Women’s health is one of the largest cost categories for employers, health plans, and third-party benefit administrators. When viewed holistically, it rivals cardiometabolic and musculoskeletal conditions and represents a significant share of total healthcare spend.
For a long time, women’s health has been looked at through a narrow lens of maternity, fertility and family planning. And while important, women’s health is not a one-time event. More than 60 percent of women in midlife are managing chronic conditions that require regular monitoring, treatment and care.
However, in today’s fee-for-service healthcare system, women are bounced between specialists based on isolated symptoms, rather than looking at the full clinical picture and then determining the best treatment path. This results in delayed treatment, duplicate testing, unnecessary labs and imaging procedures, as well as a longstanding bias towards surgery/invasive procedures driving up costs.
To better understand how this unfolds, it is helpful to look at two common care experiences for women today.
Menopause: Consider a woman in her fifties experiencing symptoms that indicate the early stages of menopause: irregular periods, hot flashes, anxiety, sleep disturbances, joint pain, and brain fog.
First, she will wait an average of 41 days to see her OB/GYN. She’s then referred across a fragmented network of providers and specialists: primary care for her brain fog, OB-GYN for her menstrual irregularities, sleep medicine specialist for sleep disturbances, endocrinology for hot flashes, psychiatry for anxiety, and orthopedics for joint pain. Each appointment introduces a new test, imaging, additional medication, or medical intervention or procedure, resulting in additional delays in diagnosis and treatment and duplicative testing.
What could have been addressed by a single, coordinated care plan becomes a prolonged and costly diagnostic and treatment journey for both the patient and the health system.
Complex gynecologic care: A similar pattern plays out for a woman in her mid-30s with uterine fibroids experiencing heavy menstrual bleeding. She is fatigued, missing work, and struggling to maintain daily responsibilities. After waiting months to see an OB/GYN, she is prescribed oral contraceptives as a first and only option. When her symptoms worsen, she ends up in the emergency room with severe anemia and requires a blood transfusion.
After many years of trial and error, and chronic pain, the path often escalates directly to procedural and surgical interventions such as endometrial ablation and a hysterectomy. While these procedures are appropriate in certain cases, they are often introduced without fully exploring evidence-based, conservative and proactive methods such as iron supplementation, anti-inflammatory approaches and medication management that could have altered the course of care if implemented earlier and with a focused care plan.
These examples of fragmented, uncoordinated care are the standard rather than the exception, reflecting how the healthcare system manages women’s health today. Conditions and symptoms that are inextricably linked, such as menopause and weight gain, are treated in isolation, driving poor patient experiences and unnecessary costs.
For women who manage a lot inside and outside of their homes, the time and financial burden are substantial. Women have to navigate the fragmented system with very little support, coordinating between providers and often interpreting conflicting guidance. Specialist visits, repeated tests and unnecessary procedures often translate into significant out-of-pocket expenses, and time women don’t have and can’t get back.
Employers and health insurers also pay the cost inefficient and inadequate care models but in a way that’s far less visible. Women’s health costs aren’t grouped and itemized into a single episode of care in claims data. Instead, any billing code that would point to a larger cost trend in women’s health are disparate and buried within claims from separate providers across several years making it difficult to identify true cost drivers or assign responsibility for outcomes. The result is a compounding risk: rising spend without a clear strategy to manage it.
For employers and payers, this represents an immediate opportunity to bend the cost curve and improve care experiences and health outcomes for their members and employees. However, realizing that opportunity requires a fundamental shift in how we view, deliver and pay for care. Below are a few key building blocks that are essential to success:
- Look at women’s health as a unified cost category rather than a series of disconnected and episodic events. For payers and employers, this requires collaboration with health economics, claims/billing and data teams to create a comprehensive view of women’s health spend.
- Create a business case to get leadership buy-in. By creating a unified view of how women’s health costs accumulate over time, we can identify the true drivers and scale of cost, creating a clear mandate for action.
- Shift from reactive and episodic care to comprehensive, longitudinal care models. Many women’s health conditions require integrated, long-term support, but our care delivery model still treats the episodes like isolated events and symptoms, leading to duplicate imaging and testing. Prioritize strategic partners that take an integrated, whole person approach to address causes, not just the symptoms.
- Align incentives around the total cost of care and outcomes. Fee-for-service reimbursement rewards more visits, tests, and procedures, regardless of the outcome. Value-based care models create greater accountability across the care continuum, while delivering better outcomes and patient satisfaction, while lowering the overall total cost of care. Invest in partners that deliver clear, measurable ROI with value-based, longitudinal care models.
In summary, you can’t manage what you can’t see — and today, women’s health costs are largely invisible. Creating a unified view turns a hidden cost center into one of the most actionable opportunities to improve outcomes and bend the cost curve.
Photo: Drazen Zigic, Getty Images
Chevon Rariy, MD, DABOM is Chief Medical Technology Officer at Visana Health, a comprehensive virtual medical group for women, where she leads clinical strategy and innovation to expand virtual-first, evidence-based care across gynecology, hormonal health, and comorbid chronic conditions.
Kara Ellinger is a long-time insurance executive and former VP of commercial product at Anthem. She now serves as a strategic advisor to women’s health organizations, including Visana Health.
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