Beyond Billing: What the AMA's Maternity Care Redesign Could Mean for Maternal Risk Management

Author: Danielle Senn

Beginning January 1, 2027, the American Medical Association (AMA) will replace the longstanding global maternity billing model with a more granular framework for reporting key phases of the pregnancy journey, from prenatal care through postpartum management.

This update includes new, revised and retired billing codes to better reflect how maternity care is delivered today, including team-based care models and increasing care complexity.

At first glance, healthcare leaders may view this as a reimbursement and operational change, but the shift may represent something much larger: what it could mean for how maternal health risk is understood and managed.

By breaking apart the traditional global maternity bundle, the AMA is recognizing a reality that maternal health leaders have understood for years: pregnancy isn't a single episode of care. It's an evolving clinical journey marked by changing risks, interventions and care needs. For employers, payers, providers and maternal health advocates seeking earlier intervention, stronger care coordination and better outcomes, greater visibility across that journey may prove as important as the coding changes themselves.

Why the current model no longer fits

For decades, maternity care has largely been reimbursed through a bundled payment structure that treated pregnancy as a single episode of care. While the model worked in a different healthcare environment, today's maternal health landscape is far more complex.

Patients often move across providers and care settings. Telehealth, remote monitoring and multidisciplinary care teams play a growing role in maternal health. At the same time, conditions such as hypertension, gestational diabetes and perinatal mental health disorders require ongoing assessment and intervention throughout pregnancy and beyond.

By separating maternity care into distinct phases, the AMA's redesign acknowledges what maternal health leaders have long recognized: pregnancy isn't one event. It's a clinical journey with evolving risks, needs and opportunities for intervention.

In many ways, the coding system is catching up to how maternity care is already being delivered.

The real opportunity

Under the traditional model, much of the pregnancy journey has been embedded within a single billing structure, making it difficult to understand what occurs before delivery. A more detailed reporting framework has the potential to provide greater insight into care patterns, risk progression, intervention timing and gaps in care.

That matters because maternal risk is rarely static. Risks emerge, evolve and require different levels of support across pregnancy and the postpartum period. Greater visibility into those transitions could help stakeholders identify opportunities for earlier intervention, stronger care coordination and more effective use of maternity resources.

Better data alone doesn't create better care. However, it can create a clearer picture of where action is needed.

How the shift may reshape Maternal Health Strategy

As maternal health continues to be a priority, this change may create new opportunities to evaluate the effectiveness of maternity programs and benefits strategies.

• Health Plans may gain a more detailed view of maternal risk and utilization patterns, creating opportunities for earlier intervention and more targeted population health strategies.
• Providers face significant implementation work, including documentation updates, workflow redesign, education and payer contract reviews. Longer term, they may have greater ability to demonstrate the value of care coordination and clinical interventions that were previously hidden within a bundled framework.
• Employers may gain new opportunities to evaluate maternity programs through a clinical lens rather than primarily through engagement or utilization metrics. As reporting becomes more specific, measures such as risk identification, intervention timing, care coordination and maternal outcomes may become increasingly important indicators of program effectiveness.

For organizations that have invested in maternity navigation, behavioral health support, high-risk pregnancy programs and postpartum care, greater visibility could help determine which interventions are making the greatest difference.

What Gallagher is watching

At Gallagher, we're looking at this change through a broader clinical, operational and employer strategy lens. Our clinical and analytics teams are closely monitoring how the new reporting structure may influence the visibility of maternal health risks, care patterns and outcomes across the pregnancy journey.

For employers, the change creates an opportunity to ask more meaningful questions.

• Are risks being identified early enough?
• Are members connecting with the right support before complications escalate?
• Are care gaps visible before they become adverse outcomes?
• Are maternity benefits designed around the full journey, including postpartum care, rather than primarily around delivery?

The question that matters most

The healthcare industry is understandably focused on coding readiness, reimbursement implications and operational transition planning. Those conversations are necessary.

The greater opportunity lies in how healthcare uses new visibility to manage risk across the pregnancy journey.

For years, healthcare leaders have emphasized earlier intervention, proactive risk management and whole-person maternity care. Achieving those goals requires visibility into what happens throughout pregnancy, not simply at delivery.

The question isn't whether healthcare will bill differently beginning in 2027. The more important question is whether greater visibility will lead to earlier action, stronger support and better outcomes.

To find out more, contact a Gallagher consultant today.