More women's health benefits, same stubborn maternal outcomes
Employers have spent years expanding access to women's health benefits, fertility programs, navigation services and coaching models. Yet maternal outcomes have remained stubbornly stagnant — in many cases, continue moving in the wrong direction.
One in 10 American families begins their parenting journey not with a trip home, but with a stay in the Neonatal Intensive Care Unit (NICU),
The encouraging news is many of these outcomes are not inevitable. Evidence increasingly suggests they can be prevented through earlier intervention, continuous monitoring and more clinically integrated care.
Maternal and infant care must move beyond just navigation
Navigation and coaching models emerged to help guide patients through an increasingly fragmented healthcare system — providing education, advocacy and benefits navigation. But guidance alone has limits when clinical risk can change by the hour.
A patient experiencing rising blood pressure at 9 p.m. may be able to message a navigation platform and receive general guidance, but they often still face a difficult choice: wait until the next day (or later) for clinical evaluation or head to the emergency room. This tradeoff has real consequences. ER visits for pregnancy-related complications are among the most costly and disruptive points of care, and they frequently reflect gaps in timely clinical access rather than true emergencies.
This is the distinction behind the growing push toward clinical-first care models. Unlike navigation or coaching platforms, a clinical-first model operates as a medical practice, delivering the care necessary to improve the outcome. This means having clinicians that manage medication (as necessary), build care plans, coordinate urgent care and proactively reassess risk as a pregnancy evolves. The goal is to close the window between when a symptom appears and when a patient receives clinical care.
Conditions such as hypertension, gestational diabetes and preeclampsia often require immediate clinical assessment and ongoing monitoring, particularly because many complications become more treatable when identified early — and more dangerous when they're not. Delayed care doesn't just increase clinical risk; it increases the likelihood a patient ends up in the highest-cost, highest-acuity setting available to them.
How a clinical-first model can improve outcomes
One example of this clinical-first approach is
According to Eva Luo, Head of Obstetrics, Design & Delivery at Pomelo Care, the growing complexity of pregnancy risk is forcing employers to rethink what women's health benefits are designed to manage. As employers expand access to fertility and family-building benefits, more patients are entering pregnancy through Assisted Reproductive Technology (ART), including IVF and IUI. These pregnancies carry elevated risks for complications like preeclampsia and gestational hypertension.
This is where many navigation and coaching models fall short. While they can help patients access care and benefits, they lack the clinical infrastructure required to continuously monitor and actively manage high-risk pregnancies as conditions evolve.
Pomelo Care operates as a virtual medical practice, with patients receiving 24/7 access to clinicians, ongoing remote monitoring and proactive care throughout pregnancy and the critical first year postpartum. According to Luo, the company's clinicians are W2 employees rather than 1099 contractors, a structure designed to allow for more direct oversight of care quality and ongoing clinical feedback across the care team.
But the goal, Luo says, isn't to replace in-person OBs. It's to act as "a colleague in the cloud" — helping bridge the gaps between appointments when questions, symptoms or concerns arise outside the walls of a doctor's office.
The shift toward outcome-focused care
As maternal risk grows more complex, benefits leaders may need to start asking different questions when evaluating women's health vendors. Questions such as: Can this model actively manage pregnancy risk or simply help patients navigate the healthcare system? Can clinicians intervene in real time when complications emerge or only direct patients elsewhere for care?
The model also extends through the first year postpartum, reflecting a broader view of maternal care that recognizes recovery, mental health and infant care don't end at delivery.
There is a fundamental shift into longitudinal care that thinks beyond the bounds of a pregnancy episode, to care for women before and after, and to deliver healthcare that proactively anticipates what is next. It is the healthcare women deserve and what is required to build healthier workforces.
