Our 2026–2030 women’s health outlook finds several trends continuing from the past few years that we project will both intensify ongoing challenges and drive areas of opportunity in the years ahead. First, obstetric (OB) units continue to close as the nation’s fertility rate maintains record lows. Second, the fem-tech space—a market that emerged from the desire for personalized, women-centered care supported by technological advancements—is booming. Third, there continues to be a large, cross-industry (e.g., providers, payers, technology companies) focus on improving maternal quality of care and reducing morbidity and mortality rates by targeted interventions and evidence-based practices across the patient care journey. And finally, the development of new programs, including retail offerings, in support of holistic women’s care remains a top priority.
In addition to these continuing trends, the following three areas will have the biggest impact in the next five years:
- Payment models, specifically the anticipated change from global pregnancy billing to unique service billing codes
- Potential impacts of the looming Medicaid cuts stemming from H.R. 1
- The emergence of alternative provider models, particularly for labor and delivery coverage
Changes to the Pregnancy Care Fee Schedules
Pregnancy care and labor and delivery have historically been billed using bundled codes, which provide payment and a WRVU value for a full suite of services. While the details are continuing to emerge, the AMA has announced key changes to the WRVU structure for pregnancy-related billing, including doing away with global codes, using existing evaluation and management codes for new and follow-up care, and maintaining delivery-only codes.
Supported by the AMA and ACOG, the new approach is recognized for enabling providers to bill for individual services and tailor billing codes to a patient’s complexity and specific needs, including screening and other services. The impacts of the billing changes are still unknown, however, and will vary depending on each practice’s unique structure, including its care team’s approach to OB/GYN, labor and delivery call coverage model, WRVU attribution, payer contracts, and compensation models.
Implication: Changes to the pregnancy billing structure have the potential to affect many areas of the practice, from operations to finance to strategy. We also know that incentives drive behavior, meaning this change will impact how WRVUs accrue to physicians and APPs and may influence how they practice. Despite the many unknowns, it’s not too early for health system leaders and practice executives to prepare by conducting a thoughtful qualitative and quantitative evaluation using the three-pronged approach described below.
- Operational Analysis: Talk to OBs, labor and delivery providers, clinic-based providers, and clinic leaders about how the changes could affect the practice and what they could mean for the current level of teamwork, including how physicians and APPs partner on care delivery and the role of the OB hospitalist in patient care.
- Financial Analysis: Partner with your provider compensation department to model the potential impacts under a variety of scenarios and provide thoughtful guidance on the best next steps.
- Strategy Development: Work with your payer strategy and contracting team to gain deeper insight into potential impacts and expected timing. Payers may adopt these changes at different rates. While implementation—including revised payer contracts—will take time, providers should continue to ensure the right approach in the immediate term. The right information will enable the organization to adopt a proactive versus reactive approach.
As more becomes known, ECG is planning a series of blog posts to help guide hospitals and health systems as they evaluate and plan for these billing changes and the full weight of their implications.
Impact of H.R. 1 on Maternal Health Services
Medicaid now covers pregnancy, preventive screenings, and postpartum care, which has been extended to 12 months in most states. Given that Medicaid reportedly covers more than 40% of births in the United States, proposed Medicaid funding cuts may have significant consequences on service availability; care disparities based on income, race, and ethnicity; and maternal morbidity and mortality.
Because each state has a unique approach to offering and funding Medicaid benefits, there will be 50 distinct ways that Medicaid cuts will impact providers, patients, and families. For example, if coverage is reduced for women pre-pregnancy or postpartum, rates of complex pregnancies or complications may increase. Additionally, decreased funding at the health system level may affect the sustainability of facilities that provide women’s health services broadly (most notably in labor and delivery but also in gynecology and emergency services).
Implication: While each organization must develop a customized approach to evaluating and navigating expected Medicaid cuts based on its state’s unique payment environment, there are a few universal strategies to help them prepare:
- Double down on the fundamentals of healthcare leadership, including managing costs and optimizing revenues, selecting the right strategic partnerships for the local market, and making smart investments in clinical areas to offset essential services that may operate at a deficit.
- Assess the impact of your women’s health program on your overall financials, including DSH and other funding sources, and partner with women’s health leaders to understand the patient mix and any current or projected challenges in providing OB/GYN services.
- Engage with local organizations to establish connections or partners for coverage. Organizations like federally qualified health centers may be looking to partner more intentionally to ensure they can fully serve their patient populations.
Alternative Provider Models
Health systems continue to face OB/GYN shortages and other resource constraints. To address this, many systems are assessing the effectiveness of their care delivery models and carefully evaluating how to balance clinic and hospital demands. In many cases, group structures and incentives have not kept pace with the current set of demands, leaving practices to reconsider their provider models, including incorporating nonphysician roles (midwives, doulas, APPs, etc.), hospital-focused providers, or OB-qualified family practice physicians to augment the care team, improve provider satisfaction, and provide much-needed primary care access. This trend underscores the fact that every type of provider can play a role in addressing the complexities of providing high-quality women’s healthcare through a thoughtful, well-planned system of care that both optimizes provider services and considers the impacts of the pregnancy care billing changes discussed above.
In addition to exploring alternative provider models, practices may be evaluating how to partner with community organizations, implement home health programs, and use technology to bolster services and secure the resources necessary to serve an expanded geography. For example, using a hub-and-spoke model, in which health systems support rural providers, including family practice providers, can expand services for patients in their communities and minimize travel for routine care.
Implication: OB-trained physicians and nonphysician providers offer high-quality OB/GYN care to patients and, in many circumstances, allow access to other services patients are seeking, such as midwifery. The expanded care team also provides more entry points into the health system, bolstering volumes while mitigating the financial resources required to support greater access.
To achieve these benefits, however, leaders must enable providers to work to their highest clinical capabilities by developing strong protocols and care delivery standards that clearly outline care pathways by acuity, support appropriate patient scheduling, and ensure warm handoffs when patient complexity changes.
Planning for Success Amid the Uncertainty
The healthcare industry is facing a challenging future—and women’s health is no exception. While the true impacts of the trends discussed herein remain to be seen, there is one common strategy that sticks out as the primary tool to weather the storm: assess, plan, and pivot. Health system executives who (1) understand and monitor the financial and operational performance of their women’s health service line, (2) proactively plan for potential changes, and (3) remain open to varied approaches to care delivery and staffing will build their program’s resilience and protect access to these critical services.
