Notes and feedback · Versions
Versions and change log
Every version of the business plan and deck, what changed in each, and why. Released versions are never edited; each change makes a new numbered file.
Versions
Every version of each document is kept. The newest is marked Current; the site menu opens it.
| Document | Version | Date | What changed | Open |
|---|---|---|---|---|
| Business plan | v0 | Oct 14, 2026 | Original business plan, before clickable citations. | Open v0 |
| Business plan | v1 | Oct 14, 2026 | Clickable citations: 96 linked sources and 30 inline cites. v1 notes. | Open v1 |
| Business plan | v2 | Oct 14, 2026 | Dr. Sami's feedback applied (decisions D-1 to D-7). 40 logged changes. | Open v2 |
| Business plan | v3 Current | Oct 14, 2026 | Pending items P-1 to P-3 decided: rent wording clarified (number unchanged), MD2 fee updated to $26,000, Houston Methodist Brockman gift added. 12 logged changes. | Open v3 |
| Deck | v0 | Oct 14, 2026 | Original deck, before clickable citations. | Open v0 |
| Deck | v1 | Oct 14, 2026 | Source lines linked; clicking a link no longer advances the slide. v1 notes. | Open v1 |
| Deck | v2 | Oct 14, 2026 | Dr. Sami's feedback applied (decisions D-1 to D-7). 97 logged changes. | Open v2 |
| Deck | v3 Current | Oct 14, 2026 | Pending items P-1 to P-3 decided: rent wording clarified (number unchanged), MD2 fee updated to $26,000, Houston Methodist Brockman gift added. 9 logged changes. | Open v3 |
Note: business-plan.html and deck.html are identical copies of v1, kept at their original paths so old links still work. They are not updated.
How versioning works
- Never edit a released version. Every version stays in
uthealth-obgyn-chair/, numbered-v0,-v1,-v2, and so on. - Next version: copy the latest file to a new number (for example
deck-v3.htmltodeck-v4.html) and edit only the copy. - Record it: add a change log JSON in
changes/(for examplev4-deck-changes.json), re-runpython changes/build_changes.py, and add an entry to the decision log.
v3 change log
Version 3 settles the three pending items P-1 to P-3, decided Oct 14, 2026: the satellite rent wording is clarified (the $320K number does not change), the MD2 Houston fee is updated to $26,000 a year, and Houston Methodist's $110M Brockman gift is added. No pro forma numbers changed. See the decision log.
Changes by decision
| Decision | What was decided | Deck | Plan |
|---|---|---|---|
| P-1 | Satellite rent: wording clarified, number unchanged | 1 | 3 |
| P-2 | MD2 Houston fee updated to $26,000 a year | 2 | 3 |
| P-3 | Houston Methodist $110M Brockman gift added | 3 | 5 |
| Other | Version marker | 3 | 1 |
| Total | Logged changes | 9 | 12 |
A change tagged with two decisions (for example "D-1 / D-6") counts under each, so the decision rows can add up to more than the total.
Deck v3: 9 changes, by slide
Before (v2)After (v3)Markup is shown as text; citation numbers appear in [brackets].
| ID | Element | Before | After | Reason |
|---|---|---|---|---|
| Slide 1: Title (1)v3 slide 1 v2 | ||||
| DK-01Version marker | ElementTitle slide version label | BeforeVersion 2 - Oct 14, 2026 | AfterVersion 3 - Oct 14, 2026 | ReasonMark this as version 3. |
| Slide 8: Houston Methodist head-to-head (3)v3 slide 8 v2 | ||||
| DK-02P-3 | ElementWhere they are strong, Capital bullet (merged one-bullet version) | BeforeCapital: ~$4.4B revenue, ~$470M surplus (FY2024, one entity); Centennial Tower 2027 | AfterCapital: ~$4.4B revenue, ~$470M surplus (FY2024); record $110M Brockman gift (2026), $10M to OB/GYN | ReasonThe record $110M gift (incl. $10M OB/GYN) was missing from the deck. The six-bullet version overflowed, so the merged one-bullet version from the analysis is used. |
| DK-03P-3 | ElementSources line: add HM release and InnovationMap | BeforeForm 990 FY2024 (via philanthropy.org); Houston Methodist newsroom ( | AfterForm 990 FY2024 (via philanthropy.org); HM $110M Brockman gift (June 2026); InnovationMap ($10M OB/GYN split); Houston Methodist newsroom ( | ReasonCite the $110M gift and the $10M OB/GYN split (the HM pages give no dollar split). |
| DK-04P-3 | ElementSpeaker notes, new line before 'So I would not fight them...' | Before(none) | AfterAnd they have new money. In June 2026 the Brockman foundation gave Methodist 110 million dollars, the largest gift in its history, and about 10 million of it is an excellence fund for their OB/GYN department. They can fund a women's health push quickly, which is why we should move first on the lanes they have left open. | ReasonBrief the presenter on the new gift; leads into the existing closing line. |
| Slide 12: 1. Suburban satellites (2)v3 slide 12 v2 | ||||
| DK-05P-1 | ElementInputs source line: rent wording | BeforeHouston MOB rent ~$30/SF (Matthews 2025); | AfterHouston MOB asking rent ~$30-34/SF, ~$38-39 in Sugar Land and Far West (Matthews Q4 2025; Transwestern Q4 2025, full service); model uses $40/SF all-in for new space; | ReasonOld wording implied the model uses $30/SF; it uses $40/SF all-in, above Transwestern full-service rents. Rent number unchanged. |
| DK-06Version marker | ElementInputs source line: 'Full model' link | Before<a href="business-plan-v2.html#finance" | After<a href="business-plan-v3.html#finance" | ReasonLink to the matching v3 plan. |
| Slide 13: 2. UTHealth Signature (2)v3 slide 13 v2 | ||||
| DK-07P-2 | ElementBenchmarks line under the tier list | BeforeMDVIP "low four figures"; MD2 Houston $24,000. No Houston concierge OB/GYN price found. | AfterMDVIP "low four figures"; MD2 Houston $26,000 a year. No Houston concierge OB/GYN price found. | ReasonMD2's Houston page states $26,000 a year (checked Oct 14, 2026); $24,000 was the 2022 launch price. |
| DK-08P-2 | ElementSources line: MD2 link | BeforeMD2 River Oaks | AfterMD2 Houston pricing (2026) | ReasonPoint to MD2's own current price page. |
| Slide 32: Appendix: key sources (1)v3 slide 32 v2 | ||||
| DK-09Version marker | ElementFull source list link | Before<a href="business-plan-v2.html#sources" | After<a href="business-plan-v3.html#sources" | ReasonLink to the matching v3 plan. |
Business plan v3: 12 changes, by section
Before (v2)After (v3)
| ID | Element | Before | After | Reason |
|---|---|---|---|---|
| Cover (1)v3 v2 | ||||
| BP-01Version marker | ElementMeta line | BeforeVersion 2 - Oct 14, 2026 | AfterVersion 3 - Oct 14, 2026 | ReasonMark this file as version 3 of the plan. |
| 1 Executive summary - Top 3 risks (1)v3 v2 | ||||
| BP-02P-3 | ElementRisk 3: Houston Methodist | BeforeHouston Methodist (#7 U.S. News OB/GYN, new $10M OB/GYN fund) | AfterHouston Methodist (#7 U.S. News OB/GYN, new $10M OB/GYN fund from a record $110M gift[153]) | ReasonOptional tightening applied; the $10M figure comes from InnovationMap. |
| 4 Competitive analysis (1)v3 v2 | ||||
| BP-03P-3 | ElementCompetition table: Capital row, Houston Methodist cell | Before~$4.4B revenue, ~$470M surplus (FY2024, one entity); $10M OB/GYN fund (2026) | After~$4.4B revenue, ~$470M surplus (FY2024, one entity); record $110M Brockman gift (June 2026), incl. $10M OB/GYN women's health excellence fund[152,153]; Brockman Centennial Tower 2027 | ReasonThe $110M total is the capital signal; name the fund correctly and cite it. |
| 5 Initiatives - 2 UTHealth Signature hybrid membership (1)v3 v2 | ||||
| BP-04P-2 | ElementWhy now: MD2 benchmark | BeforeMDVIP "low four figures", MD2 Houston $24,000. | AfterMDVIP "low four figures", MD2 Houston $26,000 a year[154]. | ReasonMD2's Houston page states $26,000 a year (checked Oct 14, 2026). |
| 7 Financial plan (2)v3 v2 | ||||
| BP-05P-1 | Element7a satellite inputs caption: rent | Beforerent $320K; | Afterrent $320K (8,000 SF x $40/SF all-in; Houston full-service asking rent is $33.56/SF metro and $37.54-39.42 in the Sugar Land and Far West submarkets, Q4 2025[71,147]); | ReasonShow how $320K is built and that $40/SF all-in is above market full-service rents. Rent number unchanged; cites src-71 and src-147 for the first time. |
| BP-06P-1 | Element7c midlife inputs caption: rent | Beforeramp 55% / 80% / 95%; capex $1.0M. | Afterramp 55% / 80% / 95%; rent $200K (5,000 SF x $40/SF all-in); capex $1.0M. | ReasonState the midlife rent the model already uses. Number unchanged. |
| 8 Funding sources (1)v3 v2 | ||||
| BP-07P-3 | ElementPhilanthropy row: Peers | BeforePeers: HM Brockman gift included a $10M OB/GYN fund; UTHealth's $22M McWilliams gift for AI. | AfterPeers: HM's record $110M Brockman gift (June 2026) included a $10M OB/GYN women's health excellence fund[17,153], so the competitor for local donors is moving now; UTHealth's $22M McWilliams gift for AI. | ReasonGive the full gift and cite the $10M split. |
| 11 Sources (5)v3 v2 | ||||
| BP-08P-3 | Elementsrc-17 label | Beforerel="noopener">HM Brockman gift | Afterrel="noopener">Houston Methodist Giving: Brockman Medical Research Foundation $110M gift, Brockman Centennial Tower (June 24, 2026) | ReasonRelabel for clarity; same gift. |
| BP-09P-1 | Elementsrc-71 label | Beforetarget="_blank" rel="noopener">Houston medical office rents | Aftertarget="_blank" rel="noopener">Matthews: Houston medical office market report, Q4 2025 | ReasonName the report the rent figure comes from. |
| BP-10P-2 | Elementsrc-127 label | BeforePaperCity: MD2 Houston concierge practice in River Oaks ($24,000 membership) | AfterPaperCity, Dec 2022: MD2 Houston opens in River Oaks ($24,000 membership at launch) | ReasonKeep as history; relabel so it does not read as the current price. |
| BP-11P-3 | ElementSources list: new entries src-152, src-153 | Before(none) | AfterHouston Methodist Newsroom, 'Houston Methodist receives transformational $110 million gift to support neuroscience, neurological care and women's health', June 24, 2026: https://www.houstonmethodist.org/newsroom/houston-methodist-receives-transformational-110-million-gift-to-support-neuroscience-neurological/ InnovationMap, 'Houston Methodist receives record $110M gift, names future tower', Jun 25, 2026 ($100M innovation fund; $10M to OB/GYN): https://houston.innovationmap.com/houston-methodist-centennial-tower-2677096169.html | Reasonsrc-152 Houston Methodist newsroom release (June 24, 2026, $110M gift) and src-153 InnovationMap (Jun 25, 2026, $10M OB/GYN split); both cited inline. |
| BP-12P-2 | ElementSources list: new entry src-154 | Before(none) | AfterMD2 Houston: "The annual fee is $26,000 for an individual, paid on a monthly basis" (checked Oct 14, 2026; locations/houston-tx lists $2,167/month): https://www.md2.com/houston | ReasonMD2 Houston pricing page ($26,000 a year, checked Oct 14, 2026); cited in initiative card 2. |
v2 change log
Version 2 carries out Dr. Sami's feedback, decided Oct 14, 2026. See the decision log for what was decided and why (D-1 to D-7).
Changes by decision
| Decision | What was decided | Deck | Plan |
|---|---|---|---|
| D-1 | Apply the proposed wording fixes | 40 | 23 |
| D-2 | New slide 11 palette (slide 10 matches) | 5 | 0 |
| D-3 | CPT 2027 as a sixth "why now" force | 6 | 6 |
| D-4 | Texas Medicaid connected-care billing | 11 | 5 |
| D-5 | No revenue for the pelvic floor trainer | 6 | 3 |
| D-6 | Slide 12: conservative case stays in the caption | 10 | 1 |
| D-7 | Find URLs for unlinked deck sources | 17 | 2 |
| Other | Evidence hedge, Sources, Version marker | 2 | 3 |
| Total | Logged changes | 97 | 40 |
A change tagged with two decisions (for example "D-1 / D-6") counts under each, so the decision rows can add up to more than the total.
Deck v2: 97 changes, by slide
Before (v1)After (v2)Markup is shown as text; citation numbers appear in [brackets].
| ID | Element | Before | After | Reason |
|---|---|---|---|---|
| Slide 1: Title (1)v2 slide 1 v1 | ||||
| DK-01Version marker | ElementTitle slide: version label + CSS (.slide.title .ver) | Before(none) | AfterVersion 2 - Oct 14, 2026 (small, 72% white, bottom-right) | ReasonMark this as version 2; <title> unchanged |
| Slide 3: Why now (14)v2 slide 3 v1 | ||||
| DK-02D-3 | ElementHeadline (h2) | BeforeFive forces have shifted in the last 24 months | AfterSix forces have shifted in the last 24 months | ReasonCPT 2027 added as a sixth force |
| DK-03D-1 | ElementPolicy row, What changed | BeforeTexas Medicaid postpartum coverage extended to 12 months (effective March 1, 2024). About 1 in 4 Texas pregnancy-related deaths occur 43 days to 1 year after pregnancy; about 80% judged preventable. | AfterTexas Medicaid/CHIP postpartum coverage is 12 months (HB 12, effective March 1, 2024; CHIP Perinatal excluded). About 1 in 4 Texas pregnancy-related deaths occur 43 days to 1 year after pregnancy; about 80% judged preventable. | ReasonLaw confirmed current; names HB 12 and the CHIP Perinatal exception |
| DK-04D-1 | ElementPolicy row, What it opens | BeforeA billable, accountable postpartum year | AfterA billable, accountable postpartum year. Problem visits, collaborative care and monitoring are billed outside any OB package; Texas Medicaid already pays per visit. | ReasonAnswers Dr. Sami's 'still billable beyond the OB package?' question |
| DK-05D-3 | ElementNew table row (between Payment and Demographics) | Before(none) | AfterOB coding | CPT 2027 retires the global OB codes (59400, 59510, 59610, 59618, 59430): from Jan 1, 2027 every prenatal and postpartum visit is billed on its own. | Every visit in the pregnancy year is paid on its own, so continuity becomes revenue | ReasonNew 'why now' force (AAFP, MGMA); 'What it opens' cell written to match the row |
| DK-06D-3 | ElementCSS: table | Beforetable.t at 19px; columns 18% / 47% / auto | Aftertable.t at 17.5px (inline style); columns 15% / 52% / auto | ReasonFit six rows on the fixed 1600x900 canvas |
| DK-07D-3 | ElementSources line | BeforeSources: Texas HHSC / HB 12; Texas MMMRC-DSHS 2024 Joint Biennial Report; ... | AfterSources: Texas HHSC / HB 12; HB 12 one-pager (CHIP Perinatal exception); AAFP (CPT 2027 maternity codes); MGMA (Aug 2026); Texas MMMRC-DSHS 2024 Joint Biennial Report; ... | ReasonCite the policy and CPT 2027 facts |
| DK-08D-3 | ElementSpeaker notes, paragraph 1 | BeforeWalk the five rows quickly; the audience knows each one individually. The point is that they converged. | AfterWalk the six rows quickly; the audience knows each one individually. The point is that they converged. | ReasonRow count changed |
| DK-09D-1 | ElementSpeaker notes, Policy paragraph | Before... We now have a payer for that period and a reason to own it. | After... We now have a payer for that period and a reason to own it. The law is current; CHIP Perinatal members are the one group without the full 12 months. | ReasonDr. Sami asked whether the law is current |
| DK-10D-4 | ElementSpeaker notes, Payment paragraph | Before... where many patients monitor for the first two weeks. | After... where many patients monitor for the first two weeks. These are Medicare and commercial codes; Texas Medicaid pays home BP monitoring differently, as S9110 plus 99091. | ReasonTexas Medicaid does not pay the RPM code stack |
| DK-11D-3 | ElementSpeaker notes, new paragraph | Before(none) | AfterOB coding: from Jan 1, 2027 the global OB package is gone, so every prenatal and postpartum visit is billed on its own (confirm against the final AMA CPT 2027 code set). | ReasonOne short line for the new force |
| DK-72D-7 | ElementSources line | Before; FDA via Contemporary OB/GYN and ; AMA CPT 2026; | After; FDA via Contemporary OB/GYN and ; AMA CPT 2026; | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| DK-89D-1 | ElementPolicy row, What changed (MMMRC figures) | BeforeAbout 1 in 4 Texas pregnancy-related deaths occur 43 days to 1 year after pregnancy; about 80% judged preventable. | AfterOf Texas pregnancy-related deaths in 2020, about 1 in 4 occurred 43 days to 1 year after pregnancy; about 80% were judged preventable. | ReasonClaim check: MMMRC 80% preventable and 1 in 4 postpartum are confirmed but are 2020 deaths only; name the year |
| DK-90D-1 | ElementSources line (new source) | BeforeHB 12 one-pager (CHIP Perinatal exception); | AfterHB 12 one-pager (CHIP Perinatal exception); Texas Tribune (Jan 17, 2024); | ReasonSource for the corrected '43rd state approved' wording in the notes |
| DK-91D-1 | ElementSpeaker notes, Policy paragraph | BeforePolicy: Texas was the 43rd state to extend postpartum Medicaid to 12 months. One in four pregnancy-related deaths in Texas happens between six weeks and one year. | AfterPolicy: Texas became the 43rd state approved to extend postpartum Medicaid to 12 months (federal approval January 2024, per the Texas Tribune; coverage began March 1, 2024). Of Texas pregnancy-related deaths in 2020, one in four happened between six weeks and one year after pregnancy, and the state review committee judged about 80 percent preventable. | ReasonClaim check: '43rd' counts federal approvals (Texas Tribune, Jan 17, 2024), not KFF; MMMRC figures are 2020 deaths |
| Slide 5: Houston by the numbers (1)v2 slide 5 v1 | ||||
| DK-73D-7 | ElementSources line | BeforeMetro births is an estimate pending DSHS Table 9. | AfterMetro births is an estimate pending DSHS Table 9. | ReasonD-7: same source name as slide 6 (DSHS Table 9); linked for consistency; visible text unchanged |
| Slide 6: TAM / SAM / SOM (1)v2 slide 6 v1 | ||||
| DK-74D-7 | ElementSources line | BeforeCensus/ACS, KFF, NHANES-based prevalence, Monash VMS cohort, | AfterCensus/ACS, KFF, NHANES-based prevalence, Monash VMS cohort, ACS B01001 and births with DSHS Table 9 before decisions. | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 7: Competitive landscape (3)v2 slide 7 v1 | ||||
| DK-12D-1 | ElementFetal / MFM row, Houston Methodist cell | BeforeNo MFM division listed | AfterMFM through affiliated groups (Pediatrix at TMC; Texas Children's at West). No academic MFM division, fellowship or fetal therapy found. | ReasonMethodist does have MFM doctors; the gap is academic MFM |
| DK-13D-1 | ElementSources line | Before(no Methodist MFM links) | AfterAdded links: Houston Methodist MFM; Pediatrix MFM at Houston Methodist; Texas Children's MFM locations | ReasonCite the MFM finding |
| DK-14D-1 | ElementSpeaker notes, new paragraph | Before(none) | AfterOn MFM: Methodist does have MFM doctors, mostly through affiliated groups. What we could not find is an academic MFM division, an MFM fellowship or a fetal therapy program. | ReasonPrepare for a Houston audience |
| Slide 8: Houston Methodist head-to-head (7)v2 slide 8 v1 | ||||
| DK-15D-1 | ElementWhere they are thin, bullet 1 | BeforeNo Level IV maternal designation anywhere; top is Level III | AfterNo Level IV maternal designation anywhere; top is Level III (The Woodlands contingent) | ReasonDSHS lists The Woodlands Level III as contingent |
| DK-16D-1 | ElementWhere they are thin, bullet 2 | BeforeNo MFM division or fetal therapy listed; Texas Children's lists an MFM clinic at the Methodist West address | AfterMFM largely affiliated, not an academic division; no fetal therapy center or MFM fellowship found | ReasonProposed wording; Methodist has affiliated MFM |
| DK-17D-1 | ElementWhere they are thin, bullet 5 | BeforeNo public postpartum RPM program or obstetric hospital-at-home found | AfterNo public postpartum home BP monitoring or home-based antepartum program found | ReasonOptional wording applied; drops the confusing 'hospital at home' term |
| DK-18D-1 | ElementSources line | Before(no Methodist MFM links) | AfterAdded links: Houston Methodist MFM and Pediatrix MFM at TMC | ReasonCite the MFM finding |
| DK-19D-1 | ElementSpeaker notes, paragraph 2 | BeforeTheir highest maternal level of care anywhere is Level III. They do not list a maternal-fetal medicine division, and Texas Children's lists an MFM clinic at the Methodist West campus address. | AfterTheir highest maternal level of care anywhere is Level III (TMC, Willowbrook, and The Woodlands, which is listed as contingent). Their MFM coverage comes mainly through affiliated groups, such as Pediatrix at the TMC hospital and a Texas Children's MFM office at Methodist West; they have no fetal therapy program or MFM fellowship that we could find. | ReasonProposed notes wording plus the contingent designation |
| DK-20D-1 | ElementSpeaker notes, new paragraph | Before(none) | AfterIf asked about hospital at home: it is inpatient-level care at home, paid by Medicare under a CMS waiver. It covers few OB patients, so the OB version is home monitoring before and after birth. | ReasonDr. Sami asked what hospital at home is |
| DK-75D-7 | ElementSources line | BeforeAmbience 2026; virtual nursing). | AfterAmbience 2026; virtual nursing). | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 10: The framework (2)v2 slide 10 v1 | ||||
| DK-21D-2 | ElementCSS: engine label colors (.fw .eng.e1-.e4, scoped to slide 10) | Before.e1 navy #13294B, .e2 teal #0F7C80, .e3 coral #C8553D, .e4 gray #5B6676 | After.fw .eng.e1 #13294B, .e2 #00695C, .e3 #B23A1E, .e4 #4B5563 (global .e1-.e4 rules left unchanged) | ReasonMatch the new slide 11 palette |
| DK-22D-5 | ElementConnected care row, H2 cell | BeforeCardio-obstetrics clinic; tele-MFM and eConsult hub; pelvic floor RTM | AfterCardio-obstetrics clinic; tele-MFM and eConsult hub | ReasonApp-guided trainer removed from the recurring-revenue engine |
| Slide 11: The portfolio (4)v2 slide 11 v1 | ||||
| DK-23D-2 | ElementCSS: portfolio cards (scoped to .pf) | BeforeWhite cards with 6px left border in navy/teal/coral/gray; faint #E1E5EB number at top right; body text #5B6676 at 15.5px; green/gold/indigo horizon tags | AfterGroup fills #E8EEF8 / #E0F2F1 / #FBE9E4 / #F3F4F6; header bands #13294B / #00695C / #B23A1E / #4B5563 with white uppercase labels; white numeral in a filled 32px group-colored circle; body text #374151 at 17px; neutral outlined pill .tag.hz (#1F2937 text, white fill, #4B5563 border). Old .tag.h1/.h2/.h3 rules kept but no longer used. | ReasonHigh-contrast palette from the notes page |
| DK-24D-2 | ElementCards 1-11 markup | BeforeNumber in the corner; tags H1 / H2 / H3 | AfterBand label (FRONT DOOR, CONNECTED CARE, DATA, ENABLER) + number circle; pills H1 -> 'Year 1', H2 -> 'Years 1-3', H3 -> 'Years 3-5' (card 4: 'Year 1' 'Years 1-3'; card 8: 'Years 1-3' 'Years 3-5'; card 11: 'Year 1' 'Years 1-3') | ReasonColor is no longer the only cue; plain-language horizons |
| DK-25D-2 | ElementLegend card | BeforeNavy front door · Teal connected care · Coral data · Gray enabler. Pro formas: 1-3; savings: 11. | AfterLegend: band chips FRONT DOOR / CONNECTED CARE / DATA / ENABLER; 'Pills show when it starts:' Year 1 / Years 1-3 / Years 3-5; Pro formas: 1-3; savings: 11. | ReasonLegend matches the new palette and pills |
| DK-26D-2 | ElementSpeaker notes | BeforeEleven initiatives. Not all start at once. Those marked H1 can start in the first year without new buildings; | AfterEleven initiatives. Not all start at once. The colored band names the engine; the pill shows the horizon (Year 1, Years 1-3, Years 3-5), matching H1, H2 and H3 on the framework slide. Those marked Year 1 can start in the first year without new buildings; | ReasonNotes match the new labels |
| Slide 12: 1. Suburban satellites (11)v2 slide 12 v1 | ||||
| DK-27D-6 | ElementRight-column table title (h3) | BeforeOne 4-physician site ($M) | AfterOne new 4-doctor clinic: loses money alone, profitable for the system by Year 2 ($M) | ReasonSimpler title that states the message |
| DK-28D-6 | ElementTable row 1 label | BeforeClinic revenue | AfterClinic collections | ReasonPlain-language row label |
| DK-29D-6 | ElementTable row 2 label | BeforeClinic margin | AfterClinic profit (loss) after its own costs | ReasonPlain-language row label |
| DK-30D-6 | ElementTable row 3 label | BeforeHospital margin (30%) | AfterHospital profit from the clinic's deliveries and surgeries (30% margin) | ReasonPlain-language row label |
| DK-31D-6 | ElementTable row 4 label | BeforeSystem margin | AfterCombined profit, UTHealth + Memorial Hermann | ReasonPlain-language row label |
| DK-32D-6 | ElementNew table row (last) | Before(none) | AfterDeliveries / surgeries sent to MH | 154/66 | 336/144 | 532/228 | ReasonOptional row; it fits cleanly |
| DK-33D-6 | ElementCaption under table | BeforeCapex $1.6M. Clinic-only breakeven needs ~$106 collections per wRVU. Conservative hospital case (Merritt Hawkins): Y3 system ~+$1.0M. | AfterThe clinic alone loses money through Year 3. Its deliveries and surgeries earn Memorial Hermann about $0.75-2.6M a year, so the combined system turns positive in Year 2. This is why we ask MH for a funds-flow agreement. Capex $1.6M; the clinic breaks even alone only at ~$106 collected per wRVU (model: $95). Conservative hospital case (Merritt Hawkins): Year 3 combined ~+$1.0M. | ReasonProposed caption; conservative case kept in the caption, not as a row |
| DK-34D-6 | ElementCSS: table and caption | Beforetable.t at 19px; caption .small at 18px | Aftertable.t compact at 17px; caption 16.5px, line-height 1.4 | ReasonFit longer labels and the extra row |
| DK-35D-6 | ElementSources line | Before... are ASSUMPTIONS to replace with actuals. | After... are ASSUMPTIONS to replace with actuals. Full model: business plan, section 7a (link to business-plan-v2.html#finance) | ReasonPoint to the model detail |
| DK-36D-6 | ElementSpeaker notes, new paragraph | Before(none) | AfterReading the table: the clinic loses money every year on its own; the hospital row is Memorial Hermann's profit on the deliveries and surgeries our doctors send there (154 deliveries in Year 1, 532 by Year 3); the bottom row adds the two. | ReasonDr. Sami asked what the table is telling us |
| DK-76D-7 | ElementSources line | Beforebuild-out estimated from TDLR filings; | Afterbuild-out estimated from TDLR filings; | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 13: 2. UTHealth Signature (1)v2 slide 13 v1 | ||||
| DK-77D-7 | ElementSources line | Before; The Hospitalist on academic concierge; MD2 River Oaks; Monetizely concierge pricing guide. | After; The Hospitalist on academic concierge; MD2 River Oaks; Monetizely concierge pricing guide. | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 14: 3. Midlife & Pelvic Health (5)v2 slide 14 v1 | ||||
| DK-37D-5 | ElementFlow step 'First line' | BeforePelvic floor PT; FDA-cleared app-guided trainer (RTM billing to confirm) | AfterPelvic floor PT; FDA-cleared app-guided trainer (Medicare RTM only; device often not covered) | ReasonTrainer is a clinical step only |
| DK-38D-5 | ElementSpeaker notes, paragraph 2 | Beforestart with pelvic floor PT and an FDA-cleared app-guided trainer that may be billable under remote therapeutic monitoring, pending payer confirmation, then office procedures | Afterstart with pelvic floor PT and an FDA-cleared app-guided trainer, then office procedures | ReasonDrop the revenue implication |
| DK-39D-5 | ElementSpeaker notes, new paragraph | Before(none) | AfterThe trainer is a clinical step, not a revenue line. Only Medicare pays remote therapeutic monitoring for it; Texas Medicaid does not pay RTM codes, and Blue Cross Blue Shield of Texas calls home devices like it not medically necessary. | ReasonExplain the payer position if asked |
| DK-40D-5 | ElementSources line | Before(no payer links) | AfterAdded links: UTHealth billing compliance (RTM); BCBSTX policy PSY301.016 | ReasonCite the payer findings |
| DK-78D-7 | ElementSources line | Before; Veozah liver warning Dec 2024) ... and Obstet Gynecol (leva RCT); ... ; FDA PMA P200036 (eCoin); ... ; AUA/SUFU OAB guideline 2024. | After; Veozah liver warning Dec 2024) ... and Obstet Gynecol (leva RCT); ... ; FDA PMA P200036 (eCoin); ... ; AUA/SUFU OAB guideline 2024. | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 15: 4. The Postpartum Year (11)v2 slide 15 v1 | ||||
| DK-41D-4 | ElementBullet 4 (Billing) | BeforeBilling: RPM 99453/99454 or 99445 (2-15 days) + 99457 or 99470 (10 min), + 99458; ~$73-140 per patient-month at 2026 Medicare national rates | AfterBilling, Texas Medicaid: home BP telemonitoring as S9110 (hospital, home health agency, FQHC or RHC; prior auth; hypertension plus a risk factor) and 99091 for the physician once per 30 days. Medicare and commercial: RPM codes, ~$73-140 per patient-month | ReasonTexas Medicaid pays S9110 + 99091, not the RPM code stack (this bullet set at 21px to fit) |
| DK-42D-1 | ElementKPI '0.5% vs 3.7%' subtext | BeforeUW, non-randomized | AfterUW, non-randomized; newer randomized evidence is mixed | ReasonShort hedged caveat; the 2025 meta-analysis is unverified |
| DK-43D-4 | ElementSources line | Before... Texas HHSC 12-month postpartum coverage. Texas Medicaid (TMPPM) and commercial RPM rates to be confirmed. | After... Texas HHSC 12-month postpartum coverage; TMPPM telecommunication services handbook (Sept 2026); UTHealth billing compliance. Commercial rates to be confirmed; monitoring revenue is outside the base case. | ReasonCite the Medicaid rule; state the base case is unchanged |
| DK-44D-1 | ElementSpeaker notes, new paragraph | Before(none) | AfterCaveat: newer randomized evidence is mixed. A 2025 meta-analysis of randomized trials reportedly found that postpartum remote BP monitoring did not cut readmissions and raised ED visits; we have not verified it yet. The UW readmission figure is non-randomized, so I lean on the Penn trial for the case. | ReasonHedged evidence caveat |
| DK-45D-4 | ElementSpeaker notes, 'What is new' paragraph | BeforeWhat is new is that Texas now covers the full postpartum year, and the 2026 short-duration codes make the first two weeks billable even when a patient monitors for only ten days. | AfterWhat is new is that Texas now covers the full postpartum year. For Medicaid patients, Texas pays home BP monitoring as S9110 to a hospital, home health agency, FQHC or RHC, with prior auth and a hypertension diagnosis plus a risk factor, plus 99091 for the physician once per 30 days. For Medicare and commercial patients, the 2026 short-duration RPM codes make the first two weeks billable even when a patient monitors for only ten days. | ReasonReframe for Texas Medicaid |
| DK-46D-4 | ElementSpeaker notes, billing note | BeforeBilling note: the rates on this slide are 2026 Medicare national rates; most postpartum patients are Medicaid or commercial, so Texas Medicaid and commercial rates must be confirmed. | AfterBilling note: the dollar range on this slide is 2026 Medicare national rates and applies to Medicare and commercial patients only. One open question for TMHP or the MCOs: whether gestational hypertension or preeclampsia counts as "hypertension" under the Medicaid rule. This revenue sits outside the base-case pro forma either way. | ReasonOpen question from the notes page; no pro forma change |
| DK-79D-7 | ElementSources line | Before; CPT 2026 and vendor rate summaries | After; CPT 2026 and vendor rate summaries | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| DK-92D-1 | ElementKPI tile 2 subtext (UW 0.5% vs 3.7%) | BeforeUW, non-randomized; newer randomized evidence is mixed | AfterUW, single site, non-randomized. A 2025 meta-analysis of 4 RCTs found no significant reduction | ReasonReplace the hedged caveat with the confirmed 2025 meta-analysis (Zullo et al., J Perinat Med 2025); keep the UW figure, labeled single site and non-randomized |
| DK-93D-1 | ElementKPI tile 4 subtext (1 in 4) | BeforeMMMRC 2024 | After2020 deaths (MMMRC 2024 report) | ReasonClaim check: the 1 in 4 figure covers 2020 deaths only |
| DK-94D-1 | ElementSources line (new source) | BeforeHoppe et al., AJOG / UW Dept OB/GYN; | AfterHoppe et al., AJOG / UW Dept OB/GYN; Zullo et al., J Perinat Med 2025 (meta-analysis of 4 RCTs); | ReasonCite the 2025 meta-analysis on the slide |
| DK-95D-1 | ElementSpeaker notes, evidence paragraphs | BeforeWisconsin reported hypertension readmissions of 0.5 percent with remote monitoring versus 3.7 percent without. ... Caveat: newer randomized evidence is mixed. A 2025 meta-analysis of randomized trials reportedly found that postpartum remote BP monitoring did not cut readmissions and raised ED visits; we have not verified it yet. The UW readmission figure is non-randomized, so I lean on the Penn trial for the case. | AfterWisconsin, in a single-site, non-randomized study, reported hypertension readmissions of 0.5 percent with remote monitoring versus 3.7 percent without. ... Say this up front: a 2025 meta-analysis of 4 randomized trials (714 patients; Zullo et al., J Perinat Med 2025) found remote BP monitoring did ... Show all (775 characters)Wisconsin, in a single-site, non-randomized study, reported hypertension readmissions of 0.5 percent with remote monitoring versus 3.7 percent without. ... Say this up front: a 2025 meta-analysis of 4 randomized trials (714 patients; Zullo et al., J Perinat Med 2025) found remote BP monitoring did not significantly reduce hypertension-related readmissions (5.3 vs 11.8 percent) and was linked to more ED visits. The pooled trials also found BP checks by day 10 similar between groups, so present Penn's 92 versus 44 percent as one trial. The UW readmission figure is single-site and non-randomized. A UTHealth OB/GYN faculty member co-authored this paper, so cite it up front and frame the Postpartum Year on BP control, follow-up and access, not readmission savings alone. | ReasonReplace the UNVERIFIED meta-analysis caveat with the confirmed citation; label UW as single-site non-randomized; add the UTHealth co-author framing line |
| Slide 16: Recurring revenue stack (10)v2 slide 16 v1 | ||||
| DK-47D-4 | ElementCSS: headline and table | Beforeh2 at 50px; table.t at 19px, no column widths | Afterh2 at 42px (one line), margin 18px; table.t compact at 17px; columns 21% / 27% / 17% / auto | ReasonFit the added row with no overflow |
| DK-48D-4 | ElementRPM row, Service cell | BeforeRemote physiologic monitoring | AfterRemote physiologic monitoring (Medicare, commercial) | ReasonRPM codes do not apply to Texas Medicaid |
| DK-49D-4 | ElementNew row after RPM | Before(none) | AfterHome BP telemonitoring (Texas Medicaid) | S9110 (hospital, home health agency, FQHC or RHC) + 99091 (physician, once per 30 days) | TMPPM rates; prior auth | Hypertension plus a risk factor; pregnancy hypertension fit to confirm | ReasonShow how Texas Medicaid actually pays (no dollar figure invented) |
| DK-50D-5 | ElementRTM row, Fit cell | BeforeApp-guided pelvic floor therapy (payer fit to confirm) | AfterApp-guided pelvic floor trainer: Medicare only; not paid by Texas Medicaid; BCBSTX deems home devices not medically necessary. | ReasonProposed wording |
| DK-51D-1 | ElementCollaborative care row, Codes cell | Before99492-99494 (to confirm); APCM add-ons G0568-G0570 | After99492-99494; APCM add-ons G0568-G0570 | ReasonTexas Medicaid coverage confirmed |
| DK-52D-1 | ElementCollaborative care row, Fit cell | BeforePerinatal depression and anxiety | AfterPerinatal depression and anxiety (Texas Medicaid benefit since 2022) | ReasonConfirmed since June 2022 |
| DK-53D-4 | ElementSources line | Before... CMS PFS 2026 (G2211: 0.52 RVU x CF). Verify all amounts ... | After... CMS PFS 2026 (G2211: 0.52 RVU x CF); TMPPM telecommunication handbook (S9110, 99091); UTHealth billing compliance (RTM); BCBSTX PSY301.016; BCBSTX Medicaid (collaborative care, 2022). Verify all amounts ... | ReasonCite Medicaid, RTM and collaborative care findings |
| DK-54D-4 | ElementSpeaker notes, paragraph 2 | BeforeFirst, these are Medicare national rates; most obstetric patients are Medicaid or commercial, so the real rates differ, and Texas Medicaid RPM rates must be confirmed in the provider manual. | AfterFirst, these are Medicare national rates; most obstetric patients are Medicaid or commercial, so the real rates differ. Texas Medicaid does not use the RPM codes: it pays home BP monitoring as S9110 to a hospital, home health agency, FQHC or RHC, with prior auth, plus 99091 for the physician once per 30 days. Connected-care revenue is outside the base case, so the financials do not change. | ReasonReframe for Texas Medicaid |
| DK-55D-1 | ElementSpeaker notes, paragraph 3 | Beforeso OB/GYN fit and Texas Medicaid coverage are unconfirmed, and 99492-99494 rates still need to be pulled. | Afterso OB/GYN fit is unconfirmed, and 99492-99494 rates still need to be pulled. Texas Medicaid has covered collaborative care since June 2022, with attestation and prior auth after 6 months. The app-guided pelvic floor trainer is a clinical step only; we attach no revenue to it. | ReasonCollaborative care confirmed (D-1); trainer carries no revenue (D-5) |
| DK-80D-7 | ElementSources line | Before(MM14315); AMA CPT 2026; | After(MM14315); AMA CPT 2026; Laborie 2026 (urodynamics, mixed professional/facility); ... Verify all amounts in the CMS PFS Look-Up Tool; | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 18: 7. Perinatal Data Commons (1)v2 slide 18 v1 | ||||
| DK-81D-7 | ElementSources line | Before; Mirvie (Business Wire 2025); ... ; Northwestern PlacentaVision (2024); Baylor College of Medicine (PeriBank). | After; Mirvie (Business Wire 2025); ... ; Northwestern PlacentaVision (2024); Baylor College of Medicine (PeriBank). | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 19: 8. Precision prediction (4)v2 slide 19 v1 | ||||
| DK-56D-1 | ElementsFlt-1/PlGF row, Regulatory cell | BeforeFDA-cleared (Breakthrough), 2023 | AfterFDA-cleared (Thermo Fisher 2023; Roche 2025) | ReasonTwo cleared tests now |
| DK-57D-1 | ElementSources line | BeforeThermo Fisher (May 2023); PRAECIS; | AfterThermo Fisher (May 2023); Roche Elecsys (MLO, Feb 2025); PRAECIS (AJMC summary); | ReasonCite the Roche clearance and PRAECIS |
| DK-58D-1 | ElementSpeaker notes | Beforehypertensive disorders at 23 to 35 weeks, | Afterhypertensive disorders at 23+0 to 34+6 weeks, | ReasonExact cleared indication |
| DK-82D-7 | ElementSources line | Before; PRAECIS (<a ... ; ASPRE (Rolnik et al.) and <a ... ; Sonio 510(k) 2023; | After; PRAECIS (ASPRE (Rolnik et al.) and Sonio 510(k) 2023; | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 20: 9. Prevention at scale (1)v2 slide 20 v1 | ||||
| DK-83D-7 | ElementSources line | Beforeand 360Dx (Teal, 2025); ... ; Mercer employer fertility benefit surveys. | Afterand 360Dx (Teal, 2025); ... ; Mercer employer fertility benefit surveys. | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 21: 10. AI to revenue (1)v2 slide 21 v1 | ||||
| DK-84D-7 | ElementSources line | Before; NEJM AI 2025 ambient scribe RCT (Lukac et al.); | After; NEJM AI 2025 ambient scribe RCT (Lukac et al.); | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 22: 11. Lower the cost to serve (9)v2 slide 22 v1 | ||||
| DK-59D-1 | ElementRow 5, Initiative | BeforeFewer NTSV cesareans; extend the Ob/Gyn Hospitalist division's model across suburban MH sites | AfterFewer NTSV cesareans (low-risk first births); extend the Ob/Gyn Hospitalist division's model across suburban MH sites | ReasonSpell out NTSV on first use |
| DK-60D-1 | ElementRow 7, Initiative | BeforeOB safety program: AIM bundles, simulation, EFM certification | AfterOB safety program: AIM/TexasAIM bundles, team drills, fetal-monitoring certification, OB safety nurse; meets CMS obstetric training and quality requirements due 2027 | ReasonProposed wording; answers 'what is an OB safety program' |
| DK-61D-1 | ElementRow 7, Evidence | BeforeYale: claims payments $50.7M to $2.9M across two 5-year periods (single site) | AfterYale: claims payments $50.7M to $2.9M across two 5-year periods (single site; 1998-2002 vs 2003-2007 data) | ReasonDate the Yale evidence (both periods shown so '2003-2007' is not misread as the whole range) |
| DK-62D-1 | ElementSources line | Before... Pettker et al. (Yale OB safety); MiPATH; ... | After... Pettker et al. (Yale OB safety); AIM bundles; TexasAIM; SMFM (CMS obstetric requirements); MiPATH; ... | ReasonCite the safety program components |
| DK-63D-1 | ElementSpeaker notes, Yale paragraph | Beforeacross two five-year periods. That is a single site, so I present it as direction, not a forecast. | Afteracross two five-year periods (1998-2002 vs 2003-2007). That is a single site with old data, so I present it as direction, not a forecast. | ReasonDate the evidence |
| DK-64D-1 | ElementSpeaker notes, new paragraph | Before(none) | AfterIf asked what an OB safety program is: a standing program, run with the hospital, that makes labor and delivery care consistent. AIM safety bundles through TexasAIM, team drills for hemorrhage, eclampsia and shoulder dystocia, fetal monitoring certification, and an OB safety nurse. CMS now requires obstetric staff training and an OB quality program by Jan 1, 2027, so part of this is mandatory for Memorial Hermann anyway (phase timing to re-check). | ReasonDr. Sami asked what it is |
| DK-65D-1 | ElementCSS: table | Beforetable.t compact at 16.5px; columns 4% / 33% / 30% | Aftertable.t compact at 15.5px; columns 4% / 38% / 28% | ReasonFit the longer row 7 with no overflow |
| DK-85D-7 | ElementSources line | Before; BMC Health Serv Res 2015; Becker's/MGMA. | After; BMC Health Serv Res 2016; Becker's/MGMA. | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged, except label year corrected 2015 to 2016 (Kheirkhah et al., published Jan 2016) |
| DK-96D-1 | ElementTable row 8-10, Evidence | BeforeSite-of-service and readmission data | AfterSite-of-service data; readmission evidence mixed | ReasonPostpartum remote BP readmission savings: single-site studies favor it, but the 2025 RCT meta-analysis found no significant reduction; savings figure unchanged |
| Slide 23: Who captures the savings (4)v2 slide 23 v1 | ||||
| DK-66D-1 | ElementRight column, bullet 2 | BeforeValue-based MCO contracts that pay for NTSV, readmission and postpartum outcomes | AfterValue-based contracts with Medicaid health plans (MCOs: Community Health Choice, Texas Children's Health Plan, UnitedHealthcare, Wellpoint, Molina) that pay for fewer low-risk first-birth cesareans (NTSV; Texas 27.9% vs 23.6% national target), fewer readmissions and better postpartum outcomes | ReasonSpell out MCO and NTSV |
| DK-67D-1 | ElementSources line | BeforeAll figures are ESTIMATES; ... before decisions. | AfterAll figures are ESTIMATES; ... before decisions. Plans and rates: HHSC managed care service areas (Aug 2026); CMQCC (NTSV definition); March of Dimes Texas report card; Healthy People 2030 MICH-06. | ReasonCite plan list and rates |
| DK-68D-1 | ElementSpeaker notes, new paragraph | Before(none) | AfterIf asked about the terms: an MCO is a Medicaid managed care organization, a private health plan the state pays to run Medicaid and CHIP. NTSV is the cesarean rate for low-risk first births: first baby, term, one baby, head down. The plan list is the Harris service area as of Sept 2026; the state's plan re-procurement was paused in court, so check the list before presenting. | ReasonDefinitions plus the re-procurement caution |
| DK-69D-1 | ElementCSS: layout | Beforetwocol 1.1fr / 0.9fr; bullets 24px | Aftertwocol 1fr / 1fr (inline); bullets 20px via new ul.clean.sm class | ReasonFit the longer bullet with no overflow |
| Slide 24: Profitability summary (1)v2 slide 24 v1 | ||||
| DK-86D-7 | ElementSources line | BeforeHouston MOB rents, TDLR filings, Scripps pricing | AfterHouston MOB rents, TDLR filings, Scripps pricing | ReasonD-7: same source name as slides 12 and 32 (TDLR filings); linked for consistency; visible text unchanged |
| Slide 25: Sensitivities and risks (2)v2 slide 25 v1 | ||||
| DK-70D-4 | ElementRight column, bullet 4 | BeforePayer acceptance: RTM for pelvic floor and Texas Medicaid RPM rates must be confirmed | AfterPayer rules: Texas Medicaid pays home BP monitoring as S9110 + 99091 with prior auth, not RPM codes; the pelvic floor trainer carries no revenue | ReasonOpen question now answered (D-4 Medicaid reframe; D-5 trainer has no revenue) |
| DK-87D-7 | ElementSources line | Before; SIR). | After; SIR). | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| Slide 32: Appendix: key sources (3)v2 slide 32 v1 | ||||
| DK-71Version marker | ElementClosing link to business plan | Beforebusiness-plan.html#sources | Afterbusiness-plan-v2.html#sources | ReasonPoint the v2 deck at the v2 business plan |
| DK-88D-7 | ElementKey sources list | Before; KFF births ... and Transwestern Houston MOB reports; TDLR filings ... (MM14315); AMA CPT 2026; ... ; FDA Veozah warning ... ; ASPRE; , Sonio, PeriGen FDA clearances; ... ; eCoin PMA; , newsroom; | After; KFF births ... and Transwestern Houston MOB reports; TDLR filings ... (MM14315); AMA CPT 2026; Laborie ... ; FDA Veozah warning ... ; ASPRE; , Sonio, PeriGen FDA clearances; ... ; eCoin PMA; NEJM AI ambient scribe RCT (2025); , newsroom; | ReasonD-7: link a source name that had no URL (v2-source-urls.json); visible text unchanged |
| DK-97D-1 | ElementKey sources list (new source) | BeforePMC10428007 | AfterPMC10428007; Zullo et al. meta-analysis (2025) | ReasonList the 2025 remote BP meta-analysis with the other postpartum sources |
Business plan v2: 40 changes, by section
Before (v1)After (v2)
| ID | Element | Before | After | Reason |
|---|---|---|---|---|
| Cover (1)v2 v1 | ||||
| BP-01Version marker | ElementMeta line | Before(none) | AfterVersion 2 - Oct 14, 2026 | ReasonMark this file as version 2 of the plan. |
| 2 Situation - Market forces (5)v2 v1 | ||||
| BP-02D-1 | ElementPolicy row: postpartum coverage | BeforeTexas 12-month postpartum Medicaid/CHIP effective March 1, 2024 (HB 12)[41]. | AfterTexas Medicaid/CHIP postpartum coverage is 12 months (HB 12, effective March 1, 2024; CHIP Perinatal excluded)[41,97]. | ReasonDr. Sami asked if the law is current; it is, and CHIP Perinatal members are the one exception. |
| BP-03D-1 | ElementPolicy row: HB 2727 | BeforeHB 2727 (2023)[49] requires high-risk pregnancy home telemonitoring if cost-effective (implementation UNVERIFIED). | AfterHB 2727 (2023)[49] requires high-risk pregnancy home telemonitoring if cost-effective; it appears not yet implemented, since the Sept 2026 Texas Medicaid telecommunication handbook still lists only diabetes and hypertension[102]. | ReasonReplace the open UNVERIFIED with what the Sept 2026 Medicaid manual shows. |
| BP-04D-1 | ElementPayment row: hospital at home | BeforeMedicare hospital-at-home waiver extended to Sept 30, 2030 (Medicare fee-for-service only; covers few obstetric patients). | AfterMedicare hospital-at-home waiver (inpatient-level care at home) extended to Sept 30, 2030[51] (Medicare fee-for-service only; covers few obstetric patients). | ReasonDr. Sami asked what hospital at home is; add a plain definition and the source. |
| BP-05D-3 | ElementPayment row: CPT 2027 | BeforeNo OB-specific AI billing codes. Recurring, time-based services gain relative value. AI earns through capacity and coding accuracy, not new fees. | AfterNo OB-specific AI billing codes. CPT 2027 deletes the global OB codes (59400, 59510, 59610, 59618, 59430) on Jan 1, 2027, so every prenatal and postpartum visit is billed on its own[98,99]; confirm against the AMA CPT 2027 code set. CMS has proposed optional Medicare maternity G-codes (not final). Recurring, time-based services gain relative value. AI earns through capacity and coding accuracy, not new fees. The OB package goes away in 2027, which supports a billable, accountable postpartum year. | ReasonAdd CPT 2027 as a new why-now payment force (approved D-3). |
| BP-36D-1 | ElementPayer mix and need row: MMMRC figures | BeforeAbout 80% of pregnancy-related deaths judged preventable; 1 in 4 occur 43 days to 1 year postpartum. | AfterOf Texas pregnancy-related deaths in 2020, about 80% were judged preventable and 1 in 4 occurred 43 days to 1 year postpartum[38]. | ReasonClaim check: 80% preventable and 1 in 4 postpartum are confirmed for 2020 deaths only; name the year and cite the MMMRC report (src-38). |
| 3 Market analysis - TAM / SAM / SOM (1)v2 v1 | ||||
| BP-06D-1 | ElementRow E (rural tele-hub): MCO first use | Beforegrant and MCO funded | Afterfunded by grants and Medicaid managed care organizations (MCOs) | ReasonSpell out MCO on its first use in the plan. |
| 4 Competitive analysis (5)v2 v1 | ||||
| BP-07D-1 | ElementCompetition table: Houston Methodist top maternal level | BeforeLevel III (no Level IV) | AfterLevel III (no Level IV); The Woodlands Level III is contingent[13] | ReasonDSHS lists The Woodlands Level III as contingent. |
| BP-08D-1 | ElementCompetition table: Houston Methodist MFM / fetal | BeforeNo MFM division listed; TCH lists an MFM clinic at the HM West campus address | AfterMFM through affiliated groups (Pediatrix at TMC; Texas Children's at West)[106,107,20]. No academic MFM division, fellowship or fetal therapy found. | ReasonMethodist does have MFM physicians; 'no MFM division listed' would read as wrong to a Houston audience. |
| BP-09D-1 | ElementStance toward Houston Methodist callout | BeforeCompete on complexity (Level IV vs their Level III ceiling, The Fetal Center, MFM), menopause, | AfterCompete on complexity (Level IV vs their Level III ceiling, The Fetal Center, an academic MFM division and fellowship where their MFM comes mainly through affiliated groups), menopause, | ReasonMatch the corrected Methodist MFM finding. |
| BP-10D-1 | ElementSWOT Opportunities: HM gaps | BeforeHM gaps in Level IV, MFM, menopause | AfterHM gaps in Level IV, academic MFM and fetal therapy, menopause | ReasonMatch the corrected Methodist MFM finding. |
| BP-11D-3 | ElementSWOT Opportunities: postpartum and codes | Before12-month postpartum Medicaid; new RPM codes | After12-month postpartum Medicaid; new Medicare RPM codes; CPT 2027 ends the global OB package | ReasonRPM codes are Medicare (D-4); CPT 2027 is a new opportunity (D-3). |
| 5 Initiatives - 3 Midlife & Pelvic Health Center (2)v2 v1 | ||||
| BP-12D-5 | ElementWhat | Beforescreen, digital pelvic floor therapy, PT, | Afterscreen, app-guided pelvic floor trainer (a clinical step only, no revenue claimed), PT, | ReasonKeep the trainer as a clinical step with no revenue attached (D-5). |
| BP-13D-5 | ElementCodes: RTM | BeforeRTM 98975/98977/98980 (pelvic floor fit UNVERIFIED); Category III | Afterno revenue claimed for the app-guided pelvic floor trainer: RTM codes (98975/98977/98980) are Medicare only, Texas Medicaid does not pay RTM codes[103], and BCBSTX policy PSY301.016 calls home devices like leva not medically necessary[104]; Category III | ReasonAnswer Dr. Sami's 'entitled to' question: Medicare only; not Texas Medicaid; BCBSTX says not medically necessary. |
| 5 Initiatives - 4 The Postpartum Year (6)v2 v1 | ||||
| BP-14D-3 | ElementWhy now: RPM codes and CPT 2027 | Beforenew 2-15 day RPM codes make short monitoring months billable. | Afternew 2-15 day Medicare RPM codes make short monitoring months billable; CPT 2027 ends the global OB package on Jan 1, 2027[98]. | ReasonLabel the RPM codes as Medicare (D-4) and add the CPT 2027 force (D-3). |
| BP-15Evidence hedge | ElementWhy now: evidence | Before(non-randomized). No HM maternal digital program found. | After(non-randomized). Newer randomized evidence on postpartum remote BP and readmissions is mixed UNVERIFIED. No HM maternal digital program found. | ReasonA 2025 meta-analysis reportedly found no readmission benefit; only a search summary was seen. |
| BP-16D-4 | ElementCodes | BeforeCodes 99453 (~$22), 99454 or 99445 (~$47), 99457 (~$52) or 99470 (~$26), 99458 (~$41): ~$73-140 per patient-month at 2026 Medicare national rates. Most postpartum patients are Medicaid or commercial; Texas Medicaid (TMPPM) and commercial rates and the prior-auth path are UNVERIFIED. | AfterCodes Medicare and commercial: 99453 (~$22), 99454 or 99445 (~$47), 99457 (~$52) or 99470 (~$26), 99458 (~$41): ~$73-140 per patient-month at 2026 Medicare national rates; commercial rates UNVERIFIED. Texas Medicaid (most postpartum patients) does not use that stack. It pays home BP telemonitoring ... Show all (680 characters)Codes Medicare and commercial: 99453 (~$22), 99454 or 99445 (~$47), 99457 (~$52) or 99470 (~$26), 99458 (~$41): ~$73-140 per patient-month at 2026 Medicare national rates; commercial rates UNVERIFIED. Texas Medicaid (most postpartum patients) does not use that stack. It pays home BP telemonitoring as S9110, billed by a hospital, home health agency, FQHC or RHC with prior auth and a diabetes or hypertension diagnosis plus a risk factor, plus 99091 for the physician once per 30 days[102]. Whether gestational hypertension or preeclampsia counts as "hypertension" is unclear; ask TMHP (Texas Medicaid & Healthcare Partnership) or the MCOs. Texas Medicaid fee amounts UNVERIFIED. | ReasonTexas Medicaid pays S9110 + 99091, not the Medicare RPM stack (D-4). TMHP spelled out on first use. |
| BP-17D-3 | ElementNew 'Billing today' row (inserted before Lead metric) | Before(none) | AfterBilling today Through Dec 31, 2026, the commercial and Medicare global OB codes cover only routine postpartum care to about 6 weeks; problem visits, remote monitoring, collaborative care, cardiology and LARC are billed separately[100]. Texas Medicaid has no global package: it pays per visit, with one postpartum code per pregnancy[101]. From Jan 1, 2027 every visit is billed on its own[98]. | ReasonAnswer 'still pay extra beyond the OB package?': yes, and from 2027 there is no package. |
| BP-37D-1 | ElementWhy now: MMMRC figure | Before12-month Texas postpartum Medicaid; 1 in 4 pregnancy-related deaths occur 43 days to 1 year postpartum; | After12-month Texas postpartum Medicaid; 1 in 4 Texas pregnancy-related deaths in 2020 occurred 43 days to 1 year postpartum[38]; | ReasonClaim check: the 1 in 4 figure covers 2020 deaths; cite the MMMRC report (src-38). |
| BP-38D-1 | ElementWhy now: readmission evidence | BeforePenn reported HTN readmissions 5% to 1%[55]; UW 0.5% vs 3.7%[56] (non-randomized). Newer randomized evidence on postpartum remote BP and readmissions is mixed UNVERIFIED. | AfterPenn reported HTN readmissions 5% to 1% (single site)[55]; UW 0.5% vs 3.7%[56] (single site, non-randomized). A 2025 meta-analysis of 4 randomized trials (714 patients) found remote BP monitoring did not significantly reduce hypertension-related readmissions and was linked to more ED visits[150]; the case rests on BP control, follow-up and access, not readmission savings alone. | ReasonReplace the UNVERIFIED caveat with the confirmed 2025 meta-analysis (Zullo et al., J Perinat Med 2025;53(4):439-448, src-150); label Penn and UW as single-site / non-randomized. |
| 5 Initiatives - 5 Perinatal mental health collaborative care (1)v2 v1 | ||||
| BP-18D-4 | ElementCodes: Texas Medicaid CoCM | BeforeDMHT G0552-G0554. Texas Medicaid coverage UNVERIFIED. | AfterDMHT G0552-G0554. Texas Medicaid has covered CoCM 99492-99494 since June 2022 (provider attestation; prior auth after 6 months)[105]. | ReasonCoverage confirmed; remove UNVERIFIED (D-4). |
| 5 Initiatives - 8 Precision prediction portfolio (2)v2 v1 | ||||
| BP-19D-1 | ElementWhat: sFlt-1/PlGF | BeforesFlt-1/PlGF triage for patients hospitalized with hypertensive disorders at 23-35 weeks (FDA cleared May 2023[58]; ratio ≥40 = high risk; PRAECIS, 18 US hospitals, manufacturer-funded). | AftersFlt-1/PlGF triage for singleton pregnancies hospitalized with hypertensive disorders at 23+0 to 34+6 weeks, the cleared label window (PRAECIS enrolled 23-35 weeks)[108]. Thermo Fisher cleared May 2023[58]; Roche Elecsys cleared Feb 2025[109]. Ratio ≥40 = high risk; PRAECIS, 18 US hospitals, manufacturer-funded. | ReasonCorrect the label window and add the Roche clearance. |
| BP-20D-1 | ElementRevenue model | BeforeRevenue model Comparative-effectiveness grants; industry partnerships; shorter antepartum stays. | AfterRevenue model Comparative-effectiveness grants; industry partnerships; shorter antepartum stays. For inpatients the sFlt-1/PlGF test is bundled into the hospital's DRG payment, so its value is shorter length of stay, not test revenue. | ReasonMake clear the business case is length of stay, not test revenue. |
| 5 Initiatives - 11 Lower the cost to serve (2)v2 v1 | ||||
| BP-21D-1 | ElementWhat: NTSV first use | BeforeNTSV cesarean reduction through TexasAIM; | AfterNTSV cesarean reduction through TexasAIM (NTSV = nulliparous, term, singleton, vertex: the cesarean rate for low-risk first births[113]; Texas 27.9% in 2024[39] vs the Healthy People 2030 target of 23.6%[114]); | ReasonSpell out NTSV on first use with the Texas rate and national target. |
| BP-22D-1 | ElementValue model: MCO plans | Beforepayer savings through value-based contracts with MCOs. See Section 6. | Afterpayer savings through value-based contracts with MCOs (Harris service area STAR plans as of Sept 2026: Community Health Choice, Molina, Texas Children's Health Plan, UnitedHealthcare, Wellpoint[115]; the state's plan re-procurement is paused in court[116], so confirm the list before naming plans). See Section 6. | ReasonName the Medicaid plans Dr. Sami asked about, with the procurement caution. |
| 6 Lowering the cost to serve (5)v2 v1 | ||||
| BP-23D-1 | ElementRanked table row 7 (OB patient safety program): Mechanism | BeforeAIM bundles, simulation, EFM certification, patient safety nurse | AfterAIM/TexasAIM safety bundles[111,112], team drills, fetal monitoring (EFM) certification, an OB patient safety nurse. CMS obstetric Conditions of Participation require OB staff training and an OB QAPI program by Jan 1, 2027[110] (status of that phase UNVERIFIED) | ReasonExplain what an OB safety program is and that CMS now requires part of it. |
| BP-24D-1 | ElementRanked table row 7 (OB patient safety program): Evidence | BeforeModerate-strong (Yale), single site | AfterModerate-strong (Yale, 2003-2007 vs 1998-2002), single site | ReasonLabel the age of the Yale data. |
| BP-25D-1 | ElementThree best-evidenced items: 3 OB patient safety program (Yale years) | Beforereported claims payments falling from $50.7M to $2.9M | Afterreported claims payments falling from $50.7M (1998-2002) to $2.9M (2003-2007) | ReasonLabel the age of the Yale data. |
| BP-26D-1 | ElementThree best-evidenced items: 3 OB patient safety program (CMS requirement) | Beforeso claims improvement can lower premiums, with a 3-5 year lag. | Afterso claims improvement can lower premiums, with a 3-5 year lag. Part of this program is becoming required: CMS obstetric Conditions of Participation call for OB staff training and an OB quality (QAPI) program by Jan 1, 2027[110] (whether that phase stays on schedule is UNVERIFIED), which makes it an easy partnership with Memorial Hermann. | ReasonCMS 2027 obstetric requirements make part of the program mandatory for the hospital. |
| BP-39D-1 | ElementRow 10 Postpartum remote BP: Evidence | BeforeModerate (small cohorts); net $93 per patient after $309 program cost | AfterMixed: single-site cohorts favor it, but a 2025 meta-analysis of 4 RCTs found no significant readmission reduction[150]; net $93 per patient after $309 program cost (one modeled analysis) | ReasonEvidence label made accurate; savings range unchanged. |
| 7 Financial plan (3)v2 v1 | ||||
| BP-27D-1 / D-6 | Element7a satellite table: plain-language caption (inserted before Inputs) | Before(none) | AfterWhat this table says. The clinic loses money on its own in each of the first three years. Its deliveries and surgeries earn Memorial Hermann about $0.75-2.6M a year, so the combined system turns positive in Year 2. That is why the ask to Memorial Hermann is a funds-flow agreement. On a more conservative hospital benchmark the satellite is still about +$1.0M in Year 3 (see 7d). | ReasonDr. Sami asked what the table is telling us; conservative case stays in text, not a new row (D-6). |
| BP-28D-4 | Element7d 'Upside not in totals' callout | BeforeUpside not in totals: connected care. The Postpartum Year RPM: ~$73-140 per patient-month plus ~$22 setup at 2026 Medicare national rates (Texas Medicaid and commercial rates to confirm); SOM ~$0.5M direct, with larger value in avoided readmissions (cost-saving at a program cost of about $309 per ... Show all (664 characters)Upside not in totals: connected care. The Postpartum Year RPM: ~$73-140 per patient-month plus ~$22 setup at 2026 Medicare national rates (Texas Medicaid and commercial rates to confirm); SOM ~$0.5M direct, with larger value in avoided readmissions (cost-saving at a program cost of about $309 per patient; net saving about $93 per patient in one analysis) and payer quality credit. Perinatal collaborative care: ~$146-162 per patient-month (comparable Medicare APCM add-on rates, vendor-reported; 99492-99494 to confirm). eConsults: ~$35 per consult (99451). These are left out of the combined figures until Texas Medicaid fees and prior-auth paths are confirmed. | AfterUpside not in totals: connected care. The Postpartum Year RPM: ~$73-140 per patient-month plus ~$22 setup at 2026 Medicare national rates, for Medicare and commercial patients (commercial rates to confirm). Texas Medicaid pays instead through S9110 plus 99091 once per 30 days, with prior auth and a ... Show all (993 characters)Upside not in totals: connected care. The Postpartum Year RPM: ~$73-140 per patient-month plus ~$22 setup at 2026 Medicare national rates, for Medicare and commercial patients (commercial rates to confirm). Texas Medicaid pays instead through S9110 plus 99091 once per 30 days, with prior auth and a qualifying diagnosis[102]; whether gestational hypertension or preeclampsia qualifies is still to confirm with TMHP or the MCOs. SOM ~$0.5M direct, with larger value in avoided readmissions (cost-saving at a program cost of about $309 per patient; net saving about $93 per patient in one analysis) and payer quality credit. Perinatal collaborative care: ~$146-162 per patient-month (comparable Medicare APCM add-on rates, vendor-reported; 99492-99494 rates to confirm), a Texas Medicaid benefit since June 2022[105]. eConsults: ~$35 per consult (99451). These are left out of the combined figures until Texas Medicaid fees, prior-auth paths and the qualifying-diagnosis question are confirmed. | ReasonReframe connected-care upside for Texas Medicaid S9110 + 99091; CoCM coverage confirmed. No numbers changed. |
| BP-40D-1 | ElementConnected care callout: avoided readmissions | Beforewith larger value in avoided readmissions (cost-saving at a program cost of about $309 per patient; net saving about $93 per patient in one analysis) | Afterwith possible further value in avoided readmissions (cost-saving at a program cost of about $309 per patient; net saving about $93 per patient in one modeled analysis, though a 2025 meta-analysis of randomized trials found no significant readmission reduction[150]) | ReasonEvidence label made accurate; no figures changed. |
| 10 Risks and mitigations (1)v2 v1 | ||||
| BP-29D-4 / D-3 | ElementReimbursement uncertainty row | BeforeTemporary +2.5% expires end of 2026; Texas Medicaid RPM and CoCM coverage unconfirmed; OPPS neuromodulation cuts proposed for 2027 Keep connected care out of the base case; confirm TMPPM rules before scaling | AfterTemporary +2.5% expires end of 2026; Texas Medicaid pays home BP monitoring only as S9110 + 99091 with prior auth (unclear whether gestational hypertension or preeclampsia qualifies) and does not pay RTM codes; global OB codes end Jan 1, 2027, changing how every pregnancy is billed; OPPS neuromodulation cuts proposed for 2027 Keep connected care out of the base case; confirm TMPPM rules with TMHP and the MCOs before scaling; set up billing for pregnancies that cross Jan 1, 2027 | ReasonReplace 'RPM and CoCM coverage unconfirmed' with what is now known; add CPT 2027. |
| 11 Assumptions to replace before decisions (2)v2 v1 | ||||
| BP-30D-4 / D-5 | ElementItem 11: Texas Medicaid RPM / CoCM / RTM | BeforeTexas Medicaid RPM fee schedule and prior-auth path; Texas Medicaid coverage of CoCM; payer acceptance of RTM for pelvic floor training. | AfterTexas Medicaid S9110 and 99091 fees, prior-auth path, and whether gestational hypertension or preeclampsia counts as "hypertension" (ask TMHP or the MCOs); Texas Medicaid rates for CoCM 99492-99494 (coverage confirmed since June 2022); commercial RPM rates. RTM for pelvic floor training is treated as Medicare only, with no revenue claimed. | ReasonUpdate open items to match D-4 and D-5. |
| BP-31D-3 | ElementItem 21: Texas Medicaid prenatal payment method | BeforeTexas Medicaid prenatal payment method (global vs per visit) and potentially preventable readmission rules for obstetrics. | AfterTexas Medicaid pays prenatal and postpartum care per visit, with one postpartum code per pregnancy (TMPPM, March 2026)[101]; still to confirm: potentially preventable readmission rules for obstetrics, and how UT Physicians' main commercial payers and the Harris-area MCOs bill pregnancies that cross the Jan 1, 2027 CPT change (confirm against the AMA CPT 2027 code set). | ReasonPayment method now answered; CPT 2027 transition is the new open item. |
| 11 Sources (3)v2 v1 | ||||
| BP-32Sources | ElementSources list: new entries src-97 to src-116 (grouped) | Before(none) | AfterHB 12 one-pager (benefits, CHIP Perinatal exception): https://www.texaschildrenshealthplan.org/sites/default/files/2024-02/HB12%20One%20Pager%20APPROVED%2020240205.pdf AAFP: CPT 2027 maternity code changes: https://www.aafp.org/practice-operations/billing-and-coding/maternity-obstetrical-cpt-codes ... Show all (3170 characters)HB 12 one-pager (benefits, CHIP Perinatal exception): https://www.texaschildrenshealthplan.org/sites/default/files/2024-02/HB12%20One%20Pager%20APPROVED%2020240205.pdf AAFP: CPT 2027 maternity code changes: https://www.aafp.org/practice-operations/billing-and-coding/maternity-obstetrical-cpt-codes MGMA: 2027 maternity coding transition (Aug 2026): https://www.mgma.com/articles/obgyn-2027-maternity-coding-chn SMFM: services billable outside the global obstetric package: https://smfm.org/news/services-billable-outside-of-global-obstetric Texas Medicaid Provider Procedures Manual, OB/GYN handbook (March 2026): https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-03-march/2_07_gyne_and_repro_health_srvs.pdf Texas Medicaid telecommunication services handbook (Sept 2026): https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-09-september/2_19_telecommunication_srvs.pdf UTHealth billing compliance: remote therapeutic monitoring: https://med.uth.edu/mshbc/digital-health-services/remote-therapeutic-monitoring-rtm/ BCBSTX medical policy PSY301.016 (Feb 2025): https://medicalpolicy.bcbstx.com/content/dam/bcbs/medicalpolicy/pdf/mental/PSY301.016_2025-02-01.pdf BCBSTX Medicaid: collaborative care became a benefit June 2022: https://www.bcbstx.com/provider-medicaid/education-and-reference/news/2022-archive/effective-june012022-collaborative-care-model-new-medicaid-benefit Houston Methodist: maternal-fetal medicine: https://www.houstonmethodist.org/pregnancy/maternal-fetal-medicine/ Pediatrix MFM of Houston at Houston Methodist Hospital: https://www.pediatrix.com/find-care/practices/mfmhouston/facilities/houston-methodist-hospital Thermo Fisher: sFlt-1/PlGF indication and PRAECIS performance: https://thermofisher.com/us/en/home/clinical/diagnostic-testing/brahms/prenatal-screening/preeclampsia-screening/clinical-solutions.html MLO: Roche Elecsys sFlt-1/PlGF clearance (Feb 2025): https://www.mlo-online.com/diagnostics/news/55268748/roche-elecsys-sflt-1-plgf-ratio-for-preeclampsia-receives-fda-510k-clearance SMFM summary of CMS obstetric requirements and phases: https://assets.noviams.com/novi-file-uploads/smfm/Advocacy/2024_11_08_Summary_of_Obsetric_CoP_Requirements.pdf AIM patient safety bundles: https://saferbirth.org/patient-safety-bundles/ Texas DSHS: TexasAIM: https://dshs.texas.gov/maternal-child-health/programs-activities-maternal-child-health/texasaim CMQCC: NTSV cesarean definition: https://www.cmqcc.org/focus-areas/quality-improvement/ntsv-c-sections Healthy People 2030, MICH-06 (23.6% target): https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-cesarean-births-among-low-risk-women-no-prior-births-mich-06 Texas HHSC: managed care service areas map (Aug 2026): https://www.hhs.texas.gov/sites/default/files/documents/services/health/medicaid-chip/programs/managed-care-service-areas-map.pdf Fierce Healthcare: Texas pauses Medicaid contract awards: https://www.fiercehealthcare.com/payers/texas-pauses-116b-medicaid-contract-awards-state-health-plans-relieved | ReasonSources for the new facts, all taken from the Oct 14 feedback notes page. |
| BP-33D-7 | ElementSources list: new entries src-117..src-149 | Before(none) | AfterContemporary OB/GYN: FDA initiates removal of boxed warnings for menopausal hormone therapy (Nov 10, 2025): https://www.contemporaryobgyn.net/view/fda-initiates-removal-of-boxed-warnings-from-hormone-therapy-for-menopause AMA press release: AMA releases CPT 2026 code set (Sep 11, 2025): ... Show all (5945 characters)Contemporary OB/GYN: FDA initiates removal of boxed warnings for menopausal hormone therapy (Nov 10, 2025): https://www.contemporaryobgyn.net/view/fda-initiates-removal-of-boxed-warnings-from-hormone-therapy-for-menopause AMA press release: AMA releases CPT 2026 code set (Sep 11, 2025): https://ama-assn.org/press-center/ama-press-releases/ama-releases-cpt-2026-code-set KFF State Health Facts: Births financed by Medicaid: https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/ Nygaard et al., Prevalence of symptomatic pelvic floor disorders in US women, JAMA 2008 (NHANES 2005-2006): https://doi.org/10.1001/jama.300.11.1311 Gartoulla, Worsley, Bell, Davis (Monash), Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years, Menopause 2015: https://doi.org/10.1097/GME.0000000000000383 ACS table B01001 (Sex by Age), Houston-Pasadena-The Woodlands MSA, via Census Reporter: https://censusreporter.org/data/table/?table=B01001&geo_ids=31000US26420&primary_geo_id=31000US26420 Texas DSHS Vital Statistics Annual Reports (Table 9: Births by Region, County, and City of Residence): https://www.dshs.texas.gov/center-health-statistics/vital-statistics-data/vital-statistics-annual-reports Houston Methodist Center for Innovation: Care Redesign (virtual nursing program): https://www.houstonmethodist.org/center-for-innovation/our-work/care-redesign/ TDLR Texas Architectural Barriers (TABS) project search: https://www.tdlr.texas.gov/TABS/Search The Hospitalist (MDedge, reprint of KFF Health News): Hospitals cash in on a private equity-backed trend: concierge physician care (Apr 2024): https://blogs.the-hospitalist.org/content/hospitals-cash-private-equity-backed-trend-concierge-physician-care PaperCity: MD2 Houston concierge practice in River Oaks ($24,000 membership): https://www.papercitymag.com/fashion/md2-houston-concierge-medical-practice-personal-doctors Monetizely: How to Price Concierge Healthcare & Membership Medical Services (Oct 10, 2025): https://www.getmonetizely.com/articles/how-to-price-concierge-healthcare-amp-membership-medical-services-a-comprehensive-guide FDA Drug Safety Communication: Veozah (fezolinetant) liver injury; 12-16-2024 update adds Boxed Warning: https://www.fda.gov/drugs/drug-safety-communications/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due Weinstein MM et al., Digital Therapeutic Device for Urinary Incontinence: A Randomized Controlled Trial, Obstet Gynecol 2022;139(4):606-615: https://doi.org/10.1097/AOG.0000000000004725 FDA Recently Approved Devices: eCoin Peripheral Neurostimulator, P200036: https://www.fda.gov/medical-devices/recently-approved-devices/ecoin-peripheral-neurostimulator-p200036 AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024): https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder TMHP: Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook (Oct 2026): https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-10-october/2_19_telecommunication_srvs.pdf Laborie: Reimbursement (2026 Uro CPT codes and Medicare national average allowable payment): https://www.laborie.com/reimbursement CMS Physician Fee Schedule Look-Up Tool: https://www.cms.gov/medicare/physician-fee-schedule/search Mirvie (Business Wire, Apr 8, 2025): Largest molecular study in pregnancy and clinical validation of blood test to predict preeclampsia risk: https://www.businesswire.com/news/home/20250408885501/en/Mirvie-Announces-Results-from-Largest-Molecular-Study-in-Pregnancy-and-Clinical-Validation-of-Simple-Blood-Test-to-Predict-Risk-for-Preeclampsia-Months-Before-Symptoms Northwestern Now (Dec 17, 2024): Using AI to analyze placentas for faster detection of neonatal, maternal problems: https://news.northwestern.edu/stories/2024/12/ai-tool-analyzes-placentas-at-birth-for-faster-detection-of-neonatal-maternal-problems Baylor College of Medicine OB/GYN: PeriBank: https://www.bcm.edu/departments/obstetrics-and-gynecology/research/peribank Thadhani R et al., Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy (PRAECIS), NEJM Evidence 2022: https://doi.org/10.1056/EVIDoa2200161 Rolnik DL et al., Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia (ASPRE), NEJM 2017;377:613-622: https://doi.org/10.1056/NEJMoa1704559 FDA 510(k) K230365: Sonio Detect (decision Jul 25, 2023): https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K230365 360Dx: Teal Health Wand Gets FDA Approval for At-Home HPV Self-Collection (May 2025): https://www.360dx.com/regulatory-news-fda-approvals/teal-health-wand-gets-fda-approval-home-hpv-self-collection Mercer: New survey finds employers adding fertility benefits (May 2021; National Survey of Employer-Sponsored Health Plans): https://www.mercer.com/en-us/insights/us-health-news/new-survey-finds-employers-adding-fertility-benefits-to-promote-dei/ Lukac PJ et al., Ambient AI Scribes in Clinical Practice: A Randomized Trial, NEJM AI 2025: https://doi.org/10.1056/AIoa2501000 Kheirkhah P et al., Prevalence, predictors and economic consequences of no-shows, BMC Health Serv Res 2016;16:13: https://doi.org/10.1186/s12913-015-1243-z Society of Interventional Radiology: Medicare Physician Fee Schedule Final Rule for 2026 conversion factor (Nov 6, 2025): https://www.sirweb.org/publications/news/medicare-physician-fee-schedule-final-rule-for-2026-conversion-factor/ Transwestern: Houston Healthcare Market, Q4 2025: https://transwestern.com/Upload/MarketResearchFactsheet_PDF/639057383644939762.pdf FDA 510(k) K241009: PeriCALM Patterns 3.0 (PeriGen), decision Jan 10, 2025: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K241009 Houston Methodist Newsroom: https://www.houstonmethodist.org/newsroom/ | ReasonD-7: 33 distinct sources from v2-source-urls.json not already in the list (src-117..src-149). Skipped: Becker's denial rework URL (already src-95). |
| BP-35D-1 | ElementSources list: new entries src-150, src-151 | Before(none) | AfterZullo F, Di Mascio D, Amro FH, et al. Postpartum remote blood pressure monitoring and risk of hypertensive-related readmission (meta-analysis of RCTs). J Perinat Med. 2025;53(4):439-448. PMID 40123081: https://doi.org/10.1515/jpm-2024-0515 Texas Tribune, Karen Brooks Harper, 'Feds approve 12 months of Medicaid coverage for low-income Texas moms', Jan 17, 2024: https://www.texastribune.org/2024/01/17/texas-medicaid-postpartum/ | ReasonClaim checks: Zullo et al. 2025 meta-analysis (cited in Initiative 4 and the savings table); Texas Tribune Jan 17, 2024 (source for the deck's corrected '43rd state approved' note). |
| Body (sections 2, 3, 5, 6) (1)v2 v1 | ||||
| BP-34D-7 | ElementSuperscript cites for the new sources (13 spots) | Before(Nov 10, 2025)[52] ... Fezolinetant carries a liver-injury boxed warning with lab monitoring. ... Source 61">61, Sonio), AI cytology ... but the temporary +2.5% expires end of 2026. ... New short-duration RPM codes 99445 and 99470. ... Medicaid finances about half of Texas births. ... ~956K women ... Show all (644 characters)(Nov 10, 2025)[52] ... Fezolinetant carries a liver-injury boxed warning with lab monitoring. ... Source 61">61, Sonio), AI cytology ... but the temporary +2.5% expires end of 2026. ... New short-duration RPM codes 99445 and 99470. ... Medicaid finances about half of Texas births. ... ~956K women 45-64 x 20% moderate/severe x $1,200 = $229M. ... ~1.49M women 45+ x 25% x $1,500 = $560M. ... (replace with ACS B01001) and MSA births (replace with DSHS Vital Statistics Table 9). ... urodynamics 51728/51729 + 51797; ... (Baylor/Texas Children's PeriBank, since 2011) ... cut preterm preeclampsia by >60%; ... $196 per missed visit (2008 data); | After(Nov 10, 2025)[52,117] ... Fezolinetant carries a liver-injury boxed warning with lab monitoring[129]. ... Source 61">61, Sonio[141]), AI cytology ... but the temporary +2.5%[146] expires end of 2026. ... New short-duration RPM codes 99445 and 99470[118]. ... Medicaid finances about half of Texas ... Show all (713 characters)(Nov 10, 2025)[52,117] ... Fezolinetant carries a liver-injury boxed warning with lab monitoring[129]. ... Source 61">61, Sonio[141]), AI cytology ... but the temporary +2.5%[146] expires end of 2026. ... New short-duration RPM codes 99445 and 99470[118]. ... Medicaid finances about half of Texas births[119]. ... ~956K women 45-64 x 20% moderate/severe[121] x $1,200 = $229M. ... ~1.49M women 45+ x 25%[120] x $1,500 = $560M. ... (replace with ACS B01001[122]) and MSA births (replace with DSHS Vital Statistics Table 9[123]). ... urodynamics 51728/51729 + 51797[134]; ... (Baylor/Texas Children's PeriBank, since 2011)[138] ... cut preterm preeclampsia by >60%[140]; ... $196 per missed visit (2008 data)[145]; | ReasonLight-touch cites only where the plan text states the sourced claim. MD2, Transwestern rent and the HM newsroom (Brockman gift) are listed but not cited, pending Norman's decisions. |
v1 change log
Version 1 made every citation clickable. No wording or numbers changed from v0.
- Business plan v1: 96 linked sources and 30 inline citations, all clickable.
- Deck v1: Source lines linked; clicking a link no longer advances the slide.
- Backup of the v0 originals:
D:\work\onrounds\.claude\backups\testsam-20261014-180449\
Open items not yet decided
No open items. The three pending items (P-1 to P-3) were decided Oct 14, 2026 and carried out in v3. When a new question comes up, list it here; once decided, add it to the decision log and carry it out in the next version.