iMSO identifies research-stage innovations that improve outcomes and lower cost, then proves their value under shared-risk contracts. This model quantifies one such innovation — the PreTRM® blood test paired with remote monitoring and high-intensity case management — across the Medicaid birthing population, nationally and by state.
History-based screening catches only a fraction of at-risk pregnancies. iMSO adopts a validated biomarker to screen broadly, wraps identified patients in proactive care, and takes downside risk on the result — so the clinical and economic value can be measured and priced by actuaries.
A single maternal blood draw at 19–21 weeks returns an individualized preterm-birth risk score — surfacing risk that history-based screening misses.
High-risk patients enter remote monitoring and high-intensity case management — clinical touchpoints, adherence support, and evidence-based interventions in the home.
Fewer of the earliest, costliest births means measurable savings. iMSO takes downside risk on that result — aligning the innovation's price to the value it actually creates.
Model the annual Medicaid savings from screening the eligible birthing population and preventing the most severe preterm births. Set the PreTRM test cost (every screen) and the iMSO program cost (high-risk pregnancies only), the screen-positive rate, and uptake; choose a NICU cost basis. Defaults reflect the PRIME randomized trial and published NICU cost data.
Prevented preterm births shrink the population carrying a prior-PTB history — today's primary screening trigger. As that pool contracts, broad biomarker screening identifies risk that history alone would now miss, compounding value year over year.
A confident risk flag may increase timely, complete antenatal corticosteroid courses in babies born <34 weeks — where diagnostic doubt (is this really preterm labor?) currently leaves roughly half of courses mistimed. Shown separately from the PreTRM savings above: this rests on an unproven assumption — how much of the timing gap a risk flag actually closes. No trial has yet demonstrated it.
States with the largest Medicaid birthing populations and highest preterm-birth burden carry the biggest addressable value. Modeled at the current scenario, test-cost, uptake, and cost-basis settings above.
The eligible population excludes multiple gestations (~3.4%), prior spontaneous preterm birth (~8%), and short cervix (~1.5%), per PRIME enrollment criteria. Every eligible Medicaid pregnancy is screened with the PreTRM test (test cost applied to all screened); only the high-risk screen-positive subset receives the iMSO program of monitoring + high-intensity case management (program cost applied to that subset only). The screen-positive rate and per-pregnancy program cost are adjustable inputs — planning assumptions, not sourced constants. Efficacy is applied as measured in PRIME (intention-to-screen: screen all, treat positives), so prevented births reflect the whole screened population.
From the PRIME randomized trial of the PreTRM® test (Iriye et al., Pregnancy / SMFM, 2026; NCT04301518; n≈5,018). The model runs a range. Optimistic = PRIME's exploratory gestational-age reductions (56% fewer births <32 wk, 32% <35 wk). Conservative = cost avoidance driven by the ~20% NICU-admission reduction — closer to PRIME's co-primary endpoints (composite neonatal morbidity + length of stay) and AVERT's 18% severe-morbidity reduction — rather than the band shift. Exploratory-endpoint significance is company-reported (peer-reviewed paper not yet PubMed-indexed); the savings tiles show the conservative-to-optimistic bracket.
This is a Medicaid value-based-contract analysis, so unit costs are stated on a Medicaid basis, not commercial charges. Conservative (Medicaid-reimbursement): <28 wk ≈ $165K, 28–31 wk ≈ $82K, 32–35 wk ≈ $36K. Upper bound (population all-payer): <28 wk ≈ $318K, 28–31 wk ≈ $180K, 32–35 wk ≈ $22K. Commercial charges run higher still (Beam et al. 2020: ~$604K at 24 wk), so the Medicaid figures are deliberately conservative. The breakdown shows the resulting range.
The ~1.5%/yr expansion of the eligible screening population as prior-PTB prevalence declines is a modeling assumption, not measured data, and it compounds the 5-year projection. Included because the mechanism is real; flagged because the rate is assumed.