong neurological impairments (such as cerebral palsy). The total national cost of infertility treatment unfortunately equals the cost of providing care to these babies in the nursery and neonatal intensive care unit. This article explores the potential benefit of the integration of information technology with clinical case management to reduce overall cost and improve provider accuracy.

Primary Practice Setting(s): Office-based telephonic nurse case management and pharmacology management practice.

Findings/conclusions: The article demonstrates that the challenging integration of information technology with clinical case management is very effective and improves provider accuracy, resulting in the best transfer of real-time information. The case management program at Women's Integrated Network Healthcare has been shown to lower infertility treatment costs by 30% to 40% and lower the numbers of high-order multiple gestations.

Implications For Case Management Practice: Eighty-one percent of the cost reduction is related directly to case management, not reduction in physician fees or unit pharmaceutical costs. Case management can improve effectiveness and quality of conception, and there is a reduction in high-order multiple gestations. It was also found that, by expanding infertility benefits and including case management as the pivotal element, payers and employers could recognize significant savings and, more importantly, the women and families would benefit.