Reimbursement Roadblocks

Jodi Neuhauser:
I'm really bullish on maternal health right now. I think there's lots of opportunity for us over the course of the next year or two years, four years, because I think you can tell the cost-cutting story. I think you can tell the efficiency story. I think you can tell the ROI story. You can demonstrate the outcomes, which are going to be really important for I think healthcare moving forward in the United States, and then you're also increasing the access as well into these deserts.

Jennifer Sargent:
Welcome to Maternity Reimagined, a podcast exploring the future of maternal healthcare through the lens of innovation and human connection. I'm Jennifer Sargent. In each episode, I'll be speaking with healthcare leaders, providers, and change makers who are working to transform how we support expecting parents and families. From hybrid care models and emerging technologies to policy shifts and real world solutions, we'll uncover insights that are shaping a more connected, accessible future for maternal care. Whether you're a healthcare leader, provider, or just passionate about advancing maternal health, this podcast is for you. Join me as we reimagine what maternal healthcare can and should be.
Welcome back to another episode of Maternity Reimagined. I'm your host, Jennifer Sargent, and today's episode we'll be chatting with Jodi Neuhauser, CEO and founder of In Women's Health, the largest education platform and community for women's health careers with a mission to connect, upskill, and develop talent across the women's health ecosystem. Additionally, Jodi was the co-founder of the bipartisan group Women's Health PAC.
Jodi, it's so great to have you. I'm excited for our conversation today.

Jodi Neuhauser:
Thank you, Jennifer, so much for having me. I'm really excited to have this really important conversation about both the work you're doing and some of the systemic changes we need to make on the reimbursement side.

Jennifer Sargent:
Yeah and speaking of reimbursement, we recently met for the first time at the Women's Health Reimbursement Summit, and it was a first-of-its-kind event, which you hosted at Cure in New York City and really fascinating and great conversation. There were people from across the spectrum of women's health industry there representing a variety of sectors and life stages in women's health, really all talking about the challenges that we face in regards to reimbursement. I personally learned so much and thought the conversation was really valuable and it's a nuanced topic and a lot to unpack there. But I thought maybe before we dig into that, you could tell us a little bit about your work with Women's Health PAC and your company, In Women's Health.

Jodi Neuhauser:
Yeah, totally. So happy to share. I'm a three-time founder in the women's health space. My first company was helping women freeze their eggs in Cape Town, South Africa because it's a third of the cost to do it there. And I jokingly tell people that it's going to be a Netflix Christmas movie one day because I actually ended up meeting my husband on Bumble on that trip while I was freezing my eggs. So a little bit of a funny story. Then from there, I had an opportunity to co-found a company with Dr. Norbert Gleicher called Ovaterra. What we did there was really commercialize a portfolio of IP mostly in the fertility space. So my background in women's health has been mostly on the fertility side and mostly in the direct-to-consumer space. And so I didn't really have to eat, sleep and breathe reimbursement until really the last couple of years with my work with the Women's Health PAC.
And after I left Ovaterra, I was supposed to be taking the summer off, but ended up going to a women's health conference and got together with founders and friends just like yourself, Jennifer, and a bunch of people said, "Well, who's looking for jobs? I need an engineer. I need a chief of staff. Who's out there?" And I ended up going back to my hotel room, I guess like a good founder does, and just wrote a list of every job that people have asked me about. Then you probably get LinkedIn requests all the time for people who want to get into the space. There hasn't really been a platform for us as founders to send people to to help them navigate this transition into women's health or to accelerate their career in the women's health space.
And so I put together this Substack newsletter. I sent it to a bunch of people who had reached out to me on LinkedIn DMs, and then that night I just happened to put it up on LinkedIn as a post. And I woke up in the morning and we had 600 people signed up for my Substack who were interested in working in the women's health space. And I was like, "Wow, there's really an opportunity here." So that has now become the In Women's Health jobs newsletter. It's the largest careers newsletter in the women's health space. It goes out to about 8,500 people once a week with usually more than 100 or 150 women's health jobs that are less than seven days old, which is really important in this environment right now.
And that just merged into people really wanting to get together, talk to others who were interviewing, get interviewing tips from others, connect with others who were trying to navigate the space. And so that merged into a Slack community, which is then now merged into a whole education platform. So really we're kind of building the LinkedIn meets master class meets Netflix of women's health from an upscaling and education and a community building and connections platform. It's really designed for all of us as founders to have a place for our teams to be able to go and learn things that everybody needs to know in the ecosystem so that we can all go faster rather than every individual founder having to teach their teams about reimbursement, for example, is a great example of that.
So that's my one hat that I wear and I absolutely love that work. And then I also had an opportunity after I left Ovaterra to go work on a presidential super PAC and really get my hands dirty in what politics looks like from the inside and realized, well, why doesn't something like this exist for women's health? And we as women's health experts, and we really are losing the influence game in Washington. So not only are 70% of our congressmen men and so they don't necessarily have our needs as women top of mind. We also aren't spending enough, frankly, in and around Capitol Hill in order to be top of mind in the conversation.
We did a quick analysis and realized that while pharmaceutical companies and other healthcare companies were spending hundreds and hundreds of millions of dollars in lobbying and in other efforts on the Hill, altogether, the women's health ecosystem spent 1.97 million in, I think it was 2023. And so it was a really sad number for us to find. So I got together with two leading executives in the space, Liz Powell, a very well known lobbyist on the Hill, and my co-founder Candace McDonald, and we started the bipartisan Women's Health PAC last summer. And really we had some great success. We really opened Pandora's box and couldn't put everything back there. After we did, we had eight events around the country, we raised over $250,000 in less than six months, and we ended up supporting 16 candidates in the 2024 election cycle, about 60% Democrats and about 40% Republicans, and really had some good success there. Of the 16, 11 were elected and one is now serving as the Secretary of Labor.
So really good opportunity for us to have some strong influence and relationships on the Hill. But moving back to the reimbursement conversation, every time I traveled around the country to these events last summer, especially people from industry and founders, Jennifer, like yourself, were saying to me, "What are you going to do to fix reimbursement? How do we get reimbursement fixed?" Because we talk a lot in our ecosystem about how much research we need, and I don't want to downplay that at all. We absolutely need a significant amount of women's health research, but we can have all the research in the world and if we can't commercialize it, it's not going to help us at the end of the day. We're not going to get investor dollars into our space and we're going to continue to have this pushing a rock up a hill mentality sometimes that it feels like building a women's health company.
And so I looked around and said, "Okay, well, who's working on this?" And there was a group, Dr. Jocelyn Fitzgerald, Dr. Louise King out of Boston and Pittsburgh respectively. They were doing some really great research in the discrepancies around reimbursement, like the actual reimbursement numbers. But we as an ecosystem haven't really been having this conversation at all. And it's really important to me now that we start talking about reimbursement, we start talking about the systemic challenges in reimbursement. And that was really why we all got together in New York a couple of short weeks ago to pull together all the stakeholders at the table to really figure out what is our policy roadmap that we can work in a bipartisan way on in order to change things both in the executive branch and in Congress to really help smooth out this reimbursement process for us. So that's where we are now.

Jennifer Sargent:
That's great. And maybe you can speak a little bit broadly. I know we're focused on maternal health today, but as you think about that summit, what were some of the most surprising things that you heard coming out of that summit?

Jodi Neuhauser:
First of all, I think what's surprising to me is just the lack of knowledge of understanding about how reimbursement works in this space. I was having dinner with a C-level executive of a $500 million company last week who's been in this space for a long time, and literally going through a one-on-one on what, who is the REC committee? How are reimbursement rates determined? What is a conversion rate? What is an RVU? And sort of how does it all come together? And so I think the first thing we need to do as an ecosystem is just get really smart in the basics of how it works, who are the key players, and making sure we understand how we can navigate through that. So I think that's been the most surprising thing to me.
I think the other part was just the... It wasn't necessarily surprising, but it was heartwarming in seeing a whole group of fertility executives and maternal health executives and primary care executives from all different walks of life in the ecosystem come together. And a lot of fierce competitors in that room and the fierce competitors were sitting around the table having the same conversation with each other, realizing that we've got to fix this for everybody because that's the only way everybody is going to win here. And so the competition really went out the door, I think, at the Reimbursement Summit, and it was all about collaborative work, which was great to see.

Jennifer Sargent:
Yeah, I would agree. I really enjoyed that part of it. And I think as we think about reimbursement rates in our world, Pacify is intentionally focused on a doula-led solution. So we're primarily focused on doula and lactation, and we're intentionally focused on that in a way that we want to make sure we're working better within the care team structure. So not adding fragmentation. But as we think about reimbursement rates, I think in particular for doula, because that's a newer reimbursable event, we also then have to think about what the broader maternal health reimbursement structure is because to a certain degree, it's a little bit fighting for dollars. So if we look at doula reimbursement and us needing it to be at a certain level to make sure we can get doulas the right living wage and income that they need, we then have to also look at, well, what are midwives and advanced practitioners getting reimbursed, OB-GYN, right?
And so if they're not getting reimbursed high enough at any of those levels and the trickle-down effect for pacify as a part of that sort of infrastructure or care team just gets amplified. So I think although we aren't reimbursing for full labor and delivery, those reimbursement rates do impact how we think about reimbursement rates. I also think the challenges that we face too with doula work being slightly different is, and particularly this is happening at the state levels for Medicaid, they're taking the same system structure and applying it to doula. So things like visits in 15 minute increments. That just overly complicate the care and the billing that I think we're trying to educate people on how doula work can be different than some of the other visit types. Those are some of the things that I think we're thinking about on the Pacify side, but do you have any other specific insights that you learned or that you're working on in maternal health as a part of this reimbursement work?

Jodi Neuhauser:
Well, I think what I'd love to just have you do also for those listeners, Jennifer, who don't necessarily know how reimbursement works in the maternal healthcare space is maybe just explain how it works in the sense that how are doulas reimbursed now? The fact that it is state by state, the fact that hey, isn't there just one code for all doulas that you can just, hey, here's a doula for the whole pregnancy. I think there's a lot of misconceptions about the reimbursement structure. So maybe just give people kind of a one-on-one quickly on what you had to learn about reimbursement when you started Pacify.

Jennifer Sargent:
Sure. So you're right, I think because right now we have doulas being reimbursed, mostly we're seeing in Medicaid, we're now starting to see commercial insurers kind of jump on the wagon, if you will. And I think each state has set up its own different reimbursement structure, which makes it challenging obviously, to operate in multiple states. So it could be the number of visits that are eligible. Some have a, you get two prenatals, two postpartum, some have four and four. And so you don't have a consistency around what even the model of care looks like, which I think is probably more standardized in typical OB care from a birth perspective.
There's different structures, like I mentioned, in visit length. Some are 15 minute increments, some might be a prenatal visit, one can be two hours at a flat fee, but then the rest of them are 15-minute increments. So that just again, makes it sort of challenging for think about the doula out there that is independent and wants to serve Medicaid population or work within the system. This way overcomplicates their life and they're just not set up administratively to be able to work within that system, which is certainly something that Pacify can provide.
And then we're just thinking about the overall reimbursement rates and think about the care and work that a doula does, particularly in labor and birth. They are there oftentimes 12, 15 hours, even more depending upon the service provided, and in some states are getting reimbursed as little as $500 for that. And so what we're starting to see, however, is that those states that were early in reimbursing for doula services are now trying to right size some of that. So it's like moving in the right direction. But I think back to my earlier comment, until I think we can look more holistically around how is a pregnancy episode reimbursed broadly across the continuum to make sure everybody is getting reimbursed at the right rates, we won't be able to fix the individual components of that, if it makes sense.

Jodi Neuhauser:
Now, I think you asked me what was most surprising, and I just had a conversation with another maternal health executive last week or week before last, and she was telling me that they're actually pulling out of a state that they have been in because the reimbursement rates are so low. She just can't, literally from an economic perspective, make it work. And I think I didn't realize even having done this work now for a little bit more than a year, the discrepancy in reimbursements across, she was telling me that there are some states that reimburse $1,500 and there are some states that reimburse $350, and you're like, I can't even imagine how hard it was for you to build a pro forma for a business, trying to manage all of these variables and what ifs, and then going to have a conversation with investors about how you're actually going to put this whole puzzle piece together to make money. So congratulations on figuring that out. I think that's a huge win.

Jennifer Sargent:
Maybe one other area to think about from a reimbursement outside of just the dollars is modality as well. I think we've had good learnings, and as we look to enter new states, one of the first things we look at is our virtual visits for prenatal and postpartum allowable and reimbursable at that state level. And for us, the ability to be tech enabled, particularly in the prenatal and postpartum visits just allows us to scale more efficiently, see more members, all of the good learnings we had on how virtual care can be delivered.
Do you have some insights, I think more broadly on how virtual is being considered from reimbursement? I know that's kind of shifting in general in women's health.

Jodi Neuhauser:
Yeah, I mean, I think there's a lot of puzzle pieces at play here with rural care deserts specifically from an OB perspective. I think the shift with under this administration to prevention, I think we are going to see, I'm excited and actually very bullish on maternal health in this administration because not only because of the importance of just maternal health in general and our woefully bad maternal health statistics in the United States, but also the pathway through maternal health to childhood health.
We've seen this administration come out with a focus on childhood chronic disease. And I think I was really excited to see in that MAHA report that there is a lot of focus on, hey, the mom needs to be healthy and the mom needs to be taken care of, and we need to make sure that we're keeping mom in a positive place versus not.
So I think you got to play those two things off of the fact that now on the other side you see sort of Medicaid, lots of conversations about the cuts that are coming to Medicaid. And I think here is really where we really have an opportunity to kind of reframe both threat. I think we can talk about how Medicaid is under pressure, and it is. But I think for me, that just means we have to double down on what's working. We know the doulas and lactation consultants and just overall wraparound care improves outcomes and lowers costs.
Somebody put this to me the other day, they were like, "Yeah, cutting that out would be like slashing a parachute on a crashing plane." At least if the plane is going to be not going in the right direction, we need to have the parachute of doula, lactation consultants and sort all wrap around care to help make that happen. But I think for me, it's also about data. Do we have, and this is what one of the things that came out of the Reimbursement Summit is, do we have enough data? And I'm curious of your thoughts on this. Do we have enough data to show the cost savings? Five years ago we probably didn't, but is that changing, do you think?

Jennifer Sargent:
I think it is. We're certainly seeing more data come out as an industry on the impact that doulas can have. We are starting to produce our own data, which is exciting outcomes on that. I think part of the challenge in data related to doulas because they're a non-clinical role, is really a lot of times the challenges in trying to demonstrate ROI is what impact can you claim for the service that you provided? But I think that's where we like to take a holistic, the doula can be a part of a broader care team. That's where you can really start to amplify those outcomes. And we're doing some work with some provider groups like Advantia Health and the DMV where we're starting to look at can we assess some data where we had doulas sort of in partnership with the care team versus not, and looking at some outcomes there.
I think another area of focus for us back to the virtual is figuring out how can we demonstrate outcomes for virtual labor inverse support. I think we get mixed opinions on virtual for labor inverse support, but I think for us, again, back to the maternity health deserts, it's better than not having any support at all. And so we're really thinking about how we can demonstrate some outcomes there.

Jodi Neuhauser:
Well, I think this goes to your point on where does virtual, where do we think it's going to play in the future? I think this is where it's an opportunity for us to stop thinking about maternal health and talking about maternal health as a cost center. I think the data is clear and getting clearer and clearer that funding the whole team, to your point, the doulas and everybody else is, it's not a nice to have, it's not charity. There's a true sort of ROI related to that. And I think being able to then deliver that into a place where care is just not being delivered right now, one, helps from an access perspective, but it also helps, I think from a, you can still tell the cost-cutting story there and how it improves costs.
So I'm really bullish on maternal health right now. I think there's lots of opportunity for us over the course of the next year or two years, four years, however long, whatever happens with the political wins in the world. I do think there's some key opportunities here around maternal health because I think you can tell the cost-cutting story. I think you can tell the efficiency story. I think you can tell the ROI story, you can demonstrate the outcomes, which are going to be really important for I think healthcare moving forward in the United States. And then you're also increasing the access as well into these deserts.

Jennifer Sargent:
Shifting gears a bit from reimbursement and talking a little bit about innovation. I think because of your great work in women's health and just the trainings and networking that you do, I suspect that you have a really good ear to the ground on what's happening in women's health in general. I'd love for you to share some of the exciting innovation that you're seeing, I think across women's health, but then also if you're seeing specific trends in innovation in maternal health as well.

Jodi Neuhauser:
Yeah, I think maternal health, I think personalization is going to be really interesting and what can we do in terms of the data. The Oura Rings, the Apple Healths, the data that we're getting on a day-to-day basis, and how is that integrating into the entire care journey, I think is while you're pregnant is really interesting. I Oura is doing some interesting work around and research with pregnancy and monitoring women and their vital signs sort of all the way through pregnancy. I think also the full stack maternity to care models, which we've seen a lot. I think we're going to continue to see these sort of unified platforms come together, maybe even some consolidation in our space, I think is potential. Because I think right now we've got some great platforms doing things, like you're doing a Pacify. Imagine adding that into a mental health platform or I think there's a few more things you could probably add on to there to really create a full unified platform.
I think continue to looking at Medicaid first models and what is the innovation around that Medicaid population. We can't ignore the fact that 40% of the births in America come from Medicaid and much higher in some states. And so sure, we can put a lot of resources and efforts into those who aren't part of the non-Medicaid populations, but it's a significant portion of the women who give birth in our country.
And I think the kind of virtual monitoring of pregnancy all the way through the care continuum. Companies like eLovu, bringing in actual devices and hardware, but then also helping people find the right partners at the right part of their journey based on where they are. So I think all of those things are going to be really, really interesting to continue to watch.
And then there are some new payment models. I think you're seeing the Healthy Moms Healthy Babies Act down in Arkansas, I think is a really interesting policy change coming out of a Republican-led administration, looking at how do we change and unbundle our care? How do we reimburse Medicaid populations at a higher rate for pregnancy care? So I think you're going to see some states start to play with some of these different payment models, obviously depending on what happens with the budget and any of those budget cuts, but it does all go back to reimbursement. Without that reimbursement pathway, all of these innovation models stall, and so that's why we need both product innovation and policy alignment at the same time.

Jennifer Sargent:
Yeah, couldn't agree more. I love the work that you're doing with connecting talent and training folks and getting them connected into women's health. I'd love for you to share a little bit more about what you're seeing related to job roles and categories, what types of companies, maybe just general themes there. And also we got connected to a great new team member through you and through the Reimbursement Summit so it's working. She's amazing.

Jodi Neuhauser:
Love it. Yeah, Ariel's fantastic and it was a great student of our Mini MBA and all the other platforms and content that we're doing there.
So I think a couple of trends right now, and I don't have any hard data for this, this is just anecdotal data, but I believe right now it's harder to get a job in women's health than it is in finance. It really comes down to just the numbers and the percentages, the numbers of people who want to get into roles in women's health versus the number of roles that exist. We need more funding to come into women's health so that Jennifer, you can hire more and we can get more Series A companies to Series B so they can hire more and vice versa.
But even that, right now, the average women's health role, I was talking to a founder again when I was in New York last week, and she had 3,000 applications for a social media manager job in 24 hours. I'd be curious to see kind of, are you seeing something similar on the roles you're posting?

Jennifer Sargent:
We are. I mean, it's partially role dependent, and I think we have an interesting sort of dynamic where as we look at what I would call more corporate roles, I think we see way more demand than we have roles to fill. We're also really focused on workforce development with our doula networks as well. And those are kind of two, I think very different situations that we're working on. But I do think as we look at more of the corporate roles, we do see a high level of demand for roles when we post.

Jodi Neuhauser:
We see a lot of demands. I mean, just in the last six months, we've seen a lot of demand. People coming from places like USAID and other governmental roles or public sector roles looking to now make the transition into the private sector. We see a lot of women who go through their own health journey, whether it's going into perimenopause, menopause, fertility, they have trouble getting pregnant, they have an experience with the doctor usually that they've been dismissed or just not taken seriously or some other experience that they want to bring their expertise, whether that's in product or finance or operations to this industry and work on something that they're really passionate about. And so I think we have a huge influx of talent.
I mean, we have a community of 3000 people who are all interested in looking at roles in the women's health space. And so that tells you I think a lot right there, just the number of people who want to get into our ecosystem. And that's where really we've realized that education is really important for everybody. Because as I was going through that last year with In Women's Health, building it out, I was doing a lot of practice interviews with people, having a lot of conversations and realizing that, oh man, there's a lot of these candidates, even if they've worked in healthcare, they don't understand the nuances of women's health, whether it's the nuances of financing or funding or marketing or data privacy or reimbursement or care delivery, and the fact that pregnancy is a bundled payment. Just sort of these very, very key nuances. And so that's really where the Mini MBA, the Women's Health Mini MBA was born.
It's a six-week program where we literally take people through all the nuances of payers, providers, finance, marketing, data, product, you name it, policy to really kind of, yes, understand the bigger healthcare picture, but really dive in on what are those nuances that you need to know in the women's health ecosystem. So getting people educated I think has been another really important thing for us from a talent development perspective as an ecosystem.

Jennifer Sargent:
Yeah, I think the education piece is so critical and can help set candidates apart. What other advice would you have for candidates that are looking to get into women's health to sort of set them apart?

Jodi Neuhauser:
Yeah, I think we talk a lot about how passion isn't enough anymore. I think maybe 10 years ago you could call up somebody and say, "Oh, I'm passionate about women's health. I want to get a job." Yes, maybe mention your passion in passing in your cover letter, but certainly don't lead with it. At the end of the day, remember that every women's health company has to provide a return to their shareholder at the end of the day. And so going in and leading with what is your unique value proposition, what do you uniquely bring to the table that no one else does. More importantly, how does that then either drive the top line or impact the bottom line. And so if you're coming in as an operations lead, being able to talk about how you'll make the business more efficient, run more efficiently, reduce costs, or if you're a growth marketer or driving the top line, what are you going to bring to the table to do that?
I think if you can do that and then have it be underpinned by a passion and an experience, that's great, but you've got to lead with that. I think the other piece of advice I would say is a lot of people, especially looking to make a switch into women's health from another career, they will come into women's health and they'll be like, "I just want to do strategy. I want to do strategy. I want to work on strategy." And the reality is is that no women's health company just is going to hire someone to do strategy. Maybe a maven, maybe a kind body down the road, but most women's health companies, you are still very much doing about 5 to 10% strategy and 90% execution. So if you're not going in and talking about your ability to execute and your desire to execute and your drive to execute, then you're not going to stand out as a candidate.

Jennifer Sargent:
I think that's great advice, and I would agree with all of that for folks that are looking to join the Pacify team as well.

Jodi Neuhauser:
Yeah, that's what I was going to ask you. What would you say? Kind of Your piece of advice on teams?

Jennifer Sargent:
Very similar. I mean, we're obviously a very mission-driven organization, and so having passion around the space or personal experience is helpful. But I think to your point, we do need to execute. We do need to grow. We need to see the return on the investment that we've had. And so being able to couple that with the passion, I think is extremely important. And I think probably many organizations in our stage, we're a roll up your sleeves, to your point, you have to be willing to execute and sort of get in and do the work. So it's a little bit of a unique person that can be the right fit for this size of an organization in the space for sure.

Jodi Neuhauser:
Yeah, no, I couldn't agree more. I think the other thing I say to people too is if you have a women's health journey, if you have an experience, don't be afraid to talk about that, but talk about it in the context of business results. And so I tell people, if you've, for example, gone through a fertility journey and you've been to six clinics and dealt with seven insurance companies and given yourself 70 injections, talk about that. But use those numbers and talk about how many cases you've had to manage and doctors you've had to talk to and conversations you've had to have. Don't just say, "I went on a fertility journey and that's why I want to work at this company." It's, "Hey, here's my quantified metrics of my fertility journey." Because that shows that you're a business thinker for sure.

Jennifer Sargent:
That's great. Well, Jodi, I so appreciate everything that you're doing just in this space around advocacy and workforce development and have so enjoyed the conversation today and appreciate you joining us.

Jodi Neuhauser:
Thank you, Jennifer. Thank you for the opportunity and really looking forward to changing the game in maternal health with you by our side.

Jennifer Sargent:
Agreed.
Thank you for listening to Maternity Reimagined. I'm your host, Jennifer Sargent. If today's conversation resonated with you, please subscribe and listen wherever you get your podcasts. And be sure to share this episode with those who, like us, are passionate about reshaping the future of maternal health. Until next time, as we continue to build bridges and transform maternal care together.