ECG keeps a watchful eye on trends in women’s health. In 2023 we saw a birth rate that stabilized overall, with variability at local levels; unit closures; growing demand for high-risk services; and provider shortages. Will those trends continue in the new year?

Here are five key drivers that we expect to shape women’s health services in 2024.

1. Consolidation, Closures, and Growing Maternity Deserts

ECG has written on OB unit closures and the resulting maternity deserts, which are largely driven by industry-wide staffing shortages and pressure on health systems to remain financially sustainable. This year, we foresee an increase in provider group consolidation as OB/GYNs seek relief from burdensome call demands. Impacts to patient access will be substantial; limited resources will be focused on the necessary coverage of inpatient services, to the detriment of outpatient care.

Implication: This is an opportunity for providers to differentiate themselves in their markets and serve their communities in new ways, such as reimaginging care team structure/roles, seeking new partners, embracing innovation, and enhancing operational efficiency.

2. The Rise of Care Teams

As physician recruitment becomes more challenging and financial headwinds mount, successful women’s health programs are approaching care teams from a holistic perspective. To create the most efficient care model, health systems are partnering with obstetricians, midwives, doulas, physical therapists, and APPs to form teams that promote an expanded scope of services to meet patient preferences while allowing each team member to practice at the top of their license. These team-based models offer many advantages, including:

• Expanded access through greater coverage and schedule availability.
• More effective and culturally competent care delivery.
• Increased patient and workforce satisfaction.

Implication: Creating a care model that coordinates and effectively communicates activities across functions and team members is key to overall program success. Identifying governance, span of control, and agreed-upon care standards is essential to ensuring quality is maintained while care models evolve. The consensus-building process is the most critical component to this type of work, so proper staff and provider involvement is imperative.

3. Investment in Women’s Health

Market fragmentation, enhanced consumerism, and rise in overall demand for women’s health offerings has drawn the attention of private equity (PE) investors. Investment in women’s health services has more than tripled in recent years, and more deals are anticipated in 2024 as venture capitalists see opportunities in areas such as fertility/reproductive health, menopausal medicine, coordinated pregnancy care, and postpartum recovery. Investment drives innovation, as seen by the multitude of new technologies and services emerging in the women’s health sector. Depending on the perspective, specific investments may be considered a welcome addition or additional hurdle for providers.

• New care models offer opportunities for diversification for systems looking to expand their offerings with fewer resources. Apps, digital patient education, home monitoring, and virtual services augment the traditional patient care experience.
• Women’s health is becoming an increasingly competitive space. New service provider entrants to the market offer medical services to niche patient populations, potentially siphoning patients who may otherwise have sought services from existing providers and facilities.

Implication: Rapid innovation and technology gives providers an opportunity to differentiate their offerings. Providers should be watchful of the investments in women’s health and consider the impacts to their organizations. As PE investment expands, most health systems will have to make a choice: compete directly with PE-backed companies through targeted alignment, acqusition, and investment in incubator spaces, or partner with PE firms in a structure that maximizes capital investment and the system’s own management expertise.

4. Focus on Quality and Access

The maternal mortality rate continues to rise, particularly for women of color. In 2022, the White House released a Blueprint for Addressing the Maternal Health Crisis, which puts an increased focus on addressing quality and access challenges for maternal care. The report recommends several initiatives—including an expansion of programming, an increase in price transparency, and the “Birthing-Friendly” designation—that will shape the future of women’s healthcare services by holding facilities accountable.

Implication: Strategies to support operational efficiencies (particularly around outcomes) will be imperative to remaining competitive. Providers and facilities should consider targeted investments, establish transparent communication/marketing positioning, and optimize outpatient operations to remain financially sustainable.

5. Changing Regulatory and Legislative Landscape

Providers face a fluid regulatory and legislative landscape, which will continue to impact access to services as well as the cost of doing business.

• Reproductive Health: Access and regulations have changed on a state-by-state basis, potentially shifting the provision of services and resulting risk. Structuring meaningful care pathways will help organizations to maintain quality and outcomes while mitigating risks.
• Malpractice Costs: Costs for malpractice insurance are already among women’s health providers’ greatest expenses, and obstetricians are the most likely of all physicians to be sued for malpractice. While malpractice caps help balance providers’ risk, several states are proposing increases to those caps—which would heighten financial risk for providers. This may prove to be a driver of change among provider groups, adding pressure to consolidate practices, discontinue services, or retire earlier in an effort to reduce risk exposure and expenses.
• Chaperone Laws: State requirements for chaperoning physical exams vary, but women’s health providers are the most impacted. These laws continue to evolve—as is evident from recent legislation in Oregon and Wisconsin—and have the potential to impact business operations via staffing and workflow adjustments.

Implication: For many providers and facilities, women’s health is a core service—a foundational offering that must be provided regardless of the constraints. The key will be the ability to shift through changes and create operations that will enable healthcare providers to remain sustainable—and potentially grow—in an uncertain environment.