Sina Haeri, CEO of Ouma Health, on building a new maternity model

It feels like we’re increasingly hearing stories about rural hospitals contemplating the shuttering of their labor and delivery units. There was Harrison Hospital in Cynthianna, Kentucky discussing the prospect on Tradeoffs a few weeks ago and Dr. Carmelo Hernandez, the Medical Director of San Luis Valley Hospital, discussing the prospect in this story from KFF News.

It’s a trend that may be exacerbated by the recently signed One Big Beautiful Bill Act. But it’s also an area where technology can make a real difference in terms of outcomes. If you’ve ever been curious about building in the Medicaid space, working with Medicaid Managed Care, or scaling a care model for rural populations, we think you’ll enjoy our interview with CEO and co-founder of Ouma Health Dr. Sina Haeri below.

— Martin & Kevin

Background:

Having a baby in the United States is uniquely expensive and risky among its similarly situated peers. But those costs and risks aren’t evenly distributed. Medicaid pays for 41% of births in America, and in rural areas, that share goes up to 47%. These births are more dangerous, more complicated, and cause greater financial strain on the medical system due to the higher acuity and lower reimbursement rates inherent to the Medicaid program.

The root causes of these problems are, like many problems in health care, multifaceted. There are social factors and geographic elements driving the problem, along with issues specific to the health care market, like access and network adequacy concerns for Medicaid members and a shortage of OB/GYN specialists. 

Given the scale, cost, and complexity of managing pregnancy, birth, and postpartum care for Medicaid patients, there’s market demand for expertise, especially from risk-bearing provider groups and Medicaid Managed Care organizations. 

Ouma Health is one such expert. With customers spanning insurers, care delivery organizations, and employers, Ouma has built a maternity telehealth program with a team-based approach, including maternal fetal medicine specialists, nurse-midwives and nurse practitioners, addiction medicine specialists, RNs, and lactation consultants to appropriately manage high-risk pregnancies. 

Medicaid Managed Care is an important part of their business, and they are currently enrolled as Medicaid providers in 18 states with more in the pipeline. To learn more about the challenges and opportunities for care delivery companies working with Medicaid Managed Care, we spoke with Dr. Sina Haeri, the CEO of Ouma Health.

Questions:

Context:

1. Ouma Health works across the healthcare system with health plans, healthcare systems, and employers, as well as direct to consumer with Ouma Direct. Can you give a high-level overview of your care model and how that looks different for these different customer types?

2. The Ouma website mentions that you’re enrolled as a Medicaid provider in 18 states. Medicaid pays for a plurality of births in the country and close to half in more rural areas. Can you talk about the challenges you see for Medicaid mothers and mothers-to-be and how Ouma addresses these challenges?

3. I imagine the needs for commercial and Medicaid mothers to be substantially different given the interplay of social factors and higher rates of complications for the Medicaid population. Is that the case? How did you build Ouma for both populations, and how do you think about the model as similar or different across your business lines?

4. We recently spoke with Fortuna CEO Nikita Singareddy, and she talked about how the dearth of startups and innovation for Medicaid a few years ago and how that’s starting to change. One driver she cited was the sharp growth in Medicaid Managed Care creating a new set of buyers. When you’re talking to MCOs, what are they saying about their prenatal, birth, and postpartum spend? Is it an area that's top of mind for MCOs? What drives an MCO to work with you?

5. Medicaid reimbursement rates, at least for Fee For Service, are historically significantly lower than Medicare and Commercial rates. Do these lower rates pose special business challenges for a specialist-focused company like Ouma with higher labor costs? Are you finding you need to limit your Medicaid case load to prioritize other higher reimbursement rates or targeting states with higher reimbursement for prenatal care? 

6. The recently passed One Big Beautiful Bill Act includes some major changes to Medicaid eligibility and enrollment, but it seems like pregnant women and new mothers will be largely safe. On the other hand, the bill also pulls federal matching dollars out of states by ratcheting down the provider tax, which experts expect to hit rural and safety net hospitals the hardest. How is Ouma thinking about the impacts on its patients and its business?

7. Outside of a $5m grant from the CDC for Ouma and Marani Health, I’m not seeing much in the way of outside investment in Ouma. It appears you’ve largely bootstrapped the business – can you talk about that decision versus talking to venture capitalists? What tradeoffs would you encourage other founders following your journey to think about? Do you think Medicaid generally is an underinvested thesis for investors? 

Business:

8. Recently, the publicly traded MCOs have reduced their earnings estimates and generally spoke of a tougher, higher acuity population, with rate adjustments not keeping up. I can imagine that causes MCOs to take one of two approaches when thinking about ‘innovation’ – either you’re stopping activity and focusing on the core business, or you’re increasing activity as a way to transform the core business. Given that, do you see more or less activity from MCOs looking to Ouma for help managing their risk on what I imagine is one of their higher cost conditions?

9. Generally, Medicaid patients have higher social risk factors than commercially insured patients, higher risk of behavioral health issues, and higher rates of substance use disorder, and this seems to be true for mothers and mothers-to-be on Medicaid as well. How does Ouma manage this higher degree of complexity and is there risk adjustment or additional payments to help cover it?

10. How does Ouma structure its contracts with a Medicaid Managed Care plan (or state Medicaid agency if applicable)? Is it a fee for service, upside-only or upside and downside risk, or more structured around incentives for HEDIS measures (e.g. PPC1 and PPC2)? Despite the so-called Big 5 in MCOs, there are still lots of smaller, local plans. How do you think about segmenting the MCO customer market and is there a type of MCO that you find is more interested in your model?

11. I see a pretty high degree of overlap between the states you’re currently working in and the states that have performance measures focused on perinatal and birth outcomes for Medicaid. How do those performance incentives work and is that generally a good indicator for you that a state might be a good expansion site? And more broadly,a criticism of value-based care is that it’s more of an exercise in documentation than changing patient care. To what degree do you see this with the MCOs (and state agencies if applicable) that you work with? Is there a tension you’re having to navigate between checking the boxes and the actual care management and delivery you’re trying to do?

12. Can you quantify the cost savings MCOs (and perhaps employers) see when working with Ouma vs the baseline? Can you walk through a few patient / provider journeys that highlight the main drivers of these savings?

Broader View:

13. In a recent episode of Tradeoffs, they spoke with a rural hospital in Kentucky on their plans to deal with the incoming Medicaid cuts and they mentioned cutting Women’s Care as a likely contingency once the cuts take effect which seems like a common trend in rural health. In your view, what does the future of maternity care look like in rural settings?

14. In your position partnering with Medicaid Managed Care plans across the country, are there any interesting experiments or models you’d recommend checking out? Is anyone doing anything unique that makes you think “this really deserves more attention?” And on the other hand, what’s still missing from a technology or reimbursement perspective? Is there technology on the horizon that could be really game-changing? If you could pitch CMMI or a state Medicaid director on a new alternative payment model, what would it be?

15. As you think about the next few years for Ouma, how are you thinking about growth? New geographies, more risk sharing with MCO plans, growing the commercial and direct-to-consumer lines of business?

Interview

Q: Ouma Health works across the healthcare system with health plans, healthcare systems, and employers, as well as direct to consumer with Ouma Direct. Can you give a high-level overview of your care model and how that looks different for these different customer types?

Ouma Health was built to close the gaps in maternity care around the country at scale while holding true to our primary tenet of relationship medicine. The core of our model is a multidisciplinary team of clinicians — maternal-fetal medicine physicians, nurse-midwives, addiction medicine experts, behavioral health providers, lactation consultants, RNs, and social workers — all connected through telehealth and supported by data-driven protocols.

With this clinical infrastructure, we deploy programs built for each of our customer types. For health systems, hospitals, FQHCs and OBGYN clinics, we’re creating or amplifying capacity for scarce specialties, particularly in maternity deserts. For these partners, we stand up virtual clinics based on needs including Maternal Fetal Medicine (MFM), midwifery, diabetic management, or behavioral health. For health plans (including MCOs), we focus on improving access to timely care for their members, reducing risk, and improving quality metrics. In addition to clinical visits, we’re deeply involved in member outreach, behavioral health and SDoH assessments, and work closely with health plan case managers to support pregnant members holistically. Our work doesn’t stop at checking a box for a visit, but can continue throughout the entire pregnancy journey until suitable local care is established.

Our employer/health captive, third-party reproduction agency, and direct-to-consumer offering are focused on providing convenient, coordinated, and high-touch specialty support. The commonality again is relationship medicine. While our care models are customized, the essence of what we’re providing is the same. We’re clinicians, plain and simple, and our goal is to leverage telemedicine to ensure every pregnant woman, irrespective of income or geography, has equitable and timely access to expert maternity care.

Back to Questions.

Q: The Ouma website mentions that you’re enrolled as a Medicaid provider in 18 states. Medicaid pays for a plurality of births in the country and close to half in more rural areas. Can you talk about the challenges you see for Medicaid mothers and mothers-to-be and how Ouma addresses these challenges?

Although Medicaid covers so many mothers and mothers-to-be, these individuals face the highest rates of complications, behavioral health needs, and barriers like transportation and childcare. With provider shortages, many women travel hours for specialty care — or often go without. It’s sobering but not surprising how many patients we run into that haven’t had any OB care 20 or 30 weeks into the pregnancy and have been doing drop-in visits to the ER or L&D to get a sense of reassurance. We’re working hand in hand with Medicaid managed care partners to change that and provide trusted, easy access to care.

Ouma addresses this by bringing specialty-level care into patients’ homes. We integrate medical, behavioral, and lactation support into one coordinated plan, and we are licensed Medicaid providers in 18 states with more in progress. By making care easy to access, we prevent the gaps that often drive poor outcomes and high costs.

Coupled with ease of access is also timeliness. Due to provider shortages, people are waiting several weeks in certain places to get an initial visit. We pride ourselves on providing our Medicaid patients concierge level healthcare. For the most part, we’re meeting patients where they are and on their schedule - with most visits scheduled and completed within 3 days and many times on-demand.

Back to Questions.

Q: I imagine the needs for commercial and Medicaid mothers to be substantially different given the interplay of social factors and higher rates of complications for the Medicaid population. Is that the case? How did you build Ouma for both populations, and how do you think about the model as similar or different across your business lines?

Commercial and Medicaid populations do differ — Medicaid mothers face more systemic barriers and higher acuity. But the foundation of our model is universal: comprehensive, coordinated, patient-centered care irrespective of what you look like, how much you earn, where you live, or how your care is funded. For commercial families, we emphasize convenience and continuity; for Medicaid, we emphasize access, social risk support, and high-touch care. The adaptability of our model means we can succeed across populations without losing focus.

Back to Questions.

Q: We recently spoke with Fortuna CEO Nikita Singareddy, and she talked about how the dearth of startups and innovation for Medicaid a few years ago and how that’s starting to change. One driver she cited was the sharp growth in Medicaid Managed Care creating a new set of buyers. When you’re talking to MCOs, what are they saying about their prenatal, birth, and postpartum spend? Is it an area that's top of mind for MCOs? What drives an MCO to work with you?

When we speak to MCOs, maternity is absolutely top of mind. We continue to see strong demand from plans, large and small, raising their hands to work with us on improving care for their members. Despite financial headwinds, many still see investment in maternity as essential, because avoiding a NICU admission or postpartum complication isn’t just better care, it yields same-year savings.

What drives them to work with Ouma is our ability to deliver measurable cost savings while helping them hit quality performance measures. We reduce complications and improve outcomes in a way that strengthens both their financial and quality performance. It is well established that 70-80% of maternity complications are preventable with early recognition and timely access. This is why we built our delivery model based on this, and are able to impact outcomes. Members can easily get a hold of us, raise their hands, and say, “can you help me?”

Where we really differentiate ourselves from some competitors is in how we measure and talk about impact. You’ll never hear us tout that we have “XX million lives under management” when it’s disingenuous—because not all of those members are of reproductive age, and the real magic is how many of those eligible members actually engage in care. We’re clinician-founded and clinician-run, so we’re careful to share only outcomes we know we directly influenced—not broad, feel-good numbers that can’t be tied back to our work.

We work with MCOs of all sizes—from small regional plans to some of the top five in the nation. The ones who get it see the value of our clinical reach complementing their administrative infrastructure to make sure the member is taken care of. And I’ll tell you—when I’ve called the CMO of a market MCO about a specific member issue, I’ve yet to meet one who didn’t immediately jump into action. Often the problem isn’t willingness—it’s visibility. Once you uncover the issue, they’re there to help and tackle it head-on.

Back to Questions.

Q: Medicaid reimbursement rates, at least for Fee For Service, are historically significantly lower than Medicare and Commercial rates. Do these lower rates pose special business challenges for a specialist-focused company like Ouma with higher labor costs? Are you finding you need to limit your Medicaid case load to prioritize other higher reimbursement rates or targeting states with higher reimbursement for prenatal care? 

Medicaid rates can pose a financial challenge, depending on which state you’re dealing with, but we understood that going in and built a model that works in that environment. We work closely with our clients to create programs that meet their needs and are financially sustainable so we can continue to support patients for years to come and not be a flash in the pan. We’re fully committed to serving Medicaid populations rather than limiting caseloads or only entering select markets. 

We go where the need is greatest and where there’s strong alignment around improving maternal health. Working in the Medicaid world has ensured our model is feasible in a Medicaid environment and has actually set us up well for work elsewhere.

Back to Questions.

Q: The recently passed One Big Beautiful Bill Act includes some major changes to Medicaid eligibility and enrollment, but it seems like pregnant women and new mothers will be largely safe. On the other hand, the bill also pulls federal matching dollars out of states by ratcheting down the provider tax, which experts expect to hit rural and safety net hospitals the hardest. How is Ouma thinking about the impacts on its patients and its business?

The OBBBA is one of the most consequential Medicaid bills in decades. While pregnant women themselves remain exempt from new eligibility hurdles, the broader impact is undeniable. Cuts approaching a trillion dollars over ten years are projected to leave more than 10 million Americans uninsured.

• Family impact: Work requirements and administrative hurdles could strip coverage from spouses and caregivers, leaving expectant mothers under more stress.

• Cost-sharing: New state authority to impose co-pays — up to $35 per visit — risks putting critical services like behavioral health or diabetes management out of reach, despite being essential for safe pregnancies.

• Rural access: Maternity deserts will expand as provider tax cuts pressure rural hospitals. A $50 billion stabilization fund was included, but estimates suggest it covers less than a third of expected losses.

At Ouma, we see these pressures as a call to scale solutions that are efficient, preventative, and accessible. Our care model fills exactly the gaps this bill threatens to widen.

Back to Questions.

Q: Outside of a $5m grant from the CDC for Ouma and Marani Health, I’m not seeing much in the way of outside investment in Ouma. It appears you’ve largely bootstrapped the business – can you talk about that decision versus talking to venture capitalists? What tradeoffs would you encourage other founders following your journey to think about? Do you think Medicaid generally is an underinvested thesis for investors? 

We’ve bootstrapped Ouma entirely so far, and that was a very intentional decision - and as proud as we are of that $5m grant recently awarded, our portion of it is fairly small, in truth, the company has been entirely self-funded to date. 

When we founded Ouma, we were on a mission to expand access to maternal healthcare, and as a physician-led company, we wanted to do that without any compromise to clinical rigor. We’ve been approached many times by potential outside investors, but bootstrapping gave us the freedom to build it true to vision, while also forcing us to really hone a sound, sustainable business model.  

There are tradeoffs that come with that — we’ve grown more deliberately rather than hyper-aggressively. We didn’t start with immediate hype and name recognition. There are doors that a venture-backed company would have opened to them more easily by virtue of networks.  

But while venture funding has its benefits it also comes with different challenges. Instead of the repeated stress and time spent fundraising from one round to another, we get to spend more time laser focused on what we’re building - the people, products, services, relationships, technology, culture, financials. By prioritizing these things, we created a durable foundation where our people, our patients, and our clients don’t leave. 

Now before I lead any existing or future entrepreneurs astray, I would caveat that our journey has been made a lot easier due to an experienced team that works well together, and are all in a place where life and finances have made it possible to go down this path. I wouldn’t fault anyone in a different situation for going down the venture route from the get-go, but I will say it’s been really fun to do it the way we have! 

With respect to investment in Medicaid, the opportunity is enormous. There is already significant investment, even in our maternity space, but there’s still a lot more room for more. There’s so much to fix that is ripe for entrepreneurs and investors to tackle, and once you break through, you’ll find clients and partners that are excited to work with you, expand what you’re doing, and solve more problems. 

Back to Questions.

Q: Recently, the publicly traded MCOs have reduced their earnings estimates and generally spoke of a tougher, higher acuity population, with rate adjustments not keeping up. I can imagine that causes MCOs to take one of two approaches when thinking about ‘innovation’ – either you’re stopping activity and focusing on the core business, or you’re increasing activity as a way to transform the core business. Given that, do you see more or less activity from MCOs looking to Ouma for help managing their risk on what I imagine is one of their higher cost conditions?

We’re definitely seeing more activity from MCOs, not less. Even with tighter budgets, they understand that doing nothing in maternity is costlier. In fact, just the week after the passage of OBBBA, we had three MCOs raise their hand and want to talk to us about launching Ouma programs. High-risk pregnancies drive disproportionate spend, and Ouma offers a proven lever for both cost containment and quality improvement.

Back to Questions.

Q: Generally, Medicaid patients have higher social risk factors than commercially insured patients, higher risk of behavioral health issues, and higher rates of substance use disorder, and this seems to be true for mothers and mothers-to-be on Medicaid as well. How does Ouma manage this higher degree of complexity and is there risk adjustment or additional payments to help cover it?

Medicaid mothers face higher rates of social risk, behavioral health conditions, and substance use disorder. At Ouma, we’ve embedded behavioral health and addiction medicine into the core care team. That way, when a woman screens positive for depression or opioid use, support is immediate and integrated.

Contractually, some states and MCOs provide risk adjustment or add-on payments for these services, but not universally. Our argument is simple: unmanaged behavioral health and SUD dramatically increase costs, so investing upfront is the only rational choice.

Back to Questions.

Q: How does Ouma structure its contracts with a Medicaid Managed Care plan (or state Medicaid agency if applicable)? Is it a fee for service, upside-only or upside and downside risk, or more structured around incentives for HEDIS measures (e.g. PPC1 and PPC2)? Despite the so-called Big 5 in MCOs, there are still lots of smaller, local plans. How do you think about segmenting the MCO customer market and is there a type of MCO that you find is more interested in your model?

We structure our partnerships in a variety of ways depending on state and plan preferences. Many are a hybrid of:

• Fee-for-service for clinical encounters

• Quality improvement fees to support infrastructure and HEDIS measure gap closures like PPC1 and PPC2

While the “Big 5” MCOs are important partners, we also find strong alignment with smaller, regional Medicaid plans, which are often closer to their communities and more nimble in adopting innovative models.

Back to Questions.

Q: I see a pretty high degree of overlap between the states you’re currently working in and the states that have performance measures focused on perinatal and birth outcomes for Medicaid. How do those performance incentives work and is that generally a good indicator for you that a state might be a good expansion site? And more broadly,a criticism of value-based care is that it’s more of an exercise in documentation than changing patient care. To what degree do you see this with the MCOs (and state agencies if applicable) that you work with? Is there a tension you’re having to navigate between checking the boxes and the actual care management and delivery you’re trying to do?

We do see a high correlation between states prioritizing perinatal outcomes and our own expansion. When states put real dollars behind reducing NICU admissions, increasing postpartum visit rates, or improving behavioral health access, it signals alignment. Those incentives make it easier for MCOs to invest in models like Ouma’s that deliver measurable results.

Back to Questions.

Q: Can you quantify the cost savings MCOs (and perhaps employers) see when working with Ouma vs the baseline? Can you walk through a few patient / provider journeys that highlight the main drivers of these savings?

We’ve consistently demonstrated 20–30% reductions in costs compared to baseline.

For example, by identifying gestational diabetes early and providing MFM co-management, we prevent NICU admissions that would cost $100,000 or more. A good example is a recent enrollment in Washington, where the member at 8 weeks with diabetes could not find a provider. Within 48 hours, she had seen an MFM, completed diabetic education, had supplies called in, insulin regimen instituted, new pregnancy labs and viability ultrasound ordered, and a new OB provider located who was able to get her in at 22 weeks.

Integrated behavioral health support and timely access reduces readmissions and ED visits. A woman in Texas reached out to us at 5:30 PM, unable to get a hold of her provider. Within 30 minutes, she was evaluated and deemed to be experiencing a DVT. After coordinating her care, before midnight Lovenox was called in and picked up, teaching completed, and a report was provided to the on-call physician for her practice informing them of her status.

Telehealth access reduces missed appointments and enables earlier interventions for complications. Prior to our teleMFM launch with the nation’s largest FQHC, nearly half of the patients were not making it to their local MFM provider due to a variety of challenges (cost, time, transportation). Since our launch, we consistently average less than 10% no show rate, and provide the patients a 1-stop shop for their MFM needs, with a less than 5% need to visit the local MFM provider.

These are real, same-year savings for MCOs — and they’re paired with better outcomes for moms and babies.

Back to Questions.

Q: In a recent episode of Tradeoffs, they spoke with a rural hospital in Kentucky on their plans to deal with the incoming Medicaid cuts and they mentioned cutting Women’s Care as a likely contingency once the cuts take effect which seems like a common trend in rural health. In your view, what does the future of maternity care look like in rural settings?

Without intervention, rural hospitals will continue cutting obstetric services. The future of maternity care in rural America has to be hybrid: local providers supported by virtual specialty teams. Ouma is already delivering that model, ensuring women in maternity deserts receive expert, high-quality care without leaving their communities, and we are now deploying the first of our hybrid programs in the east coast, which we hope to expand nationally in the future.

Back to Questions.

Q: In your position partnering with Medicaid Managed Care plans across the country, are there any interesting experiments or models you’d recommend checking out? Is anyone doing anything unique that makes you think “this really deserves more attention?” And on the other hand, what’s still missing from a technology or reimbursement perspective? Is there technology on the horizon that could be really game-changing? If you could pitch CMMI or a state Medicaid director on a new alternative payment model, what would it be?

We’re encouraged to see more states experimenting with bundled maternity payments, enhanced behavioral health integration, and expanded postpartum coverage. Some innovative models are using community health workers and digital tools to address SDOH in real time. These deserve more attention, because they show that better outcomes and lower costs are possible when we align incentives.

Two big gaps remain:

• Technology: We need scalable tools for real-time risk prediction and SDOH integration so that interventions are proactive, not reactive.

• Reimbursement: CMMI or states should consider alternative payment models that pay for comprehensive maternity episodes, including behavioral health and lactation, rather than siloed services. That’s how we’ll move from fee-for-service fragmentation to whole-person care.

Back to Questions.

Q: As you think about the next few years for Ouma, how are you thinking about growth? New geographies, more risk sharing with MCO plans, growing the commercial and direct-to-consumer lines of business?

Our priorities are clear:

• Expand into more Medicaid states, especially those investing in perinatal outcomes.

• Increase our work within FQHCs, giving underserved communities a true one-stop shop for comprehensive maternity care.

• Partner with health systems to expand MFM access, ensuring patients in maternity deserts or resource-limited regions have timely specialty support.

• Deepen value-based arrangements with MCOs, sharing in both savings and risk.

• Grow our employer and direct-to-consumer lines to reach more mothers across payer types.

Our mission remains unchanged: ensuring every mother — regardless of zip code, insurance card, or circumstance — has timely access to safe, high-quality maternity care.

Back to Questions.