Business plan · Department of Obstetrics, Gynecology & Reproductive Sciences
Women's Health, Continuously
A Growth Plan for Obstetrics, Gynecology & Reproductive Sciences
[Candidate Name], MD
Chair candidate, McGovern Medical School at UTHealth Houston
Prepared October 2026
Labels used throughout: ESTIMATE = modeling input or derived figure; UNVERIFIED = from a secondary source or not confirmed against a primary source. All dollar figures are annual unless noted. $M = millions.
1Executive summary
Move from episodic visits to continuous, lifespan relationships. Grow where competitors are thin. Make existing AI investments pay.
The department already holds assets that only one other Houston program matches and that Houston Methodist cannot copy quickly: Level IV maternal care at Memorial Hermann-TMC, The Fetal Center, the NICHD MFMU network site, and nine hospitals served (eight Memorial Hermann plus Harris Health LBJ). This plan builds three engines and one enabler on that base, across three horizons (H1 0-12 months, H2 12-36 months, H3 3-5 years).
1. Grow the front doorSuburban satellites (west Fort Bend first), a hybrid "UTHealth Signature" membership, and a Midlife & Pelvic Health Center.
2. Connected careThe Postpartum Year (remote BP + cardio-obstetrics), perinatal mental health collaborative care, tele-MFM and eConsult hub. Recurring revenue.
3. Discovery & dataHouston Perinatal Data Commons, a precision prediction portfolio, and prevention at scale. Grants plus industry contracts.
Enabler: AI & cost to serveAI to revenue (referral-to-revenue analytics, coding integrity with the existing Abridge scribe, prior-auth automation, inbox and RPM alert triage) plus operational cost reduction (ERAS, OR supply stewardship, prenatal care redesign, safety). Not new AI research; making current investments pay.
~$3.1M
Capital ask, 3 modeled initiatives ($1.6M + $0.5M + $1.0M)
-$1.49M
Year 1 combined system contribution
+$0.98M
Year 2 system contribution (incl. MH downstream; needs funds-flow)
+$3.59M
Year 3 combined (conservative ~+$2.5M)
System contribution = clinic contribution plus downstream hospital contribution at Memorial Hermann. The plan is system-positive in Year 2 only with a Memorial Hermann funds-flow agreement. Department-only (clinic) contribution is -$2.54M / -$1.09M / +$0.22M in Years 1-3. All three models are ESTIMATE. Connected-care revenue is upside and not in these totals.
- Lowering the cost to serve: about $2.4-7.2M per year across all parties ESTIMATE, reported separately from the totals above. Most lands with hospitals and payers; the department's share comes through gainsharing, co-management and value-based contracts.
Top 3 risks
- No funds-flow agreement with Memorial Hermann. Without credit for downstream hospital margin, the satellite clinic alone still loses -$0.56M in Year 3.
- Payer mix and collections. The satellite clinic breaks even only at ~$106 collections per wRVU (model uses $95). Texas has the highest uninsured rate in the US.
- Well-capitalized competitors. Houston Methodist (#7 U.S. News OB/GYN, new $10M OB/GYN fund) and Texas Children's ($200M+ Pavilion expansion, community MFM clinics) can respond fast.
2Situation
Department strengths
- Top of the risk pyramid. Memorial Hermann-TMC holds Level IV maternal designation (exp. 5/1/2027); LBJ is Level III. The Fetal Center at Children's Memorial Hermann is a national referral center (200-250 fetal procedures per year on one page; 150-200 on an older page UNVERIFIED current figure). A Placenta Accreta Program is in place.
- Research identity. NICHD MFMU Network site since 2001 (current 2023-2030 award, more than $2M); McGovern is the only Texas institution in both the MFMU and the Neonatal Research Network.
- Breadth. Divisions in General OB/GYN, MFM, Fetal Intervention, Gyn Oncology, Genetic Counseling, AMIG, Hospitalists and a Urogynecology Program with outpatient sites at Memorial City, Sugar Land, Southeast, Greater Heights, Katy and Bellaire.
- Footprint and volume. About 7,900 deliveries per year at MH-TMC and LBJ (about 5,400 + 2,500, undated). Nine hospitals served: MH-TMC, LBJ, and MH Southwest, Sugar Land, Memorial City, Katy, Cypress, Southeast and Greater Heights.
- AI infrastructure already paid for. UT System enterprise Abridge ambient scribe agreement9 (pilot: recording clinicians +73%, monthly notes +80% in 12 months); McWilliams School of Biomedical Informatics10 ($22M gift); AI centers including TEAM-AI and SAFE; Epic. Whether OB/GYN uses Abridge today is UNVERIFIED.
- As I understand it from my briefing, an existing referral pathway for women over 60 with incontinence (nothing public, so UNVERIFIED; scope to confirm). This plan extends it rather than proposing it; please correct me on how it works today.
Market forces
| Force | What changed | Implication |
|---|
| Policy | Texas 12-month postpartum Medicaid/CHIP effective March 1, 2024 (HB 12)41. Texas is not in the CMS TMaH model. Doulas not covered by Texas Medicaid (June 2026). HB 1649 (2023)50 mandates fertility-preservation coverage in state-regulated plans. HB 2727 (2023)49 requires high-risk pregnancy home telemonitoring if cost-effective (implementation UNVERIFIED). | A payer now exists for months 2-12 postpartum. Oncofertility has insured demand by law. |
| Regulatory | FDA moved to remove boxed warnings for cardiovascular disease, breast cancer and dementia from menopausal hormone therapy (Nov 10, 2025)52; the endometrial cancer warning for estrogen-alone products remains, and labels are updating product by product. Elinzanetant (Lynkuet) approved Oct 24, 202553. Fezolinetant carries a liver-injury boxed warning with lab monitoring. FDA-cleared fetal heart AI (BrightHeart61, Sonio), AI cytology (Hologic Genius)63 and at-home HPV self-collection (Teal Wand, May 2025)62. | Expect higher menopause demand and counseling need. Tools for screening at scale are cleared. |
| Payment | CY 2026 conversion factor $33.4009 (+3.26%), but the temporary +2.5% expires end of 2026. A -2.5% efficiency adjustment hits procedures; time-based services (RPM, care management) are largely exempt. New short-duration RPM codes 99445 and 99470. G2211 still paid. Medicare hospital-at-home waiver extended to Sept 30, 2030 (Medicare fee-for-service only; covers few obstetric patients). No OB-specific AI billing codes. | Recurring, time-based services gain relative value. AI earns through capacity and coding accuracy, not new fees. |
| Demographics | Houston MSA ~7.9M, +126,720 in one year (largest US gain); median age 35.7; 5.6% of women 15-50 gave birth in the past year. Montgomery +4% and Fort Bend +2.5% in one year; Fulshear +237% in 5 years. Harris County 65+ projected +47% by 2030 (older projection, UNVERIFIED). | Growth is suburban and both young (births) and aging (midlife, pelvic floor). |
| Payer mix and need | Texas uninsured 16.7% (rank 50 of 50); Harris County under-65 uninsured 23.8%. Medicaid finances about half of Texas births. Preterm birth: Texas 11.1% (grade D), Harris County 12.0%. About 80% of pregnancy-related deaths judged preventable; 1 in 4 occur 43 days to 1 year postpartum. About 46.5% of Texas counties are maternity care deserts. | New revenue must target commercially insured and Medicare populations, while the mission base supplies research and quality leadership. |
| Competition | Houston Methodist: ~14,000 births across 8 hospitals, no Level IV. Texas Children's: $200M+ Pavilion expansion (July 2026)21, 8 community MFM clinics, Menopause Center. Kelsey-Seybold adding Cypress. Midi Health (virtual menopause) at a ~$150M run rate (CEO-reported)54. | Compete on complexity and continuity, not on low-risk suburban births. |
3Market analysis
Houston numbers
| Metric | Value | Status |
|---|
| Houston-Pasadena-The Woodlands MSA population (July 2025) | 7,904,627 | Sourced |
| MSA median household income (ACS 2024) | $81,417 | Sourced |
| MSA households | 2,768,708 | Sourced |
| MSA births per year (model input) | ~105,000 | ESTIMATE cross-checked two ways |
| Harris County births | 65,450 | Sourced (year likely 2023) |
| Harris Health System births (FY2023) | 5,494 | Sourced |
| Women in MSA: all / 15-44 / 45-64 / 65+ | ~3.98M / ~1.67M / ~0.96M / ~0.54M | ESTIMATE replace with ACS B01001 |
| Fulshear median household income | $178,398 | Sourced |
| Montgomery County / Fort Bend County one-year gain | +30,011 / +24,163 | Sourced |
TAM / SAM / SOM by service line
TAM = annual spend if every relevant woman in the 9-county MSA used the service. SAM = the part UT Physicians plus Memorial Hermann can realistically serve. SOM = what the department can capture by Year 3. All values are ESTIMATE.
| Service line | TAM | SAM | SOM (Y3) | Key assumptions |
|---|
| A. Midlife: menopause + pelvic floor | ~$790M | ~$111M | ~$4-5.5M | Menopause: ~956K women 45-64 x 20% moderate/severe x $1,200 = $229M. Pelvic floor: ~1.49M women 45+ x 25% x $1,500 = $560M. SAM = TAM x 50% catchment x 80% insured x 35% seek care. SOM 4-5% of SAM (pro forma Y3 revenue $4.2M). |
| B. Suburban OB/GYN satellites (professional fees) | ~$738M | ~$258M | ~$4.1M per site | OB: 105K births x $3,500 = $368M. Gyn: ~2.47M women 18-64 x 60% x $250 = $371M. SAM = 35% (west Fort Bend, west Harris, Waller, Montgomery). SOM ~1.6% of corridor; 4 MDs, ~530 deliveries. Hospital value is extra. |
| C. Concierge / membership | ~$830M | ~$33M | ~$1.8M | ~2.77M households x 10% earning $200K+ (UNVERIFIED) x $3,000. SAM = 40% within 25-30 min of core sites x 10% willing (~11K members). SOM = 500 members (4.5% of SAM). |
| D. Connected pregnancy RPM | ~$42M | ~$10.5M MSA at-risk; ~$0.6M dept. | ~$0.5M direct | 105K births x $400 per RPM episode; 25% at-risk share; department deliveries placeholder 6,000/yr. Main value is quality, avoided readmissions and payer credit. |
| E. Rural / maternity-desert tele-hub | Not sized | - | - | ~4.1% of Texas births (15,287) occur in maternity care deserts. Framed as MFM eConsult + RPM extension of D; grant and MCO funded. |
The two inputs that matter most for credibility: female age-band counts (replace with ACS B01001) and MSA births (replace with DSHS Vital Statistics Table 9).
Where to grow
| Corridor | Demand | Competition | Read |
|---|
| West Fort Bend / Fulshear / Richmond-Rosenberg | Fulshear +237% in 5 yrs; $178K median income | HM Sugar Land strong; MH Katy $282.5M tower; no TCH general OB/GYN found | First. UT already has Cinco Ranch and Rosenberg sites. |
| Montgomery (Conroe, north I-45) | +30K/yr, fastest numeric growth | Crowded at The Woodlands (HM, Kelsey, TCH MFM) | Second. Conroe likely under-built. |
| Cypress / 290 corridor | High growth | HM Cypress (2025), MH Cypress tower (2027), Kelsey Cypress (2026) | Avoid for general OB/GYN; MFM outreach only. |
| TMC / LBJ | Highest volume, Medicaid-heavy | TCH, HM, BSLMC, Harris Health | Mission, residency and research base. |
Corridor reads are analysis from search results; confirm with a drive-time study.
4Competitive analysis
| Dimension | Houston Methodist | UTHealth + Memorial Hermann + LBJ | Baylor / Texas Children's | Kelsey-Seybold |
|---|
| Deliveries | ~14,000/yr across 8 hospitals (2025); TMC flagship 1,506 | ~7,900/yr at MH-TMC + LBJ (undated) | 6,000+/yr Pavilion for Women | Not researched |
| Top maternal level | Level III (no Level IV) | Level IV (MH-TMC) | Level IV (TCH; Ben Taub) | Not applicable (clinic group) |
| MFM / fetal | No MFM division listed; TCH lists an MFM clinic at the HM West campus address | The Fetal Center; accreta program; MFM fellowship | Fetal Center; large MFM network, 8 community clinics | Not researched |
| U.S. News OB/GYN (2026-27) | #7 national (self-reported) | #42 national (MH-TMC) | Not found UNVERIFIED | - |
| Menopause | No dedicated program found | MH + Midi Health telehealth (2023) | Dedicated Menopause Center | Not researched |
| Pelvic floor | Strong: Center for Restorative Pelvic Medicine; Houston's first ACGME urogyn fellowship | Urogynecology Program at 6 outpatient sites | Pelvic Health and Wellness Center | Not researched |
| Fertility | Fertility and Reproductive Medicine Program (IVF) | No visible REI division | Family Fertility Center UNVERIFIED | Not researched |
| Footprint | 8 hospitals; 219 specialty + 47 primary care locations | 9 hospitals served (8 Memorial Hermann + LBJ); UT Physicians Women's Centers | TMC Pavilion; MFM clinics in suburbs; OB/GYN in Pearland | 24-25+ locations; OB/GYN in Downtown, Woodlands, Atascocita, Katy, Rice Village, Greater Heights; Cypress ~May 2026 |
| Digital / AI | Ambience ambient AI enterprise-wide; BioButton RPM on ~2,600 beds; no maternal digital program found | Abridge (UT System); SBMI AI centers | UNVERIFIED | Not researched |
| Research | Hospital academic institute; 25 OB/GYN trials; not an MFMU member (inference) | NICHD MFMU + NRN (only in Texas) | Medical school department; large research base | - |
| Capital | ~$4.4B revenue, ~$470M surplus (FY2024, one entity); $10M OB/GYN fund (2026) | Partner capital via MH towers (Katy, Cypress) | $200M+ Pavilion expansion | - |
Stance toward Houston Methodist. Compete on complexity (Level IV vs their Level III ceiling, The Fetal Center, MFM), menopause, the postpartum year and data. Partner where useful, for example tele-MFM and transfer agreements with Level I-II community hospitals, after alignment with Memorial Hermann. Do not fight on suburban low-risk births, concierge prestige or short-term U.S. News rank.
Department SWOT
Strengths
- Level IV, The Fetal Center, accreta program
- MFMU + NRN; diverse safety-net cohort at LBJ
- Nine hospitals served (eight Memorial Hermann plus LBJ)
- Urogyn sites across suburbs; a 60+ incontinence referral pathway (as I understand it)
- Abridge and SBMI AI infrastructure in place
Weaknesses
- Payer mix concentrated in Medicaid and uninsured at TMC/LBJ (mission strength, margin pressure)
- From public sources, no dedicated menopause, cardio-obstetrics or REI program found; please correct me where these exist (UT Physicians' adult congenital heart clinic already manages high-risk pregnancy with MFM)
- Ranking: MH-TMC newly ranked #42 (2026-27); room to climb
- Department AI work not yet publicly visible (opportunity to publish)
Opportunities
- 12-month postpartum Medicaid; new RPM codes
- HRT label change and new non-hormonal drugs
- Suburban growth; MH Katy and Cypress towers
- HM gaps in Level IV, MFM, menopause
- New LBJ hospital (late 2028); ORWH budget up
Threats
- HM capital, brand and suburban birth franchise
- TCH Pavilion expansion and MFM clinics in HM corridors
- Baylor Menopause Center; Midi Health virtual care
- 2027 fee schedule cut pressure; OPPS neuromodulation cuts proposed
- High uninsured rate
5Initiatives
Horizons: H1 0-12 months, H2 12-36 months, H3 3-5 years. Medicare figures are 2026 national, non-facility, approximate; Houston, facility, commercial and Texas Medicaid rates differ.
Engine 1 · Grow the front door
1. Suburban satellite networkH1 plan · H2 open
- What
- 8,000 SF OB/GYN satellite in west Fort Bend / Fulshear-Richmond first; Conroe / north Montgomery second. Avoid Cypress for general OB/GYN. Add MFM outreach clinics in Methodist corridors, in Memorial Hermann suburban campuses.
- Why now
- Fulshear +237% in 5 years at $178K median income; MH Katy tower adds a delivery partner; Texas Children's lists an MFM clinic at the Methodist West campus address.
- Revenue model
- Professional fees + ancillary (ultrasound, labs); downstream deliveries and gyn surgery at Memorial Hermann under a funds-flow agreement.
- Lead metric
- New patients per month; wRVU ramp vs 55% / 80% / 95% plan; deliveries to MH (154 / 336 / 532).
2. "UTHealth Signature" hybrid membershipH1
- What
- Concierge women's health membership inside an existing TMC / Bellaire / Memorial City site. Core ~$2,500, premium ~$5,000 per year. Still bills insurance for covered visits. Membership covers only non-covered services (access, navigation, extended counseling); compliance review for Medicare and Medicaid members and institutional approval of the fee schedule before launch. Paired with a mission program.
- Why now
- No Houston concierge OB/GYN price found; benchmarks: Scripps $3,780, MDVIP "low four figures", MD2 Houston $24,000.
- Revenue model
- Membership fee (average $3,000) + ~$600 per member per year insurance billing. Feeds commercial deliveries, surgery and philanthropy.
- Lead metric
- Members (150 / 350 / 500); operating and cumulative breakeven in Y2 (~370 members at full Y3 staffing); renewal rate.
3. Midlife & Pelvic Health CenterH1-H2
- What
- Extend the existing referral pathway for women over 60 with incontinence (as I understand it; scope to confirm) into a closed-loop continence pathway: screen, digital pelvic floor therapy, PT, PTNS / implantable tibial stimulation, surgery. Add integrated menopause care (cardiometabolic, bone, GSM). Differentiate from Baylor's Menopause Center by network reach and integration.
- Why now
- HRT boxed warnings for CV, breast cancer and dementia being removed (Nov 2025); elinzanetant approved (Oct 2025); no dedicated HM menopause program found. UI reaches ~38% in women over 60, and only ~25% of women with UI seek care.
- Codes
- E/M + G2211; DEXA 77080; urodynamics 51728/51729 + 51797; PTNS 64566 (~$117 office per session); pessary 57160; biofeedback 90912/90913; RTM 98975/98977/98980 (pelvic floor fit UNVERIFIED); Category III codes for implantable tibial stimulation (confirm per device).
- Lead metric
- Share of referred women who complete the pathway; time to first treatment; surgical cases (82 / 120 / 214).
Engine 2 · Connected care (recurring revenue)
4. The Postpartum YearH1 pilot
- What
- Remote BP monitoring after hypertensive pregnancy through month 12, plus a cardio-obstetrics clinic that formalizes the existing cardiology-MFM collaboration (UT Physicians' adult congenital heart clinic already offers high-risk pregnancy management with MFM) and covers the postpartum year.
- Why now
- 12-month Texas postpartum Medicaid; 1 in 4 pregnancy-related deaths occur 43 days to 1 year postpartum; new 2-15 day RPM codes make short monitoring months billable. Penn reported HTN readmissions 5% to 1%55; UW 0.5% vs 3.7%56 (non-randomized). No HM maternal digital program found.
- Codes
- 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.
- Lead metric
- Share of hypertensive-pregnancy patients enrolled; BP check completion in week 1; postpartum HTN readmissions.
5. Perinatal mental health collaborative careH1-H2
- What
- Screening plus a behavioral health care manager and psychiatric consultant across prenatal and postpartum visits (ACOG-supported model).
- Codes
- 99492-99494 (rates not retrieved; comparable Medicare APCM add-on rates ~$146-162 per patient-month, vendor-reported, and APCM requires a primary-care relationship); DMHT G0552-G0554. Texas Medicaid coverage UNVERIFIED.
- Lead metric
- Screening rate; share of enrolled patients with a 50% symptom drop.
6. Tele-MFM and eConsult hubH2
- What
- MFM and urogyn eConsults and tele-MFM for maternity care deserts and for Level I-II hospitals across the region, including transfer agreements, after alignment with Memorial Hermann. Anchored on Level IV status and The Fetal Center.
- Why now
- About 46.5% of Texas counties are maternity care deserts; 15,287 babies born there. HM has no Level IV hospital.
- Codes
- 99451 (~$35.40 per consult); 99446-99449; 99452 for the referrer. Grant and MCO contracts.
- Lead metric
- eConsults per month; transfers accepted; referrals from community hospitals.
Engine 3 · Discovery & data (grants + industry)
7. Houston Perinatal Data CommonsH2-H3
- What
- Biobank (serum, cfRNA, placenta photos and pathology, ultrasound, CTG, EHR) plus real-world-evidence contracts. Built alongside the NICHD MFMU site: reuse the department's research-coordinator expertise and SOPs, under a separate IRB protocol, funding and data governance.
- Position
- Houston already has a perinatal biobank (Baylor/Texas Children's PeriBank, since 2011). The Commons links MH-TMC, LBJ and the MH suburban network, adds remote-monitoring and imaging data, and is federated-ready, so it partners with existing Houston biobanks rather than duplicating them.
- Revenue model
- Industry RWE contracts (e.g., Mirvie, Thermo Fisher, BrightHeart, PeriGen); federated consortia; NIH.
- Lead metric
- Consented participants; signed industry contracts; grant dollars.
8. Precision prediction portfolioH1-H3
- What
- sFlt-1/PlGF triage for patients hospitalized with hypertensive disorders at 23-35 weeks (FDA cleared May 202358; ratio ≥40 = high risk; PRAECIS, 18 US hospitals, manufacturer-funded). Pragmatic trial of FMF first-trimester screening vs US risk-factor selection for aspirin (ASPRE RCT: aspirin 150 mg vs placebo in FMF screen-positive women cut preterm preeclampsia by >60%; FMF screening vs US risk-factor selection not yet tested head-to-head in the US). AI fetal heart QI network (BrightHeart, Sonio). Prospective "silent trial" of a PPH model (external AUC 0.60 in one validation60).
- Revenue model
- Comparative-effectiveness grants; industry partnerships; shorter antepartum stays.
- Lead metric
- Protocols live; grant submissions; unnecessary prolonged antepartum stays and iatrogenic preterm delivery (within the cleared indication).
9. Prevention at scaleH2
- What
- At-home HPV self-collection outreach (Teal Wand, FDA May 2025) for under-screened Harris County women; AI cytology with Pathology (Hologic Genius, cleared Jan 2024; company reports 28% fewer false negatives); oncofertility service under Texas HB 1649.
- Revenue model
- Screening and follow-up visits; NCI funding (CPRIT fit UNVERIFIED); insured oncofertility demand.
- Lead metric
- Screening completion among overdue women; oncofertility consult time.
Enabler · AI & cost to serve
10. AI to revenue: make existing AI investments payH1
- What
- Referral-to-revenue loop analytics on the 60+ referral pathway. Documentation and coding integrity with the existing Abridge scribe (G2211, accurate E/M). Prior-auth automation. Inbox and RPM alert triage.
- Why
- No AI-specific OB/GYN codes exist; AI earns through capacity, coding accuracy and quality scores. HM already runs ambient AI enterprise-wide.
- Guardrail
- Compliance audit of AI-drafted notes to avoid overstating medical decision-making.
- Lead metric
- Note closure time; E/M distribution vs benchmark; G2211 capture; denial rate; referral completion.
11. Lower the cost to serveH1-H2
- What
- Extend and audit cesarean and gyn ERAS (where not already standard) with same-day discharge after minimally invasive hysterectomy; gyn OR supply stewardship; prenatal care redesign (MiPATH schedules, virtual visits, APP/RN routine care); NTSV cesarean reduction through TexasAIM; an OB patient safety program; prior-auth and denial automation.
- Why now
- About $2.4-7.2M per year across all parties ESTIMATE. Under DRG payment, hospital cost cuts become hospital margin. The UT System liability plan is self-insured and has used partial experience rating (2002 Regents policy; confirm current formula).
- Value model
- Department-direct savings of ~$0.3-1.2M; hospital savings shared through gainsharing or co-management with Memorial Hermann; payer savings through value-based contracts with MCOs. See Section 6.
- Lead metric
- Cost per case; length of stay; NTSV cesarean rate; supply spend per case; denial rate.
6Lowering the cost to serve
Growth is half the plan. The other half is lowering what each patient, case and claim costs. All savings below are ESTIMATE, based on a department of 60-80 faculty and about 8,000 deliveries per year, a 32% cesarean rate (~2,560 cesareans), 400-700 hysterectomies and 3,000-5,000 gyn OR cases. None of these volumes is confirmed UNVERIFIED. Many source studies are old (2008-2016) and not inflation-adjusted. These savings are reported separately and are not added to the system contribution totals in Section 7.
Ranked cost initiatives
| # | Initiative | Mechanism | Evidence | Annual savings | Who captures |
|---|
| 1 | Perioperative pathway bundle | Extend and audit cesarean and gyn ERAS where not already standard (early feeding and mobilization, opioid-sparing analgesia, early catheter removal) + same-day discharge after minimally invasive hysterectomy | Moderate; pre-post and meta-analysis. Next-day discharge cost $207 more per case (2000-2010 data) | $0.99-1.60M | Hospitals (via co-management) |
| 2 | Gyn OR supply stewardship | Preference cards, surgeon cost scorecards, reprocessed sealers, robotic stewardship for straightforward benign cases | Moderate; scorecards cut supply cost per case 6.5% (JAMA Surgery); unused card items $1,294 per case; robotic benign hysterectomy $2,189 more per case (JAMA 2013, 2007-2010 data) | $355K-1.11M | Hospitals (ask for gainsharing) |
| 3 | Prenatal care redesign | MiPATH tailored schedules (~14 to ~9 visits for low-risk patients), virtual visits, APP/RN routine care | Moderate for safety (AJOG 2021; AHRQ 2023); cost is ESTIMATE | $220K-1.47M capacity | Department (capacity, space avoided) |
| 4 | Access operations | Centralized scheduling, predictive overbooking, reminders | Weak to moderate; $196 per missed visit (2008 data); reminders alone cut no-shows only 16.3% to 15.8% | $147K-784K capacity | Department / UT Physicians |
| 5 | NTSV cesarean reduction | TexasAIM bundle, labor management standards; extend the Ob/Gyn Hospitalist division's model across suburban MH sites | Strong for rate change (California, JAMA); Medicaid paid $4,459 more for cesarean than vaginal birth (2010 data, secondary) | $250K-430K | Payers (Texas Medicaid MCOs); hospital beds |
| 6 | Revenue-cycle admin | Prior-auth automation + denial prevention | Moderate; ~39 prior auths per physician per week (AMA 2024); ~$25 to rework a denial (MGMA, ~2017) | $155K-425K | UT Physicians |
| 7 | OB patient safety program | AIM bundles, simulation, EFM certification, patient safety nurse | Moderate-strong (Yale), single site | $50K-240K premium | UT System plan, department; hospitals (claims avoided) |
| 8 | Ambulatory shift | Office hysteroscopy and office procedures | Moderate; US study $1,498 per patient in charges; high end overstates cost | $50K-450K | Payers, hospital OR capacity; department revenue |
| 9 | Language and documentation | Video remote interpreting; retire scribe or transcription spend now covered by Abridge | Weak (vendor data); baseline spend UNVERIFIED | $90K-575K | Department / UT Physicians |
| 10 | Postpartum remote BP | Readmission avoidance (savings side of Initiative 4) | Moderate (small cohorts); net $93 per patient after $309 program cost | $74K-112K | Hospital and payer |
Ranked by size x strength of evidence x department control. All savings ranges are ESTIMATE. The department already has an Ob/Gyn Hospitalists division and an AMIG division, and whether ERAS runs today is UNVERIFIED; where these are already in place, the savings are partly banked and the gain is in measuring and sharing them.
Who captures the savings
| Party | From ranks | Annual savings (ESTIMATE) | Type |
|---|
| Hospitals (Memorial Hermann, Harris Health) | 1, 2, 10 | ~$1.4-2.8M | Hard cash |
| Department / UT Physicians | 6, 7, 9 | ~$0.3-1.2M | Cash |
| Payers (mostly Texas Medicaid MCOs) | 5, 8 | ~$0.3-0.9M | Cash to payer |
| Freed capacity | 3, 4 | remainder (~$0.37-2.25M) | Revenue only if freed slots are filled |
| Total, all parties | 1-10 | ~$2.4-7.2M | |
Three best-evidenced items
- Cesarean and gyn ERAS. A pre-post study of 3,679 cesareans73 found $349 lower median direct cost per cesarean and a ~0.5-day shorter stay (3.2 to 2.7 days), with no change in 30-day readmissions. A gyn ERAS meta-analysis74 reports a mean saving of $2,129 per patient (figure from a search summary, UNVERIFIED against full text).
- NTSV cesarean reduction. California's CMQCC collaboratives cut the NTSV cesarean rate from 26.0% to 22.8% (2014-2019) with no added severe newborn complications (JAMA)79, while the US rate stayed at 26.0%.
- OB patient safety program. Yale-New Haven's program90 reported claims payments falling from $50.7M to $2.9M and department malpractice premiums from $95K to $53K per year91. Single site. The UT System plan is self-insured92 and has used partial experience rating (2002 Regents policy; confirm current formula), so claims improvement can lower premiums, with a 3-5 year lag.
Deliberately not counted
- ARRIVE elective induction at 39 weeks. Shifts cost from outpatient and triage to L&D (median 20 vs 14 hours on L&D)81; offered for quality and patient choice, not savings.
- CenteringPregnancy.87 Group care costs the practice more per patient. It is a value-based contract ask to Medicaid MCOs and Community Health Choice, not a department cost cut.
- 340B. A site-of-care lever only (Harris Health reports ~$169M per year in 340B savings86); under federal policy pressure, so the plan is not built on it.
Key message. Most savings land with hospitals and payers, not the department. The department's share depends on three agreements: funds-flow terms with Memorial Hermann, gainsharing or co-management for perioperative and supply savings, and value-based contracts with Medicaid MCOs for cesarean, readmission and prenatal savings. Without them, the department does the work and partners keep the savings.
7Financial plan
All three pro formas are ESTIMATE, $M. Contribution margin = revenue minus direct costs (including build-out depreciation), before dean's tax and central overhead. Inputs are assumptions except where tied to cited benchmarks (AMGA comp and wRVU, Houston rents).
7a. Satellite OB/GYN clinic (west Fort Bend / Fulshear-Katy, 8,000 SF)
| Y1 | Y2 | Y3 |
|---|
| Professional + ancillary revenue | 1.19 | 2.61 | 4.13 |
| Direct costs | 2.62 | 3.65 | 4.69 |
| Clinic contribution margin | -1.42 | -1.04 | -0.56 |
| Deliveries / gyn surgeries to MH | 154 / 66 | 336 / 144 | 532 / 228 |
| Hospital net revenue (downstream) | 2.51 | 5.47 | 8.66 |
| Hospital contribution at 30% | 0.75 | 1.64 | 2.60 |
| Combined system contribution | -0.67 | +0.60 | +2.04 |
Inputs: capex $1.6M (7-yr depreciation $229K/yr); rent $320K; MDs 2 / 3 / 4; APPs 1 / 1.5 / 2; productivity 55% / 80% / 95% of AMGA median 7,681 wRVU69; $95 collections per wRVU; MD comp $419K + 25% benefits; 3.5 support staff per MD at $58K; malpractice $40K per MD.
7b. "UTHealth Signature" hybrid membership
| Y1 | Y2 | Y3 |
|---|
| Revenue (fees + insurance) | 0.54 | 1.26 | 1.80 |
| Direct costs | 0.73 | 1.06 | 1.34 |
| Contribution margin | -0.19 | +0.20 | +0.46 |
| Margin | -36% | 16% | 25% |
Inputs: average fee $3,000; members 150 / 350 / 500; +$600 per member insurance billing; MDs 0.5 / 1.0 / 1.5 FTE (~330 panel per FTE); nurse navigators 1 / 2 / 2 at $95K; capex $500K; marketing $150K then $100K.
7c. Midlife & Pelvic Health Center (Memorial City or west corridor, 5,000 SF)
| Y1 | Y2 | Y3 |
|---|
| Revenue | 1.31 | 2.52 | 4.18 |
| Direct costs | 2.23 | 2.76 | 3.85 |
| Contribution margin | -0.93 | -0.25 | +0.32 |
| Surgical cases to hospital | 82 | 120 | 214 |
| Hospital contribution (cases x $12K x 30%) | 0.30 | 0.43 | 0.77 |
| Combined system contribution | -0.63 | +0.18 | +1.09 |
Inputs: urogynecologist 1 / 1 / 1.5 FTE at $1.0M collections, comp $450K + 25%; menopause OB/GYN 0.5 / 0.5 / 1.0 FTE; NPs 1 / 2 / 2; pelvic floor PTs 1 / 2 / 3; procedures $250K per urogyn FTE; ramp 55% / 80% / 95%; capex $1.0M.
7d. Combined summary
| $M | Capex | Y1 | Y2 | Y3 |
|---|
| Satellite: system contribution | 1.6 | -0.67 | +0.60 | +2.04 |
| Signature membership: contribution | 0.5 | -0.19 | +0.20 | +0.46 |
| Midlife & Pelvic: system contribution | 1.0 | -0.63 | +0.18 | +1.09 |
| Combined system contribution | 3.1 | -1.49 | +0.98 | +3.59 |
| of which: clinic-only contribution | | -2.54 | -1.09 | +0.22 |
| of which: downstream hospital contribution | | +1.05 | +2.07 | +3.37 |
| Combined revenue (clinic) | | 3.04 | 6.39 | 10.11 |
| Conservative Y3 (satellite downstream at Merritt Hawkins ~$1.35M per MD70) | | - | - | ~+2.5 |
Combined rows are sums of the reported model figures. Three-year cumulative system contribution ~+$3.08M before the $3.1M capex (contribution already deducts depreciation). Conservative case: 4 x 0.95 x $1.35M x 30% = ~$1.54M hospital contribution, so the satellite is about +$1.0M in Y3 and the total about +$2.5M ($2.53M unrounded). The combined view assumes all three start in the same year; in practice openings will be staggered.
Breakeven and sensitivities
| Initiative | Breakeven | Sensitivity |
|---|
| Satellite OB/GYN | System: operating breakeven Y2; cumulative cash positive during Y3 (~+$1.1M by end of Y3). Clinic alone: needs ~$106 collections per wRVU. | At $115/wRVU the clinic earns +$0.30M/yr; at $85 it loses -$0.70M/yr (steady state, 4 MDs). |
| Signature membership | Operating breakeven in Y2; cumulative breakeven end of Y2. At full Y3 staffing, breakeven is ~370 members. | HMO patients typically excluded; equity optics require the mission pairing. |
| Midlife & Pelvic | Clinic: operating breakeven Y3; cumulative during Y5. System: positive from Y2. | Steady state (Y4): revenue $4.4M, contribution +$0.52M; with a 400-member cash-pay menopause membership at $600/yr, about +$0.74M. |
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.
8Funding sources
| Source | Use | Evidence / note |
|---|
| Memorial Hermann funds-flow or JV | Satellite and midlife capex; credit for downstream hospital margin | Downstream contribution is $3.37M of the $3.59M Y3 system total. MH is already investing in Katy ($282.5M) and Cypress ($277.5M) towers. |
| Philanthropy | Data Commons, mission pairing for Signature, endowed program support | Signature members are a grateful-patient pipeline. Peers: HM Brockman gift included a $10M OB/GYN fund; UTHealth's $22M McWilliams gift for AI. |
| NIH / ORWH | Prediction trials, postpartum outcomes, biobank | FY2026 ORWH ~$106.5M (+$30M)68; FY2027 House bill $111.5M. MFMU cooperative agreement UG1HD0405458 runs to 2030. |
| ARPA-H | Prediction and digital tools | Sprint for Women's Health67: ~$110-113M to 23-24 teams. Follow-on sprint UNVERIFIED. |
| PCORI | Comparative-effectiveness questions (FMF vs risk-factor aspirin; RPM models) | Fit by design; no PCORI program figures in the source research, so confirm current funding announcements. |
| Industry RWE and trials | Data Commons; device registries | Mirvie, Thermo Fisher, BrightHeart, PeriGen; tibial stimulation makers (Valencia, BlueWind, Medtronic). Trial budgets UNVERIFIED. |
| MCO incentive programs | Postpartum Year, CoCM, prenatal quality | Texas maternity value-based payment runs through MCO quality incentives, e.g., Community Health Choice 2026 STAR/CHIP OB Provider Incentive Program (Harris County). |
| HRSA / state grants | Tele-MFM hub for maternity care deserts | Named as fit in the market analysis; amounts not researched. |
9Implementation roadmap and KPI scorecard
First 100 days
- Listening tour: divisions, MH leadership, Harris Health, UT Physicians
- Replace assumptions with actuals (Section 11)
- Learn how the 60+ referral pathway works today and baseline its funnel; confirm Abridge use in OB/GYN
- Open funds-flow talks with Memorial Hermann
- Drive-time study for west Fort Bend site
- Design Postpartum Year pilot and Signature tiers with mission pairing
- Coding integrity review (E/M, G2211)
- Baseline cost per case, LOS, NTSV cesarean rate, supply spend
Year 1 (H1)
- Launch Signature in an existing site (150 members)
- Open Midlife & Pelvic Health Center: 5,000 SF fit-out ($1.0M), funded with Memorial Hermann; close-the-loop pathway live
- Sign satellite lease; recruit first 2 MDs + 1 APP
- Postpartum RPM pilot; start CoCM
- sFlt-1/PlGF triage protocol
- Submit FMF pragmatic trial and Data Commons grants
- ERAS and OR preference-card standardization at MH-TMC; prior-auth automation
Years 2-3 (H2)
- Satellite to 4 MDs; second satellite decision (Conroe / north Montgomery), opening in H3
- MFM outreach clinics in Methodist corridors
- Tele-MFM / eConsult hub and transfer agreements
- Cardio-obstetrics clinic
- Data Commons enrolling; first RWE contracts
- HPV self-collection outreach; oncofertility
- Prepare for new LBJ hospital (late 2028)
- Gainsharing / co-management agreement with Memorial Hermann; OB safety program and liability review
H3 (years 3-5): open the second satellite if approved; scale RWE contracts and federated data partnerships, extend the hub statewide, and decide on REI (build, buy or partner).
| KPI | Baseline | Y1 target | Y3 target |
|---|
| Satellite deliveries to MH | 0 | 154 | 532 |
| Satellite wRVU productivity (% of AMGA median) | - | 55% | 95% |
| Signature members | 0 | 150 | 500 |
| Midlife center surgical cases to hospital | Set in 100 days | 82 | 214 |
| Referred 60+ women completing pathway | Set in 100 days | Set after baseline | Set after baseline |
| Hypertensive-pregnancy patients enrolled in RPM; postpartum HTN readmissions | Set in 100 days | Pilot | Set after pilot |
| Perinatal depression screening rate | Set in 100 days | Set after baseline | Set after baseline |
| eConsults per month; HM-area referrals | Set in 100 days | - | Set after launch |
| Grant submissions; industry RWE contracts | Set in 100 days | Submissions filed | First contracts |
| Cost per case (cesarean, gyn surgery) | Set in 100 days | Below baseline | Below baseline |
| Length of stay (cesarean; hysterectomy same-day discharge share) | Set in 100 days | Below baseline | Below baseline |
| NTSV cesarean rate | Set in 100 days | Below baseline | 2-3 points below baseline |
| Gyn supply spend per case | Set in 100 days | Below baseline | 6.5-10% below baseline |
| G2211 capture; note closure time; denial rate | Set in 100 days | Improve vs baseline | Sustain |
| Combined system contribution, incl. MH downstream ($M) | - | -1.49 | +3.59 |
| Department-only (clinic) contribution ($M) | - | -2.54 | +0.22 |
10Risks and mitigations
| Risk | Impact | Mitigation |
|---|
| No MH funds-flow agreement | Satellite clinic loses -$0.56M in Y3 without downstream credit | Sign a service or JV agreement before the lease; stage-gate the second site |
| Collections below ~$106/wRVU | -$0.70M/yr at $85 per wRVU | Pick commercial-heavy corridors; use UT Physicians actuals; go/no-go at Y1 review |
| Signature uptake below ~370 members, or equity optics | Program stays negative | Start inside an existing site ($0.5M capex); keep insurance billing; pair with a mission program |
| Competitor response | HM or TCH builds MFM and menopause in the same corridors | Move first on MFM outreach; lead on complexity and evidence; offer partnership on transfers |
| Reimbursement uncertainty | Temporary +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 |
| Recruitment and ramp | Urogynecologist (URPS), MFM and pelvic floor PT hiring delays slow the ramp | Recruit early; use APPs and PTs as the margin lever; fellowship pipelines |
| AI accuracy and compliance | Upcoding risk from AI-drafted notes; prediction models lose accuracy externally | Coding audits; silent trials before go-live; SAFE center governance |
| Savings accrue to partners without a gainsharing agreement | Hospitals capture ~$1.4-2.8M and payers ~$0.3-0.9M of cost savings while the department carries the work | Negotiate gainsharing or co-management with Memorial Hermann alongside funds-flow; shared-savings asks to Medicaid MCOs; baseline costs before launch so savings can be measured |
| Data governance | Consent and privacy for the Data Commons | IRB protocols, broad consent, federated designs |
11Assumptions to replace before decisions
Every pro forma input below is an assumption. Replace each with actuals before any capital decision.
- UT Physicians OB/GYN actuals: collections per wRVU (model $95), support staff ratio (3.5 FTE per MD at $58K), malpractice structure ($40K per MD; UT may be self-insured), benefits load (25%).
- Current deliveries at MH-TMC and LBJ (dated figures used); department deliveries placeholder of 6,000/yr in the RPM sizing; current Fetal Center volume.
- Memorial Hermann net revenue per delivery ($12,000) and per gyn/urogyn case ($10,000-12,000), contribution margin (30%), and funds-flow terms.
- Female age bands (ACS B01001 for the 9 MSA counties) and MSA births (DSHS Vital Statistics Table 9; model ~105,000).
- Corridor-level income and payer mix (Katy, Fulshear, Richmond/Rosenberg, Conroe, Cypress, Pearland, League City, Sugar Land); share of households earning $200K+.
- Competitor clinic lists verified with a drive-time map (TCH, HM, Kelsey, BSLMC, Pinnacle).
- MGMA OB/GYN and AUGS-MGMA urogynecology benchmarks (paywalled); urogyn collections $1.0M per FTE.
- The 60+ incontinence referral pathway: how it is set up, volumes, completion and outcomes (known only from briefing; nothing public).
- Whether OB/GYN uses Abridge today and which internal AI projects exist.
- Whether a cardio-obstetrics or menopause clinic exists under another name.
- Texas Medicaid RPM fee schedule and prior-auth path; Texas Medicaid coverage of CoCM; payer acceptance of RTM for pelvic floor training.
- 2026 CPT descriptors for 99470 and RTM codes; Medicare figures confirmed in the CMS PFS Look-Up Tool.
- 340B status of LBJ / UTHealth clinics (HRSA OPAIS).
- Houston Methodist payer mix, FY2025 financials, NICU levels and any postpartum RPM program.
- Cost section baseline: faculty count (60-80 assumed), deliveries (~8,000), cesarean rate (32%), NTSV share (35-40%), hypertensive disorders (10-15%), hysterectomies (400-700), gyn OR cases (3,000-5,000), outpatient visits (150,000-200,000), professional claims (~200,000).
- Current cesarean and NTSV rates at MH-TMC, the 7 suburban MH sites and LBJ; whether MH-TMC and LBJ already run cesarean and gyn ERAS.
- Robotic and gyn OR volumes and supply cost per case by surgeon; whether Memorial Hermann has a device reprocessing contract.
- Harris Health and Memorial Hermann 340B registrations and qualifying sites.
- Current UT System liability premium for OB/GYN faculty and the experience-rating formula.
- Department spend on human scribes, transcription and interpreters; denial rate (10% assumed); no-show rate.
- Texas Medicaid prenatal payment method (global vs per visit) and potentially preventable readmission rules for obstetrics.
- Primary-source checks for figures from secondary summaries (Truven 2013, Bisch 2021 meta-analysis, Edmonton supply study, AMA 2024 survey).
Sources
- UTHealth Houston OB/GYN department: https://med.uth.edu/obgyn/
- Hospitals served: https://med.uth.edu/obgyn/hospitals
- Urogynecology Program: https://med.uth.edu/obgyn/divisions/urogynecologists/
- Placenta Accreta Program: https://med.uth.edu/obgyn/divisions/placenta-accreta-program
- Fetal Intervention fellowship: https://med.uth.edu/obgyn/education/fellowships/fetal-center-fetal-intervention-fellowship
- MFMU award: https://med.uth.edu/blog/2023/06/06/mendez-figueroa-rysavy-receive-prestigious-awards
- MFMU and NRN: https://med.uth.edu/pediatrics/2024/06/21/uthealth-houston-receives-two-awards-for-continuing-research-in-neonatal-care-and-womens-health
- UG1HD040545: https://www.highergov.com/grant/UG1HD040545
- Abridge UT System agreement: https://www.fiercehealthcare.com/ai-and-machine-learning/abridge-university-texas-system-enter-enterprise-wide-agreement-expanded-ai
- McWilliams School: https://sbmi.uth.edu/news/story/mcwilliams-school-of-biomedical-informatics-displays-its-new-name-to-the-world
- UTHealth AI Hub: https://aihub.uth.edu
- New LBJ hospital: https://nextlevelharrishealth.org/lbj/project-status/
- Texas maternal levels of care: https://www.dshs.texas.gov/dshs-ems-trauma-systems/maternal-levels-care-designation/texas-maternal-facilities
- UTHealth delivery volumes (teaching sites): https://med.uth.edu/obgyn/education/fellowships/maternal-fetal-medicine-fellowship/teaching-sites/
- Houston Methodist facts: https://www.houstonmethodist.org/newsroom/facts-statistics/
- Houston Methodist OB/GYN: https://www.houstonmethodist.org/for-health-professionals/department-programs/obgyn/
- HM Brockman gift: https://www.houstonmethodist.org/giving/articles/brockman-tower/
- HM Ambience rollout: https://www.businesswire.com/news/home/20260217163873/en/Ambience-Healthcare-Announces-Houston-Methodist-Enterprise-Rollout-of-AI-Platform-to-Enhance-Patient-Care-and-Clinical-Workflows
- HM Form 990 FY2024: https://philanthropy.org/990/report/352410801/methodist-hospital-group
- TCH MFM flyer (HM West clinic): https://www.texaschildrens.org/sites/tc/files/uploads/documents/acog/MFM%20Flyer.pdf
- TCH Pavilion expansion: https://www.texaschildrens.org/content/news-release/texas-childrens-pavilion-for-women-completes-transformational-expansion
- Baylor Menopause Center: https://www.bcm.edu/healthcare/specialties/obstetrics-and-gynecology/ob-gyn-care-centers/the-menopause-center
- MH-TMC U.S. News: https://memorialhermann.org/about-us/newsroom/press-releases/top-recognition-by-us-news-for-2026
- MH + Midi Health: https://memorialhermann.org/about-us/newsroom/press-releases/midi-health-collaborate-expand-access-expert-midlife-care-women
- MH Katy expansion: https://memorialhermann.org/about-us/newsroom/press-releases/katy-hospital-announces-major-expansion-2025
- MH Cypress expansion: https://memorialhermann.org/about-us/newsroom/press-releases/cypress-hospital-expansion-breaks-ground
- Kelsey-Seybold clinics: https://kelsey-seybold.com/why-kelsey-seybold/clinics-history
- MSA population: https://www.citypopulation.de/en/usa/metro/26420__houston_pasadena_the_/
- MSA growth: https://www.costar.com/article/216091039/houston-leads-the-nation-in-population-growth-for-2025
- MSA ACS profile: https://censusreporter.org/profiles/31000US26420-houston-pasadena-the-woodlands-tx-metro-area/
- Montgomery County: https://www.census.gov/quickfacts/montgomerycountytexas
- Fort Bend County: https://usafacts.org/answers/is-the-population-growing-or-shrinking/county/fort-bend-county-tx/
- Fulshear: https://houston.culturemap.com/news/real-estate/fastest-growing-wealthy-suburbs-fulshear
- Harris County births: https://houston.org/houston-data/population-growth
- Texas uninsured: https://www.americashealthrankings.org/explore/measures/HealthInsurance/TX
- Harris County uninsured: https://smartasset.com/data-studies/health-insurance-coverage-2025
- Medicaid-financed births: https://www.tpr.org/public-health/2026-05-13/40-000-pregnant-texans-faced-month-long-wait-for-medicaid-application-to-be-processed
- Texas MMMRC report: https://www.dshs.texas.gov/sites/default/files/legislative/2024-Reports/2024-MMMRC-DSHS-Joint-Biennial-Report.pdf
- Preterm birth report card: https://www.marchofdimes.org/peristats/reports/texas/report-card
- Maternity care deserts (Texas): https://marchofdimes.org/peristats/assets/s3/reports/mcd/Maternity-Care-Report-Texas.pdf
- 12-month postpartum Medicaid: https://fhb.hhs.texas.gov/sites/default/files/documents/mepd-and-twh-bulletin-24-10.pdf
- CY 2026 PFS summary (MM14315): https://www.cms.gov/files/document/mm14315-medicare-physician-fee-schedule-final-rule-summary-cy-2026.pdf
- 2026 RPM codes: https://blog.prevounce.com/2026-remote-patient-monitoring-cpt-codes-whats-new-and-what-to-know
- RTM codes: https://www.tenovi.com/rtm-cpt-codes-2026/
- Care management codes: https://www.mindbowser.com/ccm-codes-cpt-variants-guide/
- eConsult 99451: https://aasm.org/wp-content/uploads/2025/12/2025-2026-Telemedicine-Payment-and-RVU-Comparison.pdf
- PTNS reimbursement: https://www.medtronic.com/content/dam/medtronic-wide/public/united-states/products/neurological/posterior-tibial-nerve-stimulation-reimbursement-guide.pdf
- Community Health Choice OB incentive: https://provider.communityhealthchoice.org/wp-content/uploads/sites/2/2026/05/0037397_2026_STAR-CHIP_PIP-OB_Harris_121825_Final.pdf
- HB 2727 telemonitoring: https://capitol.texas.gov/tlodocs/88R/billtext/html/HB02727F.htm
- HB 1649 fertility preservation: https://capitol.texas.gov/tlodocs/88R/analysis/pdf/HB01649E.pdf
- Hospital-at-home extension: https://www.ama-assn.org/public-health/population-health/lawmakers-extend-cms-hospital-home-waiver-five-years
- HRT boxed warning change: https://www.patientcareonline.com/view/fda-removes-boxed-warnings-cardiovascular-cancer-dementia-risks-from-select-menopausal-hormone-therapy-labels
- Elinzanetant approval: https://www.bayer.com/media/en-us/bayers-lynkuet-elinzanetant-approved-in-the-us-for-treatment-of-moderate-to-severe-vasomotor-symptoms-due-to-menopause/
- Midi Health Series D: https://femtechinsider.com/midi-health-raises-100-million-series-d-surpasses-1-billion-valuation/
- Penn Heart Safe Motherhood: https://nudgeunit.upenn.edu/heart-safe-motherhood
- UW postpartum BP study: https://www.obgyn.wisc.edu/ob-gyn-department-news/hoppe-s-telehealth-blood-pressure-study-published-in-ajog
- RPM cost-effectiveness: https://pmc.ncbi.nlm.nih.gov/articles/PMC10428007
- sFlt-1/PlGF clearance: https://newsroom.thermofisher.com/newsroom/press-releases/press-release-details/2023/Thermo-Fisher-Scientific-Announces-FDA-Clearance-of-Breakthrough-Immunoassays-to-Aid-in-the-Risk-Assessment-of-Preeclampsia/default.aspx
- FMF screening cost-effectiveness: https://www.ispor.org/heor-resources/presentations-database/presentation-cti/ispor-europe-2025/poster-session-4-2/first-trimester-screening-for-preterm-pre-eclampsia-in-the-united-kingdom-a-cost-effectiveness-analysis
- PPH model external validation: https://www.medrxiv.org/content/10.1101/2025.08.20.25333642
- BrightHeart clearances: https://www.massdevice.com/fda-clears-more-brightheart-ai-capabilities-in-fetal-heart-ultrasound/
- Teal Wand approval: https://www.fiercebiotech.com/medtech/fda-approves-teal-healths-hpv-screening-test-home-alternative-pap-smear
- Hologic Genius: https://www.businesswire.com/news/home/20240131786693/en/Hologic-Announces-First-and-Only-FDA-Cleared-Digital-Cytology-System-%E2%80%93-Genius%E2%84%A2-Digital-Diagnostics-System
- leva digital pelvic floor: https://urologytimes.com/view/leva-pelvic-health-system-shows-efficacy-for-improving-symptoms-of-urinary-incontinence
- Revi Extend: https://www.contemporaryobgyn.net/view/fda-clears-revi-extend-bluewind-medical-urgency-urinary-incontinence
- UI prevalence and care-seeking: https://link.springer.com/10.1186/s12875-020-01282-y
- ARPA-H Sprint for Women's Health: https://arpa-h.gov/engage-and-connect/sprint
- ORWH FY2026: https://swhr.org/senate-appropriations-committee-advances-fy-2026-labor-hhs-bill-with-key-investments-in-public-health-and-womens-health-research/
- AMGA 2026 compensation survey: https://www.amga.org/getmedia/6b7fc588-0aa3-4d42-a80c-5919fb7cbbbb/2026-comp-survey-charts-doc-final.pdf
- Merritt Hawkins hospital revenue per physician: https://www.beckershospitalreview.com/quality/hospital-physician-relationships/the-cost-benefit-of-employed-physicians-for-18-specialties/
- Houston medical office rents: https://www.matthews.com/insights/houston-tx-medical-office-market-report-q4-2025
- Scripps concierge pricing: https://www.scripps.org/services/concierge-medicine
- Cesarean ERAS, 3,679 cesareans: https://blogs.the-hospitalist.org/content/enhanced-recovery-program-improves-outcomes-after-cesarean-delivery
- Gyn ERAS meta-analysis summary: https://nutrition-evidence.com/article/218622/enhanced-recovery-pathways-in-gynecologic-oncology
- Mayo gyn ERAS: https://www.contemporaryobgyn.net/view/enhanced-recovery-pathway-effective-complex-gynecologic-surgery
- Same-day discharge after hysterectomy: https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1307694/full
- Robotic vs laparoscopic hysterectomy cost (JAMA 2013): https://pubmed.ncbi.nlm.nih.gov/23423414/
- Office hysteroscopy savings: https://pubmed.ncbi.nlm.nih.gov/25392645/
- CMQCC NTSV cesarean reduction (JAMA): https://pmc.ncbi.nlm.nih.gov/articles/PMC8080226
- Cesarean vs vaginal birth payments: https://www.hmpgloballearningnetwork.com/site/frmc/article/study-identifies-cost-having-baby-united-states
- ARRIVE resource use: https://blogs.the-hospitalist.org/content/arrive-trial-womens-desideratum-versus-logistical-concerns
- Postpartum telehealth BP cost analysis: https://www.obgyn.wisc.edu/ob-gyn-department-news/hoppe-published-in-journal-of-maternal-fetal-and-neonatal-medicine-0
- Surgeon supply scorecards: https://www.beckershospitalreview.com/supply-chain/study-surgeon-scorecards-reduce-supply-cost-without-affecting-outcomes.html
- Unused preference-card items (JAMA Surgery): https://jamanetwork.com/journals/jamasurgery/article-abstract/2841789
- Reprocessed device savings (AMDR): https://amdr.org/wp-content/uploads/2024/10/Hospitals-Save-465M-and-Eliminate-95M-Pounds-of-GHG-Emissions-with-Reprocessed-Devices.Final_.pdf
- Harris Health 340B savings: https://www.tha.org/wp-content/uploads/2023/11/Rep-Ted-Poe-TX-2.pdf
- CenteringPregnancy SC Medicaid study: https://www.centeringhealthcare.org/uploads/files/SC-Study-Cost-Savings-CenteringPregnancy-March-2016.pdf
- No-show cost: https://pmc.ncbi.nlm.nih.gov/articles/PMC4714455/
- MiPATH prenatal schedules: https://pubmed.ncbi.nlm.nih.gov/34352810/
- Yale OB safety program: https://psnet.ahrq.gov/issue/comprehensive-obstetric-patient-safety-program-reduces-liability-claims-and-payments
- Yale premiums: https://reliasmedia.com/articles/17184-hospital-cuts-medmal-50-in-obstetrics
- UT System liability plan: https://med.uth.edu/gme/professional-liability-insurance/
- Kaiser ambient scribe hours: https://www.ama-assn.org/practice-management/digital-health/ai-scribes-save-15000-hours-and-restore-human-side-medicine
- AMA prior authorization survey: https://ama-assn.org/practice-management/prior-authorization/fixing-prior-auth-nearly-40-prior-authorizations-week-way
- Denial rework cost: https://www.beckershospitalreview.com/finance/how-to-prevent-claim-denials-and-bolster-the-bottom-line/
- Video remote interpreting: https://fiercehealthcare.com/hospitals/main-line-health-video-remote-interpretation-cost-patient-satisfaction-health-it