Women’s health continues to undergo rapid change; transformative disruptors are seeking to reimagine how, when, and where women’s health services are provided. While historically low birth rates make the headlines, every other aspect of women’s health – from reproductive family planning to longevity – is booming. Here’s what we’re watching this fall in the Women’s Health sector:
1. Reimbursement
Long a pain point unique to the specialty – exacerbated by diversity of payers across obstetrics (primarily Medicaid) and gynecology (primarily commercial and Medicare), and global payment structure for all OB services – reimbursement methodologies are finally being challenged at the state and federal levels. The Biden administration, via CMS, has begun to push substantial funding into its innovation hub for funding of new Medicaid payment models for maternal health, like the Transforming Maternal Health (TMaH) model with applications due this fall. Pressure is being applied across public and private payers to fund comprehensive services (lactation, behavioral health, chronic disease management for pregnancy care; physical therapy, education, wellness, for gynecologic conditions) – without simply adding more activities to existing codes without corresponding funding improvements.
Why your organization should care – Relief is coming. As CMS pushes reimbursement changes, and commercial payers are increasingly faced with costly high-acuity patients, reimbursement for women’s health will be realigned with services that enhance coordination, quality, and outcomes. Providers and systems who have proactively evaluated – and prioritized – offerings will be the most nimble and successful in adopting the reimbursement changes.
2. Innovation
Funding for women’s health (FemTech) continues to increase, up 3% in 2024 compared to previous years – well ahead of the historic $1.4 billion in women’s health investments made in 2021. Entrepreneurs who have been successful in other aspects of healthcare (i.e., remote patient monitoring, diagnostic devices) are turning their attention to women’s health. Private equity and venture capital firms who have entered the provider space and are beginning to understand the unique complexities of the specialty – and the value of coordinated care – are backing services that promote connectivity, enhanced experience, and improved outcomes.
Why your organization should care – It’s time to rethink how women’s health services are provided. Inpatient obstetric service closures and constricted recruitment pipelines are adding up to increased volumes for providers focused on women’s health. Under the spotlight of women’s health outcomes (particularly for maternal health), adding complementary innovations into care pathways will add value, reduce risk, bolster provider satisfaction, and alleviate access constraints.
3. Physician Shortages
Demand for women’s health specialties is greater than the supply; nationally, applicants to OB/GYN programs dropped over 5% between 2022-2023, one largest declines across all specialties. The replacement rate for OBGYNs (measuring new recruits versus retirees) already projected a shortage, and recent legislative changes have accelerated the trend. While the birth rate has been declining, the demand for providers has only increased in OB-GYN, driven dually by more higher-acuity pregnant patients and a rapidly aging population requiring post-menopausal and longevity care.
Why your organization should care – The traditional model for OBGYN physicians is no longer applicable. Providers desire reliable schedules, consultative support, and team-based approaches to care. Exploring options to build care pathways, incorporate midwives, limit on-call periods, add laborists, and streamline communication and monitoring with technology will ensure programmatic attractiveness to new recruits.
Underlying these opportunities is a disruptive paralysis – with so many options, its hard to know which ones are the best for your patients, community, and providers. As leaders and providers are confronted with new paths, the most substantial challenge is knowing when to take action – and when to wait.