MFM Practice Case Study: From Referrals to Owning Care

Why this matters if you run a referral-based practice

This practice had all three problems. Here's how it got out.

The handoff

You've seen the scan. You know what this pregnancy needs over the next few weeks. You write it up (the monitoring, the delivery plan, the red flags) and send it back to the referring obstetrician. Then you wait. Maybe it gets followed. Maybe it gets followed halfway. Sometimes you find out how it went when the baby lands in the NICU.

For years, that was the whole job at this practice. It was a respected MFM consultancy with a steady referral stream. Obstetricians sent their highest-risk patients for specialist input, kept those patients, and decided what to do with the advice.

On paper, it looked healthy. Underneath, it had three problems nobody could fix from the consulting chair:

• Outcomes swung with the referring practice. The same recommendation got carried out differently from one referring practice to the next, and preterm deliveries and NICU stays varied right along with it. Two patients, the same plan, two very different deliveries.
• Growth had a ceiling. Every patient arrived because another physician chose to send them. Push hard on protocols and you risk the relationship that feeds you. Don't push, and outcomes stay uneven. Volume plateaued. If you've ever softened a recommendation to protect a referral relationship, you know this one.
• The good work couldn't be proven. Without one standard across providers, there was no clean, population-level data, the only kind payers take seriously. You know your patients do better. Try proving it across a negotiating table with nothing to show.

The specialists could see the risk. They just weren't the ones who got to act on it.

Proving it in one market

So the practice asked a different question: What if the patients were theirs?

It picked one market that averaged about 80 deliveries a month and went direct to patients, pairing an MFM specialist with certified nurse midwives. Within 3–4 months, the pilot was handling 65–70 of those 80 deliveries.

Patients would come. The next question was whether the practice could build something that held them.

Building it with Practice Now

That's where Practice Now came in. The practice kept its referral division and added a women's care group that employs its own obstetricians, now about 35 of them. Practice Now worked through four moves with them, each one setting up the next.

1. Protocols first

   Practice Now worked with the practice's physicians to build clinical protocols and roll them out, with coaching for providers. With OBs on the same team, those protocols stopped being suggestions mailed to outside practices. They became the shared standard of care, with room for clinical judgment.

2. Then the proof

   Shared standards produced shared data, and shared data changed the payer conversation. Practice Now benchmarked the practice's outcomes against statewide hospital data and built the case payers needed to see.

3. Then the contracts

   With that case in hand, Practice Now negotiated stronger payer contracts, including shared-savings arrangements with Medicaid plans.

4. Then the physician math

   Practice Now designed the physician employment and compensation structure. The combined contract pays more per delivery, so physicians can earn more for the same work, or keep their pay and spend fewer nights on call. Those are the two objections that usually stall a change like this, and the model answers both.

What Practice Now brings to your practice

Every problem this practice faced has a fix, and every fix is work Practice Now does.

The problem	The fix	What Practice Now does
Outcomes swing with whichever practice has the patient	One physician-authored standard of care	Builds and rolls out clinical protocols, with coaching for providers
Payers can't see your results	Outcomes benchmarked against statewide data	Benchmarks your outcomes and builds the case payers need to see
Contracts underpay for the care you deliver	Stronger contracts, including shared savings	Renegotiates payer contracts, starting with the one that moves the most money
Physicians resist the change	More pay per delivery, or fewer nights on call	Designs the physician employment and compensation structure

What it bought them

The work isn't finished. Full protocol adoption is still in progress, which is exactly why the practice keeps measuring it.

Results reported by the practice. Figures are approximate.

Is this your practice?

Picture an independent specialty group anchoring a handful of referring physicians, for example a maternal-fetal medicine group working with 5–10 obstetricians. That group is sitting exactly where this practice sat. You see the risk. Someone else makes the call.

You don't have to rebuild everything at once. Some groups start with one piece: benchmarking outcomes, renegotiating a single payer contract, or standardizing one protocol. The first 90 days show which piece will move your numbers most.

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