2025 Trends Report: Steep Challenges & Uneven Progress

These facts are already deeply troubling, but in the context of the current climate around reproductive issues, they represent a matter of even more grave concern. With multiple states now restricting or banning reproductive care, a spate of new maternal health care challenges has arisen, including reduced access to reproductive care; an exodus of maternal health care providers from those states; and unclear legal mandates hamstringing medical professionals. These factors threaten to exacerbate existing systemic shortcomings at a time when the status quo is already immensely challenging.

But there is hope on the horizon, as an increasing volume of healthcare-focused experts strategize to turn this situation around—and as new trends arrive to disrupt this sector and offer fresh opportunities and solutions. These shifts promise to upend the present state of maternal and infant health, setting the nation on a new path forward.

They are also giving women a more empowering birth experience. As an example, in 2023, Saint Peter’s University Hospital in New Brunswick, New Jersey, launched its TeamBirth program to improve communication between laboring mothers and the hospital’s clinical team. As a result, the number of patients who said they felt involved in the birthing decision-making process rose from 57% to 88%.

Research shows, providing a more empowered birthing experience for women pays off dividends down the road—including mothers who are more capable of caring for themselves and their babies and of surmounting other life challenges.

Until recently, very few infants born before 26 weeks were likely to survive. Today, many infants born as early as 22 weeks are not only surviving, but thriving, due to inspiring medical advancements.

These micro preemies still only make up 0.3% of all births, but their care can account for a large swath of a health plan’s expenditures, with the mean cost of a micro preemie’s early care falling anywhere from $61,310 to $263,958. Thus, these extraordinary advances in micro preemie care often mean longer, costlier NICU stays at a time when many health plans are already facing immense financial pressures, in part due to Medicare Advantage and Medicaid redeterminations.

In the year ahead, health plans must continue to rise to this challenge and find strategic ways to manage the complex and costly micro preemie cases in their purview. How? By standardizing care, including using small baby programs that efficiently and effectively provide proactive interventions to stave off future complications, and by instituting care management programs that provide families with the support they need to prevent readmission and set early-birth infants on the best possible path.

At ProgenyHealth, our Utilization Management team makes certain that infants receive the best care by ensuring that evidence-based guidelines are followed and they receive the correct diagnosis, the appropriate level of care, and the right number of days in the NICU. Our Case Managers also support families by connecting them to additional resources and providing education on how to care for their medically complex newborns when they are discharged to avoid costly, disheartening, readmissions through their first year of life.

The reality is that physicians and health plans often struggle to extend maternal support during the “fourth trimester,” or first three months after a child’s birth, particularly since many women may have fewer scheduled touchpoints with their provider or may lack basic access to pre- and postnatal care. Indeed, an estimated 2.2 million women of childbearing age live in maternity care deserts, lacking access to OB-GYN services.

Fortunately, most states have now expanded Medicaid coverage for up to 12 months postpartum. And Medicaid Health Plans are helping to improve the postpartum period, particularly for vulnerable communities, in multiple ways, including by leveraging doulas and midwives to address patient mistrust and offer more personalized care.

Research shows that people leveraging doula support are less likely to have preterm births, less likely to experience postpartum depression, and more likely to breastfeed. And among low-risk pregnancies, midwives can help achieve improved health outcomes, including lower rates of preterm births.

Commercial payers are also zeroing in on new thinking around the postpartum period as well. Blue Cross and Blue Shield of Illinois, for example, launched a program, Special Beginnings, with $8 million targeted towards local nonprofits, technology partners, and doula training to improve pregnancy and postpartum outcomes. Meanwhile, Humana’s pregnancy and postpartum care program, HumanaBeginnings, offers services such as transportation to and from doctor’s appointments, newborn support care, and home meal deliveries.

To address the complex needs of the postpartum period, ProgenyHealth works to eliminate barriers to care by providing 12 months of personalized support to all the members we serve. This support includes mental health screenings, as well as clinical recommendations for those in need of further mental health care. By remaining in close contact with members in this particularly precarious moment in their parenthood journey, we can stem the tide of mental health crises and maternal deaths, identifying areas of concern before they become emergent.

The Long Game

Mental health difficulties for parents well beyond the postpartum period also remains a hot topic—and one for which health care experts are still unearthing solutions. Last year, Surgeon General Vivek Murthy released a landmark advisory, Parents Under Pressure, which revealed that 48% of parents report feeling “completely overwhelming” stress most days. As the healthcare industry trains its focus on postpartum mental health, it’s likely that increasing attention will also be paid to the ongoing epidemic of stress and burnout among parents of children of all ages with interventions such as continued mental health screenings.

In late 2024, Kaiser Family Foundation (KFF)’s annual employer health survey revealed an eye-popping statistic: the average annual family insurance premium topped more than $25,000 that year. “Employers are shelling out the equivalent of buying an economy car for every worker every year to pay for family coverage,” KFF president and CEO Drew Altman said in the report. And that number is only expected to increase, with Mercer predicting that per-employee health care costs will climb by 5.8% in 2025.

It’s clear that this financial burden has become untenable for all involved, and that is likely to lead to significant shifts in the collective approach to healthcare coverage in the years ahead.

Since total birth costs are one of the top cost categories for health coverage, employers will likely begin to focus on proactive managed care partnerships to provide additional support during this complex period. An integrated solution not only offers a more comprehensive level of care to members—increasing patient satisfaction and plan loyalty—but it also delivers significant cost savings to employers by identifying and thwarting potential costly conditions before they take root.

This can be particularly useful in the postnatal period, since managed care programs increase patients’ opportunities to report mental health concerns, and because they help to boost the health literacy new mothers need to effectively manage their own care and that of their infants.

Bottom line

More instances of postpartum contact between care provider and new parent equal more chances to intervene and offer guidance when it truly counts.

Children born with such anomalies may require surgical intervention, ongoing physical or occupational therapy, long-term educational support, or an array of assistive devices—needs that may evolve and last for life.

Partnering with a healthcare solution with expertise in complex cases like these can be beneficial both to expectant parents and to plans that aim to reduce their financial burden. This is particularly true in states where reproductive health restrictions have made the need for this expertise mission critical.

Early interventions—the necessity of which new parents may only recognize with the aid of an experienced care manager— have been shown to reduce neurological and motor lags common in premature infants. This kind of support represents a clear benefit to the families affected, as well as to the plans covering the cost of their continued care.

The data tells a sobering story, underscoring the critical need for continued efforts in the healthcare realm to secure brighter futures for mothers and infants. With a new administration taking office in 2025, health plan executives are bracing for shifts in the healthcare landscape—further emphasizing the importance of steadfast commitment and collaboration in the path forward.

At ProgenyHealth, we take pride in being on the front lines of this mission, providing essential support and guidance to new parents, while contributing to an industry focused on groundbreaking advancements and innovation. While the road ahead is filled with an imposing set of challenges, it is clear the policies and people necessary to change course are ready and willing to make a difference.