Women's Health,
Continuously

A growth agenda for Obstetrics, Gynecology & Reproductive Sciences: new service lines, recurring revenue, and a perinatal data asset built on this department's research network.

[Candidate Name], MD
Candidate presentation, Department Chair · McGovern Medical School at UTHealth Houston

Version 2 - Oct 14, 2026

2

The thesis

Move from episodes of care to continuous relationships across a woman's lifespan

Grow where others are thin

Complex-pregnancy referrals from community and Methodist hospitals, the postpartum year, midlife and pelvic health, and fast-growing suburbs.

Build recurring revenue

Monthly remote monitoring, care management and membership models that 2026 payment rules now reward.

Turn data into funding

Convert the department's research network and patient diversity into grants, industry partnerships and published outcomes.

And lower the cost to serve: make the AI investments UTHealth has already made pay, and share in the savings our clinical changes create.

The one idea to remember: women's health is still delivered in episodes. A prenatal course, a delivery, a six-week visit, then silence until a problem appears. The money and the outcomes are in the continuity. Three engines follow from that. First, grow the front door where competitors are thin. Second, build recurring revenue: 2026 Medicare rules spared time-based services like remote monitoring and care management from the 2.5 percent efficiency cut on procedures, and added short-duration monitoring codes. Third, turn the department's research infrastructure into a data asset that attracts grants and industry. The enabler is AI. UTHealth already has the McWilliams School, AI centers and an enterprise Abridge agreement. I will not pitch AI research. I will pitch AI tied to revenue and capacity.

3

Why now

Six forces have shifted in the last 24 months

Force	What changed	What it opens
Policy	Texas Medicaid/CHIP postpartum coverage is 12 months (HB 12, effective March 1, 2024; CHIP Perinatal excluded). Of Texas pregnancy-related deaths in 2020, about 1 in 4 occurred 43 days to 1 year after pregnancy; about 80% were judged preventable.	A billable, accountable postpartum year. Problem visits, collaborative care and monitoring are billed outside any OB package; Texas Medicaid already pays per visit.
Regulatory	FDA moved to remove boxed warnings for CVD, breast cancer and dementia on menopausal hormone therapy (Nov 10, 2025); the estrogen-alone endometrial cancer warning stays. Elinzanetant approved Oct 2025.	Pent-up midlife demand returns to clinic
Payment	2026 CPT adds short-duration monitoring codes (99445, 99470; RTM 98985, 98979). Time-based services spared the 2026 -2.5% efficiency adjustment.	Recurring monthly revenue per patient
OB 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
Demographics	Houston metro added 126,720 people in one year, most of any US metro. Montgomery County +4%, Fort Bend +2.5%.	New suburban demand, likely commercial-heavy
Competition	Texas Children's $200M+ Pavilion expansion (2026). Houston Methodist Cypress, Sugar Land and Woodlands builds. Memorial Hermann Katy and Cypress towers.	A window that closes in 24-36 months

Sources: Texas HHSC / HB 12; HB 12 one-pager (CHIP Perinatal exception); Texas Tribune (Jan 17, 2024); AAFP (CPT 2027 maternity codes); MGMA (Aug 2026); Texas MMMRC-DSHS 2024 Joint Biennial Report; FDA via Contemporary OB/GYN and Patient Care (Nov 2025); Bayer (Oct 2025); AMA CPT 2026; CMS MM14315; CoStar (2025); US Census QuickFacts; Texas Children's, Houston Methodist, Memorial Hermann newsrooms.

Walk the six rows quickly; the audience knows each one individually. The point is that they converged. Policy: 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. 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. Regulatory: the November 2025 FDA action on hormone therapy labeling is the biggest shift in menopause care since WHI. The boxed warnings for cardiovascular disease, breast cancer and dementia are coming off, product by product; the endometrial cancer warning for estrogen-alone products remains. Women who were told hormones were dangerous will come back with questions, and they need counseling capacity. Payment: the new 2026 codes let us bill monitoring months with only 2 to 15 days of data. That is exactly the postpartum blood pressure pattern, 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. OB 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). Demographics and competition: everybody sees the growth, and everybody is building. The window to establish a suburban position is the next two to three years.

4

Built on strength

I will not pitch what this department already does well

Complexity

The Fetal Center at Children's Memorial Hermann, a national referral center. Level IV maternal care at Memorial Hermann-TMC. Placenta accreta and MFM fellowship strength.

Research infrastructure

NICHD MFMU Network site (2023-2030) and the only Texas institution in both the MFMU and Neonatal Research Networks. Gilstrap Center.

Reach

Memorial Hermann-TMC plus seven suburban Memorial Hermann hospitals and Harris Health LBJ, with a new 390-bed LBJ hospital including L&D opening late 2028.

Pelvic health pipeline

Urogynecology at six outpatient sites and, as I understand it, an existing referral pathway for women over 60 with incontinence.

AI platform

McWilliams School of Biomedical Informatics, TEAM-AI and SAFE centers, ChatGPT Edu, and the UT System enterprise Abridge ambient scribe agreement.

Where I see room to build

In public sources I could not find a dedicated menopause program, cardio-obstetrics clinic, postpartum-year program or REI division; suburban general OB/GYN is lighter. Please correct me.

Sources: med.uth.edu/obgyn; NICHD MFMU announcement (2023); Harris Health LBJ project status; SBMI and AI Hub (aihub.uth.edu); Fierce Healthcare (Abridge-UT System). "Room to build" items reflect public sources; internal programs may exist.

This slide earns credibility. I studied what is here before proposing anything. Emphasize the complexity moat: Level IV maternal care and the Fetal Center are assets that Houston Methodist does not have anywhere in its system. That will matter on the competition slides. On the referral pathway for women over 60 with incontinence: I learned of this program in my briefing; please correct me on how it works today. Say that this is exactly the kind of pathway I want to extend into a closed loop, measured from referral to outcome to revenue. It is the seed of one of the initiatives. Handle the "room to build" box carefully. Say: from public sources I could not find these programs; if they exist internally, the plan builds on them rather than starting over. For example, UT Physicians' adult congenital heart clinic already manages high-risk pregnancies with our MFM team. This invites the committee to correct me, which is a good conversation to have.

5

The market

Houston: the fastest-growing large metro, with a hard payer mix

7.90M

Metro population, July 2025

+126,720 in one year, #1 in US

35.7

Median age (US 39.2)

5.6% of women 15-50 gave birth last year (US 5.0%)

~105K

Births per year, 9-county metro

Estimate; Harris County ~65,450

+237%

Fulshear growth in 5 years

Median household income $178K

16.7%

Texas uninsured, worst in US

Harris County under-65: 23.8%

~48%

Texas births paid by Medicaid

185,000+ births (2023)

~38%

Incontinence in women over 60

Only about 1 in 4 women with UI seek care

46.5%

Texas counties that are maternity care deserts

15,287 births in deserts (March of Dimes, 2023)

Implication: fund mission care at the center with commercial and Medicare growth in the suburbs and in midlife, and with recurring Medicaid-eligible services in the postpartum year.

Sources: Census via citypopulation.de and Census Reporter (ACS 2024); CoStar 2025; Greater Houston Partnership; CultureMap/GoBankingRates (Fulshear); America's Health Rankings; SmartAsset 2025; TPR (2026); BMC Primary Care 2020 (UI prevalence and care seeking); March of Dimes Texas Maternity Care report (2023). Metro births is an estimate pending DSHS Table 9.

The market is a paradox. Houston is the fastest-growing large metro in the country, young, with above-average fertility. But Texas has the highest uninsured rate in the nation and Medicaid pays for about half of births. So the strategy cannot be "more of the same everywhere." It has to cross-subsidize: commercial and Medicare growth in the west and north suburbs and in midlife care, recurring revenue in the postpartum year that Medicaid now pays for, and mission care at TMC and LBJ. Note the incontinence numbers: roughly 38 percent of women over 60, and only about a quarter of women with incontinence seek care. That is why the existing referral pathway for women over 60, as I understand it, matters: it finds the women who would never self-refer. The births figure for the full metro is my estimate from Harris County and ACS data; I would replace it with DSHS vital statistics before any capital decision.

6

Market sizing

Where the dollars are: TAM, SAM and a realistic Year-3 share

Service line	TAM	SAM	SOM (Y3)	Basis
Midlife: menopause + pelvic floor	~$790M	~$111M	$4-5.5M	~956K women 45-64 x 20% moderate/severe VMS x $1,200; ~1.49M women 45+ x 25% UI/PFD x $1,500. SAM: catchment 50% x insured 80% x care-seeking 35%
Suburban OB/GYN satellites	~$738M	~$258M	$4.1M / site	105K births x $3,500 global professional + 2.47M women 18-64 x 60% visit x $250. SAM: west Fort Bend, west Harris, Waller, Montgomery (35%)
Concierge women's health	~$830M	~$33M	$1.8M	~277K households $200K+ x $3,000. SAM: within 25-30 min of TMC / Memorial City x 10% willing. SOM: 500 members
Connected pregnancy (RPM)	~$42M	~$10.5M	~$0.5M + avoided readmissions	105K births x $400 RPM episode; 25% at-risk share. Main value: quality and payer contracts
Tele-MFM hub, rural Texas	Not sized: grant and MCO-contract funded			~15K births/yr in maternity care deserts

All values annual and ESTIMATES built from sourced inputs (Census/ACS, KFF, NHANES-based prevalence, Monash VMS cohort, Scripps concierge pricing). Full math and assumptions in the appendix and business plan. Replace female age bands with ACS B01001 and births with DSHS Table 9 before decisions.

Be explicit that these are estimates and that the math is transparent. Administrators trust a model they can argue with. TAM is the theoretical spend if every relevant woman in the metro used the service. SAM narrows to what UTHealth and Memorial Hermann can realistically reach by geography, payer and care-seeking. SOM is what we capture by Year 3. The headline: the midlife line has the best stand-alone economics: a positive clinic margin by Year 3 on 1.0 million dollars of capital, about 111 million dollars of serviceable market, with a Year-3 share of 4 to 5.5 million, built on a payer mix that is commercial plus Medicare. Satellites are large in revenue but capital-heavy and depend on hospital downstream value; concierge is small but high margin; connected pregnancy is small in fees but large in quality and payer leverage. If asked about methodology: every assumption is listed in the appendix and the business plan, and each one can be replaced with department actuals in an afternoon.

7

Competition

Four players, four different strategies

	Houston Methodist	Baylor / Texas Children's	UTHealth + Memorial Hermann	Kelsey-Seybold
Model	Multi-hospital system, suburban delivery growth	Academic + children's flagship at TMC	Academic dept. + 8 MH hospitals + LBJ safety net	Payer-integrated multispecialty group
Scale	~14,000 births, 8 hospitals	6,000+ births at Pavilion, expanding	~7,900 births (MH-TMC + LBJ)	OB/GYN at 6 sites (incl. Woodlands, Katy, Atascocita)
Top maternal level	Level III	Level IV	Level IV	n/a
Fetal / MFM	MFM through affiliated groups (Pediatrix at TMC; Texas Children's at West). No academic MFM division, fellowship or fetal therapy found.	Fetal Center, 8 MFM clinics	The Fetal Center, MFM fellowship	Not researched
Menopause	None found	Dedicated Menopause Center	None found (MH-Midi telehealth)	Not researched
Suburban moves	Cypress (2025), Sugar Land $60M, Woodlands $240M	MFM clinics in suburbs; OB/GYN in Pearland	MH Katy $282.5M, Cypress $277.5M towers	Cypress site 2026

Sources: Houston Methodist 2025 facts and newsroom; Texas DSHS maternal levels of care designations; Houston Methodist MFM; Pediatrix MFM at Houston Methodist; Texas Children's MFM locations; Texas Children's newsroom; med.uth.edu/obgyn; Memorial Hermann newsroom; Kelsey-Seybold. UTHealth births undated; TCH volume figures vary by source.

Four different strategies. Methodist wins on suburban hospitals and brand. Baylor and Texas Children's win on TMC volume and have already planted menopause and MFM flags. Kelsey-Seybold wins on payer integration. UTHealth with Memorial Hermann wins on complexity and on a nine-hospital network (eight Memorial Hermann hospitals plus LBJ). On 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. The insight: our partner, Memorial Hermann, is building the same suburban capacity as Methodist in Katy and Cypress. Those towers need physicians and service lines to fill them. That is the shared interest behind a funds-flow agreement. Births figures come from public sources and differ in date; treat them as order of magnitude.

8

The main competitor

Houston Methodist: strong brand, thin at the high end

Where they are strong

#7 nationally in U.S. News OB/GYN; #1 hospital in Texas for 15 years
~14,000 births across 8 hospitals; about 85% outside TMC (Willowbrook 3,086)
Pelvic floor center with Houston's first ACGME urogynecology fellowship
Digital ops: system-wide ambient AI scribe (2026), AI virtual nursing, inpatient wearables
Capital: ~$4.4B revenue, ~$470M surplus (FY2024, one entity); Centennial Tower 2027

Where they are thin

No Level IV maternal designation anywhere; top is Level III (The Woodlands contingent)
MFM largely affiliated, not an academic division; no fetal therapy center or MFM fellowship found
No menopause program found
Hospital-based institute (Weill Cornell affiliate), not a medical school; second OB/GYN residency (Willowbrook) began 2025
No public postpartum home BP monitoring or home-based antepartum program found

Our position: be the place every Methodist-area OB calls for a complex pregnancy, the system that owns the postpartum year and midlife care, and the department that publishes the outcomes.

Sources: U.S. News 2026-27; Houston Methodist 2025 facts page (birth sum computed); Texas DSHS maternal levels of care list; Houston Methodist OB/GYN department pages; Houston Methodist MFM and Pediatrix MFM at TMC; Form 990 FY2024 (via philanthropy.org); Houston Methodist newsroom (Ambience 2026; virtual nursing). Absence findings are from public sources.

Respect first. Methodist is the best-ranked hospital in Texas, number 7 nationally in OB/GYN, and roughly 85 percent of its 14,000 births happen in suburban hospitals. They are excellent operators and they move fast on digital. But look at the right column. Their 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. They have no menopause program we could find. They are a hospital-based academic institute with a Weill Cornell affiliation and a long-running TMC residency, not a medical school department; their second residency, at Willowbrook, began in 2025. If 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. So I would not fight them on suburban low-risk births or on rankings next year. I would make UTHealth the default destination for complexity across the region, including from Methodist's own suburban obstetricians, and I would claim the two lanes they have left open: the postpartum year and midlife.

9

Strategic choices

Where we compete, where we partner, where we do not fight

Compete

Complex pregnancy region-wide (Level IV + Fetal Center)
Midlife and pelvic health
The postpartum year
West Fort Bend / Fulshear, then Conroe

Partner

Memorial Hermann: funds-flow for suburban towers
Level I-II community hospitals: tele-MFM and transfer agreements
Industry: data and device registries
FQHCs and MCOs: screening and incentive programs

Do not fight

Suburban low-risk births head-on in Cypress
Short-term U.S. News rank
IVF scale vs. 13-site incumbents (partner first)
Reconstructive surgery volume vs. Methodist's fellowship

Strategy is mostly about what you choose not to do. Compete where we have a structural advantage or where the field is open: complexity, midlife, the postpartum year, and two suburban corridors with growth and a likely commercial-heavy payer mix. Partner where someone else owns the asset: Memorial Hermann owns the suburban towers, so we bring the service lines in exchange for a funds-flow agreement. Community Level I and II hospitals, including some of Methodist's, need MFM backup; offering it makes us the regional referral center. Check Memorial Hermann's position before approaching any Methodist hospital. Do not fight: Cypress is now crowded with three systems building. Fertility has a 13-site incumbent; partner or build slowly. And we compete on postpartum pelvic health linked to our delivery base, not on reconstructive surgery volume where Methodist has a fellowship.

10

The framework

Three engines and one enabler, staged across three horizons

H1 · 0-12 months

H2 · 12-36 months

H3 · 3-5 years

Grow the front doorAccess and share

Midlife & Pelvic Health Center (5,000 SF fit-out, funded with MH); concierge pilot (150 members)

First satellite: west Fort Bend / Fulshear; MFM outreach clinics in Methodist corridors

Second satellite (Conroe / north Montgomery); LBJ 2028 volume growth

Connected careRecurring revenue

Postpartum Year: remote BP for hypertensive disorders; perinatal mental health CoCM

Cardio-obstetrics clinic; tele-MFM and eConsult hub

MCO value-based contracts on postpartum outcomes; home antepartum monitoring (MCO/commercial)

Discovery & dataGrants and industry

Perinatal Data Commons protocol alongside the MFMU program; sFlt-1/PlGF triage pathway

Industry RWE contracts; AI fetal heart QI network; HPV self-collection outreach

FMF vs risk-factor aspirin pragmatic trial; validated PPH prediction in production

AI & cost to serveEnabler

Referral-to-revenue dashboard; Abridge coding integrity; ERAS and OR supply scorecards

Prior-auth automation; prenatal visit redesign; central scheduling; OB safety program

Gainsharing / co-management with MH; AI-supported panel sizes

11

The portfolio

Eleven initiatives on one page

Front door

1

Suburban satellite network

West Fort Bend first; system margin with Memorial Hermann

Years 1-3

Front door

2

UTHealth Signature membership

Hybrid concierge, still bills insurance

Year 1

Front door

3

Midlife & Pelvic Health Center

Closed-loop continence pathway plus menopause

Year 1

Connected care

4

The Postpartum Year

Remote BP plus cardio-obstetrics

Year 1 Years 1-3

Connected care

5

Perinatal mental health

Collaborative care model, billed monthly

Year 1

Connected care

6

Tele-MFM & eConsult hub

Deserts, Level I-II hospitals, transfer line

Years 1-3

Data

7

Houston Perinatal Data Commons

Biobank + RWE contracts, alongside the MFMU program

Years 1-3

Data

8

Precision prediction portfolio

Preeclampsia, fetal heart AI, PPH

Years 1-3 Years 3-5

Data

9

Prevention at scale

Home HPV self-collection, AI cytology, oncofertility

Years 1-3

Enabler

10

AI to revenue

Referral loop, coding integrity, prior auth, triage

Year 1

Enabler

11

Lower the cost to serve

ERAS, OR supplies, visit redesign, safety, gainsharing

Year 1 Years 1-3

Legend

FRONT DOORCONNECTED CAREDATAENABLER

Pills show when it starts:

Year 1 Years 1-3 Years 3-5

Pro formas: 1-3; savings: 11.

12

Engine 1 · Grow the front door

Satellites where growth is fastest and UTHealth already has a footprint

Corridor	Signal	Read
West Fort Bend / Fulshear / Richmond	Fort Bend +24K/yr; Fulshear $178K income; UT multispecialty in Cinco Ranch and Rosenberg; MH Katy tower	First
Conroe / north Montgomery	+30K/yr, +4%; Woodlands crowded, north I-45 likely under-built	Second
Cypress / 290	HM Cypress, MH tower 2027, Kelsey 2026	MFM only

Each site carries an MFM outreach day so complex patients flow to the Level IV center and return home for routine care.

One new 4-doctor clinic: loses money alone, profitable for the system by Year 2 ($M)

	Y1	Y2	Y3
Clinic collections	1.19	2.61	4.13
Clinic profit (loss) after its own costs	-1.42	-1.04	-0.56
Hospital profit from the clinic's deliveries and surgeries (30% margin)	0.75	1.64	2.60
Combined profit, UTHealth + Memorial Hermann	-0.67	+0.60	+2.04
Deliveries / surgeries sent to MH	154/66	336/144	532/228

The 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.

Inputs: AMGA 2026 OB/GYN median comp $419K and 7,681 wRVU; Houston MOB rent ~$30/SF (Matthews 2025); build-out estimated from TDLR filings; $95/wRVU, 140 deliveries per MD and $12K hospital net per delivery are ASSUMPTIONS to replace with actuals. Full model: business plan, section 7a.

Satellites are where most chairs start, and where many lose money. The honest version: a four-physician OB/GYN satellite does not pay for itself on professional fees alone. In this model the clinic loses money through Year 3 unless collections exceed about 106 dollars per wRVU. It works as a system investment. Each mature physician sends deliveries and surgeries to the hospital, and with a 30 percent hospital contribution margin the combined system turns positive in Year 2 and reaches about 2 million in Year 3. Using a more conservative hospital benchmark, Year 3 is still about plus 1 million. Reading 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. So the ask to Memorial Hermann is a funds-flow agreement that credits downstream margin. They are building a 282.5 million dollar tower in Katy. A UTHealth satellite in west Fort Bend helps fill it. Corridor choice: west Fort Bend first. Conroe second. Cypress is now crowded; we go there only with MFM outreach.

13

Engine 1 · Grow the front door

UTHealth Signature: hybrid membership women's health

Core (~$2,500/yr): same-week access, annual comprehensive visit, nurse navigator, secure messaging, coordinated imaging and labs
Premium (~$5,000/yr): adds midlife program (bone, cardiometabolic, VMS), executive scheduling, pelvic health and fertility counseling
Hybrid: insurance billed for covered care; the fee covers only non-covered services (access, navigation, counseling); Medicare/Medicaid compliance review first
Mission pairing: a share of membership margin funds the postpartum year program at LBJ

Benchmarks: Scripps concierge $3,780/yr (<65); MDVIP "low four figures"; MD2 Houston $24,000. No Houston concierge OB/GYN price found.

Program economics ($M)

	Y1	Y2	Y3
Members	150	350	500
Revenue	0.54	1.26	1.80
Direct costs	0.73	1.06	1.34
Margin	-0.19	+0.20	+0.46

Capex $0.5M. Operating and cumulative breakeven in Y2; ~370 members at full Y3 staffing. Y3 margin 25%. Feeds commercial deliveries, surgery and philanthropy.

Sources: Scripps concierge pricing; The Hospitalist on academic concierge; MD2 River Oaks; Monetizely concierge pricing guide. Fees, member ramp and staffing are ASSUMPTIONS.

Concierge in a public academic center needs careful framing. I propose a hybrid: insurance is still billed for covered care, and the membership covers only non-covered services: access, navigation and extended counseling. Before launch, compliance reviews the model for Medicare and Medicaid members (assignment rules and the OIG guidance on concierge fees), and the university approves the fee schedule. Scripps, a respected academic-affiliated system, charges about 3,780 dollars a year. The economics are small but clean: we pass operating breakeven in Year 2, about 370 members to break even at full staffing, and about 460 thousand dollars of margin in Year 3. The strategic value is larger than the margin. Members are commercially insured women who deliver, have surgery, refer friends and become donors. This is a women's-health membership in our existing TMC, Bellaire and Memorial City sites; it is not a head-to-head with anyone's executive health program. Address equity before someone asks: a fixed share of membership margin funds the postpartum year program for Medicaid patients. That turns a potential criticism into a mission story.

14

Engine 1 · Grow the front door

Close the loop on the 60+ referral pathway: a Midlife & Pelvic Health Center

ReferralThe existing 60+ pathway (to confirm scope)

ScreenValidated UI, VMS, GSM, bone and CV risk instruments

First linePelvic floor PT; FDA-cleared app-guided trainer (Medicare RTM only; device often not covered)

Office proceduresUrodynamics, PTNS, implantable tibial stimulation, onabotulinumtoxinA

SurgerySling, prolapse repair at MH

Menopause, integrated: HRT counseling after the 2025 label change, non-hormonal options (elinzanetant, fezolinetant with liver monitoring), bone and cardiometabolic risk
Differentiation from Baylor's center: network reach across MH suburban sites, continence plus menopause in one visit, and outcomes tracked from referral to result
Devices: leva (RCT superior to Kegels); eCoin (PMA); Revi (510(k)); AUA/SUFU 2024 guideline includes implantable TNS

$M	Y1	Y2	Y3
Revenue	1.31	2.52	4.18
Clinic margin	-0.93	-0.25	+0.32
With surgical cases	-0.63	+0.18	+1.09

Capex $1.0M. Pelvic floor PT is the margin lever. Year 4 clinic +$0.52M; +$0.74M with a cash-pay menopause tier.

Sources: FDA (Nov 2025 HRT labels; Veozah liver warning Dec 2024); Bayer (Lynkuet, Oct 2025); Urology Times and Obstet Gynecol (leva RCT); UTHealth billing compliance (RTM); BCBSTX policy PSY301.016; FDA PMA P200036 (eCoin); BlueWind/Contemporary OB/GYN (Revi); AUA/SUFU OAB guideline 2024. Pro forma inputs are ASSUMPTIONS.

This is the initiative that builds directly on what the department already does. As I understand it, the existing referral pathway for women over 60 finds the patients. I learned of this program in my briefing; please correct me on how it works today. The question is what happens next, and whether we can prove it. The pathway: screen with validated instruments, start with pelvic floor PT and an FDA-cleared app-guided trainer, then office procedures such as urodynamics, PTNS and the new implantable tibial stimulators, then surgery when needed. Each step is measured. The 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. Menopause rides on the same visit. Baylor has a branded Menopause Center, so we do not copy it. We differentiate on reach across eight Memorial Hermann hospitals and on integration: continence, menopause, bone and cardiometabolic risk in one place. Economics: about 1 million dollars of capital, clinic breakeven in Year 3, and positive in Year 2 when surgical cases are counted. Pelvic floor PT is the margin lever because visits are frequent and staffing is efficient.

15

Engine 2 · Connected care

The Postpartum Year: own the 12 months that Texas now pays for

Remote BP for every hypertensive disorder of pregnancy: cuff at discharge, text-based readings, nurse titration protocol
Cardio-obstetrics clinic with cardiology for chronic hypertension, cardiomyopathy and post-preeclampsia risk
Months 2-12: glucose follow-up after GDM, contraception, depression screening, primary care handoff
Billing, 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

92% vs 44%

BP obtained: texting vs office visit

Penn RCT, n=206

0.5% vs 3.7%

HTN readmissions with remote BP

UW, single site, non-randomized. A 2025 meta-analysis of 4 RCTs found no significant reduction

$309

Program cost per patient that is still cost-saving

Cost-effective up to $420

1 in 4

Texas pregnancy-related deaths at 43 days to 1 year

2020 deaths (MMMRC 2024 report)

We found no public postpartum monitoring program at Methodist. We publish our results and take them to MCOs as a value-based contract.

Sources: Hirshberg et al., BMJ Qual Saf 2018 (Penn RCT); Hoppe et al., AJOG / UW Dept OB/GYN; Zullo et al., J Perinat Med 2025 (meta-analysis of 4 RCTs); PMC10428007 (cost-effectiveness); Texas MMMRC-DSHS 2024; CPT 2026 and vendor rate summaries (Prevounce); 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.

This is the initiative with the strongest evidence and the clearest moral case. Penn's randomized trial showed 92 percent of women texted their blood pressure versus 44 percent who came to an office visit. Wisconsin, in a single-site, non-randomized study, reported hypertension readmissions of 0.5 percent with remote monitoring versus 3.7 percent without. One economic analysis finds the program cost-saving at a program cost of about 309 dollars per patient, a net saving of about 93 dollars per patient. 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. What 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. Add a cardio-obstetrics clinic. Cardiovascular disease is a major cause of pregnancy-related death; I would formalize the existing cardiology-MFM collaboration into a cardio-obstetrics clinic that also covers the postpartum year. Billing 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. The competitive point: we found no public program at Methodist. We can be first, publish the results, and turn it into a value-based contract with the Medicaid MCOs. Community Health Choice already runs an OB incentive program in Harris County.

16

Engine 2 · Connected care

The recurring revenue stack (2026 Medicare national, approximate)

Service	Codes	Approx. value	Fit
Remote physiologic monitoring (Medicare, commercial)	99453, 99454 / 99445, 99457 / 99470, 99458	$73-140 per pt-month + $22 setup	Postpartum and antepartum hypertension
Home 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
Remote therapeutic monitoring	98975, 98977 / 98985, 98980 / 98979, 98981	~$66-135 per pt-month	App-guided pelvic floor trainer: Medicare only; not paid by Texas Medicaid; BCBSTX deems home devices not medically necessary.
Collaborative care (BH)	99492-99494; APCM add-ons G0568-G0570	~$146-162 (APCM, vendor)	Perinatal depression and anxiety (Texas Medicaid benefit since 2022)
Principal / chronic care mgmt	99424, 99490, 99491, 99487	~$66-144 per pt-month	Chronic HTN, pregestational diabetes, prolapse
eConsults	99451, 99452, 99446-99449	~$35 per consult (99451)	MFM and urogyn for community OBs and primary care
PTNS course	64566	~$117 per session; ~$1,400 per course	Urgency incontinence, office-based
Urodynamics	51728 / 51729 + 51797, 51741, 51798	$500+ per full study	Continence pathway workup
Longitudinal visit add-on	G2211	$17.37 per visit	Midlife and chronic gyn follow-up

Sources: CMS CY2026 PFS final rule summary (MM14315); AMA CPT 2026; Prevounce, Tenovi and Mindbowser rate summaries; Medtronic PTNS 2026 guide; Laborie 2026 (urodynamics, mixed professional/facility); 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 in the CMS PFS Look-Up Tool; Houston locality, Texas Medicaid and commercial rates differ.

This slide is for the administrators. Every initiative in the connected-care engine maps to codes that exist today. Two notes. First, 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. Second, nothing here depends on an AI-specific code. In 2026 there are no OB-specific AI payment codes; AI-assisted ultrasound is paid like ultrasound. Two caveats if asked. The collaborative care figure is the comparable Medicare APCM add-on rate, vendor-reported; APCM add-ons need an APCM base code billed by the practitioner responsible for primary care, so 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. And a 2027 proposal would restructure G2211 as a percentage modifier. That is why AI in my plan is a capacity and accuracy tool, not a fee line.

17

Engine 2 · Connected care

A tele-MFM and eConsult hub: be the region's complexity partner

Who it serves

Maternity care deserts (46.5% of Texas counties, March of Dimes 2023; ~15K births a year), Level I-II community hospitals across the region, FQHCs and Harris Health clinics.

What it offers

Scheduled tele-MFM consults, 24/7 one-call transfer line to the Level IV center and Fetal Center, eConsults within 48 hours, shared RPM for high-risk patients after they return home.

How it pays

eConsult and telehealth codes, downstream transfers and fetal procedures, hospital service agreements, HRSA and state grants, MCO contracts.

Design principle: send patients home after the complex episode. Referring OBs keep their patients, so they keep referring.

Sources: March of Dimes Texas Maternity Care report (2023); Texas DSHS levels of care; CMS MM14315 (telehealth).

Texas has maternity care deserts in nearly half its counties, and many suburban hospitals in Houston are Level I or II. Every one of them will at some point need MFM help at 2 a.m. The hub makes UTHealth the first call. Scheduled tele-consults, a one-call transfer line, eConsults with a 48-hour turnaround, and shared remote monitoring when the patient goes home. The most important design choice is to send patients back to their referring obstetrician after the complex episode. That is how referral networks grow. Revenue comes from consult codes, downstream transfers and fetal procedures, and service agreements. The rural reach is grant-fundable. I do not count on the Medicare hospital-at-home waiver (extended to 2030): it pays for Medicare fee-for-service inpatients and does not cover most obstetric patients. Political note (not for the slide): confirm Memorial Hermann's position before approaching Methodist-affiliated hospitals.

18

Engine 3 · Discovery & data

The Houston Perinatal Data Commons

One consented cohort linking MH-TMC, LBJ and the MH suburban network, adding remote-monitoring and imaging data, built to partner with existing Houston biobanks such as Baylor/TCH PeriBank, not duplicate them.

Collect: serum and cell-free RNA, placenta photo and pathology, ultrasound, fetal heart tracings, RPM data, EHR outcomes
Built alongside the MFMU site: reuse coordinator expertise and SOPs, under a separate IRB protocol, funding and data governance
Governed: data use agreements; federated-ready for external consortia

Who pays

Industry RWE: diagnostics (cfRNA preeclampsia tests, sFlt-1/PlGF), fetal heart AI vendors, CTG AI vendors, pelvic device registries

Federal: NIH ORWH (~$106.5M FY2026), NICHD, PCORI comparative effectiveness, ARPA-H women's health programs (Sprint: ~$110M to 23 teams)

State and philanthropy: maternal health and prevention grants

Sources: NICHD MFMU (2023-2030); ARPA-H Sprint for Women's Health; SWHR (FY2026 ORWH appropriation); Mirvie (Business Wire 2025); Thermo Fisher (2023); Northwestern PlacentaVision (2024); Baylor College of Medicine (PeriBank). A follow-on ARPA-H sprint is unconfirmed.

The department already runs one of the most demanding research platforms in obstetrics. The Data Commons is built alongside the MFMU site: it reuses the team's research-coordinator expertise and SOPs, under its own IRB protocol, funding and data governance. MFMU network data stay with the network. Houston already has a perinatal biobank: Baylor and Texas Children's run PeriBank, enrolling since 2011. The Commons links MH-TMC, LBJ and the Memorial Hermann suburban network, adds remote-monitoring and imaging data, and is federated-ready, so it can partner with PeriBank rather than duplicate it. Why it matters commercially: diagnostic companies, AI vendors and device makers all need real-world evidence in diverse populations. Houston's patient mix is exactly what they need. That makes us a partner they pay, not a customer they sell to. Why it matters academically: it is the base for NIH, PCORI and ARPA-H applications, and it lets us validate every AI tool before we deploy it.

19

Engine 3 · Discovery & data

Precision prediction: four studies that change practice and pay their way

Study	Evidence today	Regulatory	Department role
sFlt-1/PlGF triage for inpatients with hypertensive disorders	PRAECIS (18 US hospitals; manufacturer-funded); ratio ≥40 flags severe features within 2 weeks	FDA-cleared (Thermo Fisher 2023; Roche 2025)	Protocol plus cost and length-of-stay study
First-trimester FMF screening vs risk-factor aspirin	ASPRE RCT: aspirin 150 mg vs placebo in FMF screen-positive women cut preterm preeclampsia >60%; FMF vs US risk-factor selection untested head-to-head	Algorithm not FDA-reviewed	US pragmatic trial in a Medicaid-heavy cohort (PCORI, NIH)
AI fetal heart QI network	Company data: many CHDs missed on routine scans	BrightHeart 510(k)s + PCCP; Sonio 510(k)	Detection-rate registry across MH imaging sites
PPH and severe morbidity prediction	One external validation (2025 preprint, 8 hospitals): a published model fell to AUC 0.60	Uncleared decision support	Prospective silent trial, then implementation

The gap in women's health AI is not models. It is prospective validation in diverse populations. That is what this department is built to do.

Sources: Thermo Fisher (May 2023); Roche Elecsys (MLO, Feb 2025); PRAECIS (AJMC summary); ASPRE (Rolnik et al.) and ISPOR Europe 2025 UK cost-effectiveness; BrightHeart (Business Wire, May 2025); Sonio 510(k) 2023; medRxiv 2025 external validation of PPH models.

This is where the department's research identity and the AI agenda meet. Four studies. The sFlt-1/PlGF ratio is FDA-cleared; implementing it as a triage protocol, within the cleared indication for women already admitted with hypertensive disorders at 23+0 to 34+6 weeks, can reduce unnecessary prolonged antepartum stays and iatrogenic preterm delivery, and we can measure that. PRAECIS was manufacturer-funded. In ASPRE, aspirin cut preterm preeclampsia by more than 60 percent among women the FMF algorithm flagged as high risk. Whether FMF screening beats US risk-factor selection is untested, and that is a fundable pragmatic trial in our population. AI fetal heart tools are now cleared with change-control plans, which makes a detection-rate registry the right design. And in one external validation, a 2025 preprint across eight hospitals, a published hemorrhage model fell to an AUC of about 0.60. The message to an institution that already invests heavily in AI: the scarce asset is not another model. It is prospective validation in diverse patients. That is work an MFMU site's research team is built to do well.

20

Engine 3 · Discovery & data

Prevention at scale: reach women who never come in

Home HPV self-collection

First at-home cervical screening device FDA-approved May 2025 (Teal Wand). Mailed-kit outreach to under-screened Harris County women with FQHC partners and colposcopy access. NCI-fundable.

AI-assisted cytology

Hologic Genius Digital Diagnostics FDA-cleared January 2024; company reports 28% fewer false negatives for high-grade lesions. Throughput and quality study with Pathology.

Oncofertility

Texas HB 1649 (2023) requires state-regulated plans to cover fertility preservation before gonadotoxic treatment. Referral pathway with oncology; partner on IVF rather than build.

Each program produces screening volume, downstream procedures and a publishable equity outcome, and none needs new space.

Sources: Fierce Biotech and 360Dx (Teal, 2025); Hologic (Business Wire, Jan 2024); Texas HB 1649 bill analysis; Mercer employer fertility benefit surveys. CPRIT fit unconfirmed.

21

Enabler · AI

AI to revenue: make existing investments pay

Use	What it does	Metric
Referral-to-revenue loop	Tracks every referral from the 60+ pathway: scheduled, seen, treated, billed, outcome. Flags leakage and no-shows for outreach	Referral completion rate; revenue per referral
Documentation integrity	Uses the existing Abridge scribe to capture complexity accurately (MDM, G2211), with audit sampling against upcoding	E/M distribution vs benchmark; denial rate
Prior authorization	Drafts and tracks prior auths for imaging, procedures and devices	Days to authorization; staff hours
Inbox and RPM triage	Routes patient messages and out-of-range BP readings by urgency to nurse protocols	Time to response; nurse panel size
Capacity model	Forecasts demand by site and service, sets AI-supported panel sizes	Third-next-available; visits per FTE

Ambient scribes cut note time in an NEJM AI trial (up to 9.5%) with less burnout. We found no OB/GYN-specific scribe data: we can generate it.

Sources: Fierce Healthcare (UT System-Abridge enterprise agreement); NEJM AI 2025 ambient scribe RCT (Lukac et al.); CMS MM14315 (G2211). No 2026 CPT codes pay for OB-specific AI; value is indirect.

UTHealth has already invested in AI at a level most departments cannot match. My job as chair is not to start another AI research center. It is to wire those tools to outcomes and revenue in this department. Start with the existing referral pathway for women over 60, as I understand it: measure every referral from trigger to outcome to payment. Referral programs commonly lose patients between referral and first visit. That leakage is revenue and it is also unmet need. Use the Abridge scribe to document complexity accurately, with audit sampling so we do not drift into upcoding. Automate prior authorization. Triage the inbox and remote monitoring alerts so nurses manage larger panels safely. And publish it: we found no OB/GYN-specific scribe outcome data. The NEJM AI trial tested DAX and Nabla, not Abridge.

22

Enabler · Cost to serve

Ten cost initiatives, ranked by value and evidence

#	Initiative	Evidence	Annual savings (est.)	Captured by
1	Extend and audit ERAS for cesarean and gyn surgery where not standard; same-day discharge after MIS hysterectomy	$349 less per cesarean, ~0.5 day shorter stay (n=3,679, pre-post); gyn meta-analysis ~$2,129 per patient	$0.99-1.60M	Hospital
2	Gyn OR supply: standard preference cards, surgeon cost scorecards, reprocessed sealing devices, robotic stewardship for straightforward benign cases (2007-2010 cost data; re-check)	Surgeon cost feedback (JAMA Surg); reprocessing saved US facilities $465.8M in 2023 (AMDR industry survey)	$0.36-1.11M	Hospital
3	Prenatal care redesign: fewer low-risk visits, hybrid virtual schedule, APP and RN-led routine care	MiPATH recommendations; ACOG supports tailored schedules	$0.22-1.47M capacity	Department
4	Central scheduling, automated reminders, predictive overbooking	No-show cost ~$196 per missed visit (BMC HSR, 2008 data)	$0.15-0.78M capacity	UT Physicians
5	Fewer NTSV cesareans (low-risk first births); extend the Ob/Gyn Hospitalist division's model across suburban MH sites	California: 26.0% to 22.8%, no added neonatal harm (JAMA)	$0.25-0.43M	Mostly payers
6	Prior-auth automation and denial prevention	Denial rework ~$25 per claim (MGMA-attributed, ~2017)	$0.16-0.43M	UT Physicians
7	OB safety program: AIM/TexasAIM bundles, team drills, fetal-monitoring certification, OB safety nurse; meets CMS obstetric training and quality requirements due 2027	Yale: claims payments $50.7M to $2.9M across two 5-year periods (single site; 1998-2002 vs 2003-2007 data)	$0.05-0.24M + claims	UT liability plan, hospital
8-10	Office hysteroscopy; video interpreting and scribe/transcription consolidation with Abridge; postpartum remote BP	Site-of-service data; readmission evidence mixed	$0.21-1.14M	Mixed

Sources: ERAS cesarean cohort; gynecologic ERAS meta-analysis; JAMA, PMC8080226 (California NTSV collaborative); Pettker et al. (Yale OB safety); AIM bundles; TexasAIM; SMFM (CMS obstetric requirements); MiPATH; AMDR 2024; BMC Health Serv Res 2016; Becker's/MGMA. All savings are ESTIMATES for ~8,000 deliveries and 400-700 hysterectomies per year; several sources date from 2008-2016. Replace with department and hospital actuals.

Growth is half the plan. The other half is lowering the cost to serve, and the department influences far more cost than it books. The top two are surgical: enhanced recovery for cesarean and gynecologic surgery, with same-day discharge after minimally invasive hysterectomy, and standardizing OR supplies with surgeon cost scorecards. Together they are worth roughly 1.3 to 2.7 million dollars a year, and they are among the best-evidenced items here: a pre-post cohort of about 3,700 cesareans showed 349 dollars lower cost per case and half a day shorter stay. The department already has an Ob/Gyn Hospitalists division and a minimally invasive gynecology division, and some sites may already run ERAS. If these are already in place, the savings are partly banked; the gain is in measuring and sharing them. On robotics, the message is stewardship for straightforward benign cases, not an anti-robot stance; the cost gap comes from 2007 to 2010 data and needs a current check. Next are capacity items that the department captures directly: redesigning low-risk prenatal schedules with virtual visits and APP-led care, and central scheduling with reminders. These free clinic slots; they become money only if we fill those slots, which the growth engine does. Safety pays too. Yale's obstetric safety program cut claims payments from about 51 million to about 3 million dollars across 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. If 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). What I deliberately did not count: elective induction at 39 weeks moves cost into labor and delivery rather than reducing it, and group prenatal care saves the payer, not the practice, so it belongs in a payer contract.

23

Enabler · Cost to serve

Most savings land with partners, so we negotiate the share up front

$1.4-2.8M

Hard cash to hospitals

ERAS, LOS, OR supplies

$0.3-1.2M

Cash to department and UT Physicians

Prior auth, interpreting, scribe consolidation

$0.3-0.9M

Payer savings

NTSV cesareans, office procedures

$2.4-7.2M

Total per year, all parties

Remainder is freed capacity

How the department shares in it

Co-management or gainsharing with Memorial Hermann on cost per case, LOS and quality, written into the same funds-flow agreement as the satellites
Value-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
Liability: UT's self-insured plan has used partial experience rating (confirm current formula), so safety gains can return through premiums
Capacity: freed slots are filled by the growth engine, which turns savings into revenue

Cost work and growth work are one negotiation: the department brings the clinical change, the partners share the margin it creates.

All figures are ESTIMATES; savings are reported separately and are not included in the revenue pro forma totals. Confirm current ERAS status, NTSV rates, supply cost per case, interpreter and scribe spend, and UT liability premiums (2002 Regents experience-rating policy) 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.

This is the slide administrators care most about. Of roughly 2.4 to 7.2 million dollars a year in total savings, most lands with the hospitals and the payers, not the department. If we reduce length of stay and supply cost without an agreement, the department does the work and the hospital keeps the margin. So the cost work goes into the same negotiation as the satellites: a co-management or gainsharing arrangement with Memorial Hermann on cost per case, length of stay and quality. With the Medicaid managed care plans, the ask is a value-based contract that pays for lower NTSV cesarean rates, fewer readmissions and better postpartum outcomes. If 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. And freed capacity is not money until we fill it, which is exactly what the growth engine does. That is why cost and growth are one plan. I keep these savings separate from the revenue pro forma, so neither number inflates the other.

24

The economics

Three modeled initiatives: $3.1M of capital, system-positive in Year 2 with a Memorial Hermann funds-flow agreement

■ Satellite ■ Signature membership ■ Midlife & Pelvic System contribution, $M

Initiative	Capex	Y3 system	Breakeven
Satellite (4 MD)	$1.6M	+$2.04M	Y2 (system)
Signature membership	$0.5M	+$0.46M	Y2 (operating)
Midlife & Pelvic	$1.0M	+$1.09M	Y2 (system)
Total	$3.1M	+$3.59M	Cumulative +$3.08M by Y3 (after depreciation)
Clinic-only (department)	Y1 -$2.54M · Y2 -$1.09M · Y3 +$0.22M

Conservative case (Merritt Hawkins benchmark for the satellite): Y3 total ~+$2.5M.

Upside not in totals: connected care (~$0.5M direct RPM in Y3 plus avoided readmissions), eConsults, industry RWE contracts and grants.

Contribution margin before institutional overhead (dean's tax, central admin); includes depreciation of build-out. Years run from each opening; the satellite opens in H2, so calendar-year totals will be lower in Years 1-2 and reach the Year-3 run rate later. Inputs are ASSUMPTIONS (AMGA 2026, Houston MOB rents, TDLR filings, Scripps pricing, Merritt Hawkins surveys); replace with UT Physicians and Memorial Hermann actuals.

The financial story in one slide. About 3.1 million dollars of capital across three modeled initiatives. Combined system contribution of about minus 1.5 million in Year 1, plus 1 million in Year 2, and plus 3.6 million in Year 3. Cumulatively positive by the end of Year 3, after depreciation. Years here run from each opening; the satellite opens later, in Horizon 2. Two honesty points. First, "system" includes Memorial Hermann's margin on deliveries and surgeries. Without a funds-flow agreement, the department carries the losses and the hospital collects the gains: on a clinic-only basis the department is minus 2.54 million in Year 1, minus 1.09 million in Year 2 and plus 0.22 million in Year 3. That agreement is the single most important financial negotiation in this plan. Second, the conservative case still lands at about 2.5 million in Year 3. Everything in connected care and the data engine is upside on top of these numbers.

25

The economics

What could go wrong, and what we watch

Lever	Breakeven / sensitivity
Satellite collections per wRVU	Clinic-only breakeven ~$106; at $85 loses ~$0.70M/yr; at $115 earns ~$0.30M
Hospital downstream value	Base $2.2M per MD; conservative $1.35M still positive in Y3
Signature membership	Breakeven ~370 members at full Y3 staffing; each 100 members ~ $0.36M revenue
Midlife center ramp	55% / 80% / 95% productivity; PT staffing drives margin
2027 Medicare	Temporary +2.5% expires; procedure cuts likely

Funds-flow risk: negotiate the Memorial Hermann agreement before signing a lease
Equity optics: membership margin funds the postpartum year at LBJ
Recruiting: urogynecologists (URPS), cardio-OB and menopause-certified clinicians are scarce; start search in month 1
Payer rules: Texas Medicaid pays home BP monitoring as S9110 + 99091 with prior auth, not RPM codes; the pelvic floor trainer carries no revenue
AI safety: audit sampling on scribe notes; silent trials before any prediction model goes live

Sensitivities from the pro forma model (business plan). Medicare 2026 conversion factor $33.4009 includes a temporary +2.5% that expires after 2026 (CMS; SIR).

26

The economics

How it gets funded: capital from five sources, not one

Memorial Hermann

Funds-flow or JV for satellites and the midlife center; suburban towers need service lines

Philanthropy

Midlife center naming; Signature members as donors

Federal

NIH ORWH / NICHD, PCORI, ARPA-H, HRSA for rural tele-MFM

Industry

RWE contracts, device registries, sponsored trials (menopause, preeclampsia)

Payers

MCO incentive programs (e.g., Community Health Choice OB 2026); value-based postpartum contracts

Department capital at risk is limited to H1 programs; build-outs start after partner agreements are signed.

Sources: Community Health Choice 2026 STAR/CHIP OB Provider Incentive Program; SWHR (ORWH FY2026); ARPA-H; Memorial Hermann newsroom (Katy and Cypress expansions).

27

Execution

The first 100 days, Year 1, and Years 2-3

First 100 days

Listening tour: every division, MH leadership, LBJ, residents
Baseline: 60+ referral completion; collections per wRVU; deliveries; cost per case, LOS and NTSV rate
Start searches: urogynecology (URPS), cardio-OB, menopause-certified clinician, PTs
Open funds-flow talks with Memorial Hermann
Launch remote BP for hypertensive disorders at MH-TMC

Year 1

Midlife & Pelvic Health Center: 5,000 SF fit-out ($1.0M), funded with MH
Signature membership pilot (150 members)
Perinatal mental health collaborative care
Data Commons IRB protocol
ERAS and OR preference cards at MH-TMC; prior-auth automation
Site selection and lease for west Fort Bend satellite

Years 2-3

West Fort Bend satellite open; MFM outreach in growth corridors
Cardio-obstetrics clinic; tele-MFM hub with transfer line
Prediction studies funded and enrolling; first RWE contract
MCO value-based postpartum contract
Gainsharing / co-management agreement with MH; OB safety program
Second satellite decision (Conroe), opening in H3; LBJ 2028 readiness

28

Execution

One scorecard, reviewed quarterly with faculty and partners

Domain	Measures	Year-3 target (illustrative)
Growth	New patients by site and service; suburban share; deliveries from satellite physicians	~530 deliveries per satellite
Financial	Contribution by initiative; collections per wRVU; denial rate; cost per case; LOS; recurring revenue share	+$3.6M system contribution (incl. MH downstream)
Quality	Postpartum BP ascertainment and HTN readmissions; NTSV cesarean rate; severe maternal morbidity; screening completion	BP ascertainment >85%
Access	Third-next-available; 60+ referral completion; eConsult turnaround	eConsult <48 hours
Academic	Extramural funding; industry contracts; publications from department programs	3+ new funded studies
People	Faculty retention; burnout scores; recruitment fill rate; resident outcomes	Burnout below baseline

29

Execution

None of this works without the people

Recruit

Urogynecologists (URPS), cardio-obstetrics, menopause-certified clinicians, APPs and pelvic floor PTs. Joint recruitments with cardiology and psychiatry.

Train

Residents rotate through the postpartum year, midlife center and tele-MFM hub. Prepare the program for the new LBJ hospital in 2028.

Sustain

Ambient documentation to cut after-hours work; protected time for program leads; transparent incentive tied to the scorecard.

Every initiative has a faculty lead with protected time, a budget, and a seat at the quarterly review.

Complexity is our moat.
Continuity is our growth.

Own complex pregnancy for the region. Own the postpartum year and midlife care. Turn this department's research platform into the evidence everyone else needs.

Thank you. Questions and discussion.

A1

Appendix

Assumptions to replace with actuals before decisions

Input	Value used	Replace with
Metro births	~105,000/yr (estimate)	DSHS Vital Statistics Table 9 by county
Women by age band	MSA x 50.4% female x assumed age shares	ACS table B01001, 9 MSA counties
Collections per wRVU	$95 (tested $85-125)	UT Physicians OB/GYN actuals
Hospital net per delivery / gyn case; contribution	$12,000 delivery; $10,000 gyn case (satellite); $12,000 urogyn case (midlife); 30%	Memorial Hermann actuals and funds-flow terms
Deliveries per general OB/GYN	140 per year at maturity	Department actuals
Support staff; malpractice	3.5 FTE per MD at $58K; $40K per MD	UT Physicians staffing model; UT self-insurance
Concierge fee and ramp	$3,000 average; 150 / 350 / 500 members	Market test with current patients
Midlife center productivity	PT 11 visits/day x $110; menopause 20 visits/day x $160	Department and PT benchmarks
Reimbursement rates	2026 Medicare national, secondary sources	CMS PFS Look-Up (Houston locality), TMPPM, payer contracts
Competitor footprint	Search-based clinic lists	Drive-time study by corridor

A2

Appendix

Key sources

UTHealth OB/GYN: med.uth.edu/obgyn; NICHD MFMU news (2023)
AI: aihub.uth.edu; SBMI news; Fierce Healthcare (Abridge-UT System)
Harris Health LBJ: nextlevelharrishealth.org/lbj
Texas MMMRC-DSHS 2024 Joint Biennial Report
Texas HHSC / HB 12 postpartum coverage; HB 1649; HB 2727
March of Dimes: Texas report card; maternity care deserts
Census / ACS via Census Reporter; CoStar 2025; Greater Houston Partnership
America's Health Rankings; SmartAsset 2025; KFF births
Matthews and Transwestern Houston MOB reports; TDLR filings
AMGA 2026 compensation survey; Merritt Hawkins revenue surveys

CMS CY2026 PFS final rule (MM14315); AMA CPT 2026; CMS PFS 2026 (G2211)
Prevounce, Tenovi, Mindbowser (RPM/RTM/CCM rates); Medtronic PTNS guide; Laborie
FDA HRT labeling (Nov 2025); Bayer Lynkuet (Oct 2025); FDA Veozah warning
Penn Heart Safe Motherhood (BMJ Qual Saf); UW AJOG; PMC10428007; Zullo et al. meta-analysis (2025)
Thermo Fisher sFlt-1/PlGF (2023); ASPRE; ISPOR 2025
BrightHeart, Sonio, PeriGen FDA clearances; medRxiv PPH validation (2025)
Teal Health (2025); Hologic Genius (2024); leva RCT; eCoin PMA; Revi 510(k)
NEJM AI ambient scribe RCT (2025); ARPA-H Sprint; SWHR ORWH FY2026
Houston Methodist 2025 facts, newsroom; U.S. News 2026-27; Form 990 (via philanthropy.org)
Texas Children's, Memorial Hermann, Kelsey-Seybold newsrooms

Full source list with URLs is in the accompanying business plan.

Women's Health,Continuously

Move from episodes of care to continuous relationships across a woman's lifespan

Grow where others are thin

Build recurring revenue

Turn data into funding

Six forces have shifted in the last 24 months

I will not pitch what this department already does well

Complexity

Research infrastructure

Reach

Pelvic health pipeline

AI platform

Where I see room to build

Houston: the fastest-growing large metro, with a hard payer mix

Where the dollars are: TAM, SAM and a realistic Year-3 share

Four players, four different strategies

Houston Methodist: strong brand, thin at the high end

Where they are strong

Where they are thin

Where we compete, where we partner, where we do not fight

Compete

Partner

Do not fight

Three engines and one enabler, staged across three horizons

Eleven initiatives on one page

Suburban satellite network

UTHealth Signature membership

Midlife & Pelvic Health Center

The Postpartum Year

Perinatal mental health

Tele-MFM & eConsult hub

Houston Perinatal Data Commons

Precision prediction portfolio

Prevention at scale

AI to revenue

Lower the cost to serve

Legend

Satellites where growth is fastest and UTHealth already has a footprint

One new 4-doctor clinic: loses money alone, profitable for the system by Year 2 ($M)

UTHealth Signature: hybrid membership women's health

Program economics ($M)

Close the loop on the 60+ referral pathway: a Midlife & Pelvic Health Center

The Postpartum Year: own the 12 months that Texas now pays for

The recurring revenue stack (2026 Medicare national, approximate)

A tele-MFM and eConsult hub: be the region's complexity partner

Who it serves

What it offers

How it pays

The Houston Perinatal Data Commons

Who pays

Precision prediction: four studies that change practice and pay their way

Prevention at scale: reach women who never come in

Home HPV self-collection

AI-assisted cytology

Oncofertility

AI to revenue: make existing investments pay

Ten cost initiatives, ranked by value and evidence

Most savings land with partners, so we negotiate the share up front

How the department shares in it

Three modeled initiatives: $3.1M of capital, system-positive in Year 2 with a Memorial Hermann funds-flow agreement

What could go wrong, and what we watch

How it gets funded: capital from five sources, not one

The first 100 days, Year 1, and Years 2-3

First 100 days

Year 1

Years 2-3

One scorecard, reviewed quarterly with faculty and partners

None of this works without the people

Recruit

Train

Sustain

Complexity is our moat.Continuity is our growth.

Assumptions to replace with actuals before decisions

Key sources

Speaker notes

Women's Health,
Continuously

Complexity is our moat.
Continuity is our growth.