Return-on-Investment Analysis of an Enhanced Community Doula Program: Pre- and Post-COVID-19 Considerations

Area of Science:

• Maternal Health
• Health Economics
• Public Health Interventions

Background:

• Community doulas offer vital support during pregnancy and postpartum, improving birth outcomes and care experiences.
• Lack of insurance reimbursement limits affordable doula access for low-income populations.
• A return-on-investment (ROI) analysis using real-world data is needed to assess Medicaid reimbursement for doula services.

Purpose of the Study:

• To conduct an ROI analysis of the Best Beginnings for Babies (BBB) community doula intervention from a healthcare perspective.
• To determine the financial feasibility and cost-effectiveness of community doula services for Medicaid payers.

Main Methods:

• A randomized controlled trial comparing routine maternity care with and without the BBB intervention was used.
• Healthcare costs and program expenses were collected alongside clinical outcomes.
• ROI was calculated as net healthcare savings divided by investment costs, including post-COVID-19 cost adjustments.

Main Results:

• The BBB intervention resulted in average healthcare cost savings of $1,152 per patient.
• The program demonstrated an 18% ROI, with significant savings from reduced birth hospitalization and NICU stays.
• Proposed Medicaid reimbursement rates showed a positive ROI, though current wage estimates did not.

Conclusions:

• The BBB community doula program is cost-saving for payers and enhances access for low-income individuals.
• Doula services remain financially feasible despite increased program costs, reassuring Medicaid payers of their affordability.
• This study supports the integration of community doula services into Medicaid coverage.