How to redesign women's healthcare for value

It's been 20 years since the concept of value-based care was brought into the mainstream by Michael Porter and Elizabeth Teisberg, who argued that healthcare should compete on results – health outcomes per dollar spent – rather than volume of services.

Yet progress on many of the most critical outcomes has stalled. The World Health Organization reports the world is off track on every health-related United Nations’ Sustainable Development Goal, with maternal mortality nearly three times the 2030 target. The US alone spent $5.7 trillion on healthcare in 2025 — equivalent to 18.4% of GDP and marking a third straight year of growth above 7%.

Few categories highlight the gap between spending and outcomes more clearly than in women's health, which spans the journey from preconception through postpartum (for mother and newborn) into midlife and healthy ageing. According to March of Dimes' 2025 report card, hypertension among pregnant patients in the US rose 6%, diabetes rose 8%, and the preterm birth rate remained stuck at 10.4% – a D+ grade for the fourth consecutive year.

What's preventing progress? Today's healthcare system is still designed to react once people become sick, and it still rewards visit volume over outcomes. None of this is accidental. It's the accumulation of choices — about what we invest, what we measure, and what we leave to chance.

These choices, and their consequences, start with access. Offering benefit coverage is not the same as ensuring timely, appropriate care before problems escalate.

In England, where coverage is universal, more than 550,000 women are waiting for gynaecological care, with waits falling hardest on the most deprived communities. In the US, one in three counties is a maternity care desert, leaving 5.8 million women without full access to maternity care.

Women are also building families later: across Organisation for Economic Cooperation and Development (OECD) countries, mothers are now 31.1 on average at childbirth, up two to five years since 1970. That shift makes timely access to fertility care and broader women’s health support more critical, not less.

The global consequences of inadequate women’s health access are well documented. The World Economic Forum and McKinsey Health Institute estimate women spend 25% more of their lives in poor health than men despite living longer — a gap that, closed, could add at least $1 trillion a year to the global economy by 2040.

Access is the essential starting point. But turning access into better outcomes — and lasting value — takes three further design shifts.

Prevention does not begin with diagnosis; it begins with education, risk identification and guidance that helps people act before conditions worsen. A 2026 World Economic Forum/McKinsey report shows that earlier preventive pathways can help women claim 2.5 days of healthy life annually, avert 70,000 adverse medical events in the US alone, and generate an estimated 3-6x return on investment.

In fertility care alone, underlying conditions are often missed. Consider the case of a patient who came in to discuss egg freezing, only to learn for the first time that she had polyendocrine metabolic ovarian syndrome (PMOS; until recently known as PCOS) — an often undiagnosed condition affecting up to 13% of reproductive-aged women worldwide.

Left unmanaged, PMOS carries elevated risk of type 2 diabetes, high blood pressure, heart disease and endometrial cancer, and is linked to an estimated $8 billion in US healthcare costs each year. None of it inevitable.

That conversation became an opportunity to catch health risks early, offer appropriate guidance, and change the course of that woman's present and future health. One conversation at the right time can change a long-term trajectory of care.

As this case shows, women's health is not episodic; it's a journey spanning life stages, and prevention requires a system designed to make those conversations routine rather than fortunate. At Progyny, that takes the form of evidence-based education and care advocates who offer guidance across life stages, so women have personalized support at every step.

Through the Women's Health Investment Consortium, Progyny and other stakeholders are working to further shift investment upstream — tackling the evidence, financing and commercialization barriers that keep earlier detection and prevention from reaching women at scale.

Most healthcare still rewards activity instead of impact – optimizing for upfront cost and utilization rather than healthier people and lower total cost of care. But this is a clear design choice, and payment and benefit models can and should instead be designed around the outcomes patients are trying to achieve.

Fertility care is a useful test case: demand is climbing, care is costly for patients and employers alike, and benefit design has long optimized for spend per cycle rather than the likelihood of a healthy baby. Measured against that goal, the most valuable metric is one no utilization report captures: with upstream education and guidance, nearly half of Progyny members reach their family-building goals without fertility treatment at all.

For those who do proceed, clinical outcomes drive value: a 23% higher live birth rate, 41% fewer retrievals per live birth, and a 61% lower multiples rate — together driving 30% in employer cost savings. These results are in large part driven by a close partnership and alignment with clinics, and by payment models that incentivize personalized care and reward the most important outcomes.

The pattern holds beyond fertility. A Cochrane review of continuous labour support, drawing on trials in 17 countries and more than 15,000 women, found those with a dedicated birth companion, especially a doula, were 25% less likely to deliver by caesarean. Personalized, evidence-based support produces better outcomes and lower downstream costs. The right care delivered early isn't an expense to be minimized; it's an investment with all the right returns.

Health is shaped by more than clinical encounters – by where people live and work, and whether they can navigate a complex healthcare system. In a recent survey, nearly 3 out of 4 patients said navigating healthcare adds stress to their daily lives.

A woman managing a difficult diagnosis should not also be responsible for assembling her own care team. Yet most systems answer complexity by handing people a directory — find a doctor, check the coverage, call around… good luck. That's not access; it's exhausting, unpaid work.

The alternative is a design choice: do the selection work upstream, vetting specialists on quality and experience so a woman enters a curated network that’s there for her from preconception through postpartum and beyond.

The stakes of a fragmented system can be stark. The Massachusetts trial of Lindsay Clancy has focused attention on postpartum psychosis – a rare, severe and treatable psychiatric emergency – and on the challenge of recognizing rapidly changing symptoms across care settings.

The facts, diagnoses and legal responsibility remain contested; the case should not be treated as proof that any provider or system caused a preventable outcome. It does, however, reinforce a broader design principle: capable professionals need shared information, clear accountability and escalation pathways.

A preterm birth rate stuck at 10.4% and maternity care deserts across one in three counties in a country spending 18% of GDP on health is not evidence of stability, or an anomaly.

As with lagging health-related Sustainable Development Goals and England’s wait list for gynaecological care, it's evidence of systems consistently failing women, families and society at large.

Employers are central to any fix: employer-sponsored insurance is the largest source of health coverage for Americans under 65, covering 165.6 million people. And while 81% of human resources leaders say they're committed to advancing women's health, only 52% of working women believe their benefits make healthcare affordable.

What's missing isn't commitment or investment — it's a system built around value. The $1 trillion a year that closing the women's health gap could unlock isn't a projection to admire from a distance; it's a return available to all of us, if we choose to design for it.