By: Laura Gomez Cadena

I have been covering women’s health, specifically maternity, at Healthworx Ventures for the better part of the last two years. With increased national attention on maternal health, new regulatory changes and current market tailwinds, there are countless areas of opportunity in the maternal health space, and startups are ready to fill the gaps in the current system.

What has become apparent in my experience with startups in this space is that many want further clarity on how to align their respective missions with the priorities of the many payers across the nation. If you have found yourself in this position, here is a good set of principles to keep in mind:

1. Know your audience

Not all health payers are built the same, nor do they have the same resources to allocate to vendors, therefore the priorities of regional payers versus national payers differ greatly. For example, a local plan is more likely to prioritize maternal health solutions that offer wraparound services for members because the common geography makes it relatively easier to guarantee the same service for each individual.

National plans have more members dispersed across a larger geography. Point solutions are more appealing in this case as they have the appropriate scale to support these types of solutions and are more easily implemented across the country.

2. Research the organization’s maternity goals

As a founder, one of the most important components of preparation is knowing the incentives for the internal teams you are speaking with. You can often find this intel online, and from there, can ensure your mission aligns with the priority of the payers.

For example, the BlueCross BlueShield Association set a public goal to reduce racial disparities in maternal health by 50% in five years. So, if you are engaging with their internal teams, ask what the target is for the next 12 months for that individual plan and what does the journey to achieving that target look like from these team’s perspectives.

Consider how a priority like reducing maternal morbidity rates may also affect reducing racial inequities in healthcare. Understanding these relationships and sharing how your solution can support these overarching goals will be instrumental to increasing your chances of securing contracts with payers.

3. Doulas and Referrals

Solutions supporting doulas have been top of mind for our teams in the maternity space. Research has shown that women receiving doula care have better birth outcomes (lower c-section rates and lower preterm births).

But not all solutions are the same. It is important to offer doula referrals that are independent of a physician practice, as physician-dependent referrals may propagate distrust of the medical system.

In addition, access to in-person doula care as HealthTech startups shift to more hybrid approaches will remain vital to accommodate for the preferences of patients. While these two areas of emphasis are not required to get the interest of a payer, it’s crucial to know how your solution addresses these challenges.

4. Catering to a diverse population

Maternal equity has been a hot topic over the past few years, especially for people of color. Data has shown that non-Hispanic Black women are 3x-4x more likely to die from a pregnancy-related condition than non-Hispanic white women.

Additionally, Hispanic women have greater odds of postpartum hemorrhage, gestational diabetes, and major puerperal infections than white pregnant people. A pivotal question payers will ask startups is how they plan to care for a racially diverse base of patients.

5. Electronic Health Record (EHR) Integration - letting great be the enemy of good

Having an ability to integrate into a providers’ EHR would be fantastic. However, payers understand that this can be a major pain point and a barrier to deploying the solution in a timely manner. Physician practices covered by one payer may have different EHR systems with their own unique hurdles to integration.

With these obstacles in mind, consider the possibility of being a standalone solution. If EHR integration is in your best interest, it will be important to offer convincing proof points that such an integration will not be an issue with a payer’s providers.

6. Emphasize consistent, high-quality care

Lastly, quality control is imperative for payers looking to maintain stickiness with their current members. If they are trusting you with their member base, what are you doing to control quality? Do you have a closed feedback loop? And what do these processes look like? These are just some of the questions you should be prepared to answer.

Navigating the maternal health landscape requires a deep understanding of payer priorities and a commitment to addressing the unique challenges faced by diverse patient populations. The key lies in demonstrating how your solution can effectively support the broader goals of improving maternal health outcomes – as this space will only continue to grow and expand in years to come.