Across the healthcare system, improving outcomes while managing the total cost of care remains a critical challenge—especially in maternal health. Maternal mortality rates, comorbid conditions, and persistent disparities have placed increased focus on the quality, accessibility, and effectiveness of maternity care. As organizations work to deliver safer pregnancies and healthier births, understanding the drivers of maternal health outcomes and identifying opportunities for earlier intervention and better care coordination are essential to improving both clinical results and long-term costs.
In this blog, we connect with Marcos Dachary, Chief Market Strategist and General Manager of Payer at Milliman MedInsight, and Sarah Quinn, Director of Marketing at Milliman MedInsight, to explore how advanced analytics can help drive positive changes in healthcare.
Q. What is the state of maternity care in the U.S. right now?
Marcos: Managing healthcare costs is a complex challenge, with maternity care standing out as one of the most critical areas. According to the Milliman white paper titled “Managing maternity costs and outcomes,” U.S. maternity care expenses have risen beyond those of other countries, yet birth outcomes have not seen the same improvement. This rise is particularly concerning given that 60% of maternal deaths in the U.S. are considered preventable, pointing to significant discrepancies between healthcare costs and outcomes. Moreover, disparities in maternity and childbirth outcomes, including infant mortality, persist across different races, socioeconomic statuses, and locations.
Sarah: As part of tracking industry trends, we came across a report titled “Improving postpartum maternal health outcomes.” The study analyzed maternal health outcomes with a focus on severe maternal morbidity for over 700,000 births covered by commercial insurance plans between 2019 and 2022 using data from Blue Cross Blue Shield (BCBS), as well as more than 1.5 million births covered by Medicaid using data from the Centers for Medicare & Medicaid Services (CMS), and was completed by the National Opinion Research Center (NORC) at the University of Chicago. The data show substantial racial and ethnic disparities in postpartum outcomes for both commercially insured and Medicaid-insured patients. Source: Maternal Mortality – Our World in Data
Q. What role does data and analytics play in improving these outcomes?
Marcos: Data analytics plays a critical role in addressing maternal health challenges. By analyzing claims data and outcomes, health plans and providers can work together in identifying potential high-risk pregnancies and take more targeted action. The first and most important step is establishing a clear baseline. Each organization needs to understand its own data and disparities, rather than relying solely on national trends.
Analytics also helps pinpoint key moments in the maternity care journey where improvements can be made. For example, frequent emergency department visits during pregnancy may signal gaps in care or missed opportunities for support. By examining these patterns alongside chronic conditions like hypertension, gestational diabetes, or anemia, plans can better understand what’s driving risk.
This insight enables earlier intervention, such as closer monitoring of blood pressure or glucose levels, which can help prevent serious complications. Ultimately, using data this way supports better outcomes for mothers and babies while also reducing avoidable costs.
Establishing the right benchmark is also essential. To make meaningful progress in maternal care, organizations need access to best-in-class national benchmarks that enable clinically relevant comparisons tailored to their own populations. For example, identifying regions with higher rates of C-sections, labor inductions, or other high-cost procedures can highlight opportunities for improvement and point to underlying drivers such as provider practice patterns, maternal obesity, or prior cesarean deliveries.
These comparisons create a strong baseline for ongoing monitoring and performance tracking. They also reinforce the need to take a longer-term view of maternal care. It’s not just about managing costs during pregnancy. The quality of care and support provided during this period can influence future pregnancies and shape how individuals engage with their health plan over time.
Q. What else can health plans do to manage maternity costs and outcomes for their members and how does Milliman MedInsight help?
Marcos: It starts with data. Milliman MedInsight empowers health plans with information that is readily accessible and actionable. Instead of spending valuable time parsing raw data or developing custom logic to identify emergency department visits of high-risk pregnancies, health plans can leverage MedInsight’s pre-grouped cohorts. Those cohorts can allow health plans to quickly pinpoint high-risk pregnancies (with and without a chronic condition) while providing crucial insights such as age, service encounters, and non-delivery admissions.
All the data points needed for comprehensive maternity analysis are readily available; thanks to advanced groupers we apply to data during enrichment. Organizations do not need to do these analyses themselves. MedInsight does the heavy lifting through its Health Cloud and Payer Platform.
Additionally, MedInsight offers options to suit various roles within an organization. Data scientists can dive deep in to SQL and advanced analytics via the Innovation Portal, while other team members or information consumers can easily view and interpret key metrics through intuitive dashboards. This ensures everyone, from analysts to decision makers, can harness data-driven insights to optimize maternity care and outcomes.
Q. How can the MedInsight Payer Platform be used to reduce the total cost of maternity care while improving outcomes?
Sarah: The MedInsight Payer Platform offers health plans a powerful foundation to identify key drivers of maternal health costs and outcomes. By combining healthcare claims, clinical data, and (when available) social determinants of health (SDOH), the platform identifies patterns and risk factors driving high-cost maternal cases, including preventable complications and gaps in prenatal or postnatal care.
With these insights, payers can design targeted interventions, like enhanced care management for high-risk pregnancies, provider education, or community resource referrals, that directly address the root causes of excessive spending. The platform also supports ongoing monitoring and evaluation, so payers can measure the effectiveness of their programs and adjust strategies in real time. MedInsight helps organizations deliver the right care at the right time, supporting healthier pregnancies, better outcomes for mothers and babies, and reduced unnecessary costs.
What are next steps for getting started with Milliman MedInsight?
- To learn more about our healthcare analytics solutions, schedule a call with one of our experts.
- Schedule a call: Connect with one of our healthcare analytics experts.
- Read the brochure: Find out how the Payer Platform can help your organizations make the most of its data and increase plan performance.
- Watch the webinar: Register now for our webinar “From data to strategy: Scaling payer analytics for growth” and learn how to create collaborative ecosystems across the enterprise.
