90 days. Minimum 5,000 covered lives for statistical validity. Claims-verified measurement at day 30, 60, and 90. Baseline established from your prior 12 months of maternity claims.
NTSV C-section rate. NICU admission rate. 30-day readmission rate. Steering acceptance. Navigation engagement. Member satisfaction. Cost per episode.
15% NICU reduction (primary savings lever). 15% NTSV C-section reduction. 30% readmission reduction. Modeled annual savings of $376K per 10,000 employees. Pilot-period savings proportional to population size and 90-day window.
Pregnant employees and pregnant dependents (spouses, domestic partners) enrolled in the employer's self-funded medical plan. Both commercial and high-deductible plan designs qualify.
We identify pregnancies from claims data (ICD-10 O00-O9A, Z33-Z39 codes appearing in the monthly claims feed). Members can also self-refer through their benefits portal or HR department.
For a 10,000-employee population, expect approximately 220 pregnancies per year, yielding roughly 55 pregnancies during the 90-day pilot window. For a 5,000-life minimum pilot, expect approximately 110 pregnancies per year, yielding roughly 27 pregnancies during the 90-day pilot window.
Navigation and steering value require that members live in areas with two or more delivery facilities within 30 miles. This is the threshold for meaningful facility comparison. Per CMS and March of Dimes data, 93.6% of U.S. births occur to mothers within 30 minutes of an OB hospital (PMC11080172).
Members in single-facility or "maternity desert" geographies still receive risk stratification, navigator support, and postpartum follow-up. They are excluded from steering metrics but included in all clinical quality metrics.
Our steerability model segments the population into four tiers: Full choice (55%), Quality-blind default (24%), Single-facility (18%), and Desert (3%). Effective steerable fraction: 85.6% for metro-employed populations.
Hospital-level quality metrics for every delivery facility within the employer's geographic footprint. Built from three federal data sources and one independent safety organization. Updated quarterly or when source data refreshes.
Metrics per facility: NTSV C-section rate, NICU admission rate, 30-day maternal readmission rate, Leapfrog safety grade, delivery volume, breastfeeding support score, and in-network status under the employer's plan.
Pilot agreement signed. BAA executed. Claims data request sent to TPA. Provider network file requested. Eligibility file requested. TPA data-sharing agreement initiated (critical path).
Claims data received. 12-month baseline analysis completed: historical C-section rate, NICU admission rate, readmission rate, cost per episode, complication frequency. Facility quality database built for employer's geographic footprint. Navigator(s) hired or contracted. Scorecard metrics finalized with employer.
Currently pregnant members identified from claims. Navigator outreach begins. Risk stratification run on all identified pregnancies. Communication channel activated (benefits portal, mailer, or claims-triggered outreach per employer preference).
Member enrollment in progress. Risk stratification complete for all identified pregnancies. First facility comparison conversations. Engagement metrics tracked. First scorecard delivered at day 30: enrollment rate, engagement rate, risk profile distribution, early process metrics.
Monthly navigator touchpoints active. Delivery outcomes begin appearing in claims (for members who were 32+ weeks at pilot launch). Steering acceptance data accumulating. Second scorecard at day 60: clinical metrics emerging, process metrics stabilized, cost data beginning to appear.
Full clinical outcome data for early-enrollment members. 30-day postpartum follow-ups completing. Performance guarantee assessment windows closing. Third scorecard at day 90: full clinical outcomes, cost per episode comparison, steering impact, engagement summary.
Employer receives final scorecard plus recommendation document. Three options: continue at current scope, expand to full population, or walk away with data and baseline analysis. No penalty for any decision. No termination fee.
| Metric | Definition | Source | Baseline | Target |
|---|---|---|---|---|
| NTSV C-section rate | First-time mothers, singleton pregnancy, vertex presentation, term (37+ weeks) deliveries by cesarean section. The standard quality metric for unnecessary C-sections. | Claims (ICD-10 / CPT) | Prior 12 months | 15% reduction |
| NICU admission rate | Admissions to neonatal intensive care unit per navigated delivery. The primary savings lever. One prevented NICU admission saves an average of $71,158. | Claims (DRG 789-795) | Prior 12 months | 15% reduction |
| 30-day readmission | Maternal readmission within 30 days of delivery discharge. Includes physical complications and mental health admissions (PPD). This is the performance guarantee metric. | Claims | Prior 12 months | 30% reduction |
| Steering acceptance | Percentage of members who chose the higher-quality facility when presented with the facility comparison. Measures whether the information changes behavior. | Navigator logs | N/A (new metric) | >50% |
| Navigation engagement | Percentage of identified pregnant members who engaged with the navigator (at least one substantive conversation). Measures program reach and member acceptance. | Navigator logs | N/A | >70% |
| Member satisfaction | Post-delivery survey administered by navigator at 30-day postpartum follow-up. Net Promoter Score (3-question survey; expected response rate 60-80% given existing navigator relationship). Measures member experience with navigation and facility comparison. | Survey | N/A | >50 NPS |
| Cost per episode | Total maternity episode cost: prenatal care through delivery through 30 days postpartum. Includes maternal and newborn costs. Measured as allowed amount from claims. | Claims | Prior 12 months | Reduction vs. baseline |
Clinical metrics (C-section, NICU, readmission) measured from claims data with 30-45 day lag. Process metrics (steering, engagement) measured from navigator logs in real-time. Member satisfaction measured via survey at 30-day postpartum. Cost per episode measured as allowed amount from 837/835 claims, bundled using episode grouper logic (prenatal first visit through 30-day postpartum discharge).
A 90-day pilot with 1,000-5,000 covered lives will produce 5-25 navigated deliveries. This is sufficient for process metrics (steering acceptance, engagement, satisfaction) and directional clinical signals (trend-line movement on C-section and NICU rates), but not for p<0.05 statistical significance on clinical outcomes. Full statistical power requires the 12-month contract period with 100+ measured episodes. The pilot proves the model works. The contract proves the numbers.
| Navigator(s) | $4,500-$7,500 |
| Clinical advisor | $1,500-$2,500 |
| Technology / infrastructure | $800-$1,200 |
| Malpractice / E&O | $300-$500 |
| Total monthly | $7,100-$11,700 |
Final scorecard. All seven metrics, measured against the agreed baseline. Trend data from day 30 and day 60 scorecards. Clear visual: here is where you were, here is where you are.
ROI calculation. Actual pilot costs vs. measured savings. NICU admissions prevented (if any). Steering acceptance rate and its cost implication. Readmission data.
Recommendation document. Our assessment of whether the pilot demonstrated sufficient signal to justify full deployment. We publish this honestly. If the numbers didn't move, we say so.
Standard contract period. Sufficient for 100+ measured episodes and full statistical validation of clinical outcomes.
Same tier pricing. No escalation from pilot to contract. Volume-tiered: larger populations get deeper rates.
Two-tier guarantee activates after 100 measured episodes. Tier 1: credentialed delivery providers warrant their delivery outcomes — preventable readmission costs absorbed by the provider under bundled warranty terms. Tier 2: 25% of Waybright's annual platform fee at risk against population-level maternity outcomes. We forfeit our fee on a miss. We never pay a medical claim.
Add dependents. Add locations. Add adjacent episodes: pelvic floor therapy, extended postpartum (90-day), lactation support coordination. Data retention policy: all PHI returned or destroyed within 30 days per BAA terms if employer elects not to continue.
Standard HIPAA BAA template provided. Covers: permitted uses and disclosures of PHI, safeguards, breach notification to employer and HHS (without unreasonable delay, no later than 60 calendar days per HITECH Act), subcontractor requirements, termination provisions, and return/destruction of PHI at contract end.
No novel terms. Your legal team has seen this template from every healthcare vendor. Typical review and execution: 2 weeks.
Governs the claims data feed from TPA to Waybright. Scope: maternity-related claims only (ICD-10 O00-O9A, Z33-Z39). Monthly flat-file extract via SFTP. No real-time API integration during pilot.
Standard DSA template provided. Most TPAs (Meritain, Cigna ASO, Aetna ASO, UMR, Allegiance) have executed similar agreements with navigation vendors. We handle the TPA relationship directly once the employer authorizes the data share.
Privacy Rule (45 CFR 164.502): Minimum necessary standard applied to all PHI access. Navigators access only their assigned members. Claims analysts access only de-identified aggregate data for scorecard construction.
Security Rule (45 CFR 164.312): Access controls (unique user IDs, automatic logoff), audit controls (logging on every PHI access), integrity controls (checksums on data files), transmission security (TLS 1.2+).
Supabase with RLS: Row-level security ensures each navigator sees only their assigned members. Database-level access controls enforced at the PostgreSQL layer, not the application layer.
Encryption: At rest (AES-256). In transit (TLS 1.2+). Backup encryption matches production. No PHI in logs, error messages, or client-side storage.
The Waybright performance guarantee is a two-tier contractual commitment. Not insurance. A performance guarantee backed by provider delivery warranties and our own fee at risk.
Tier 1 — Provider-held delivery warranty: Credentialed delivery providers warrant their own delivery outcomes. If a navigated member is readmitted within 30 days for a preventable delivery complication (postpartum hemorrhage, C-section wound infection, preeclampsia/hypertensive emergency, endometritis, DVT/PE), the delivering provider absorbs the cost under bundled warranty terms negotiated between the employer's plan and the provider. Tier 1 reserves sit on the provider's balance sheet, not Waybright's.
Tier 2 — Platform fee at risk: 25% of Waybright's annual platform fee is at risk against population-level maternity outcomes. Risk-adjusted maternity spend vs. baseline, measured annually. Fee forfeited on a miss. The maximum financial exposure to Waybright under the performance guarantee is forfeiture of earned platform fees.
Claims flow: Claims continue flowing through the employer's self-funded plan and TPA. Waybright does not process, adjudicate, or pay medical claims.
Provider delivery warranties are contractual terms between the employer's plan and the credentialed delivery providers, not insurance products.