Validating maternity program performance: 3 stages of proof you need to know

Health plans and employers are under growing pressure to demonstrate the value of their maternity benefits, amid rising healthcare costs, tighter budgets, and increased scrutiny of point solutions. Promises of improved outcomes are no longer enough; buyers want evidence that a program is delivering measurable results.

When it comes to maternity care, the most rigorous proof of financial ROI takes time. A pregnancy and postpartum care journey can span more than a year, and claims data takes additional time to mature. For payers and benefits consultants making decisions within annual budget cycles, long-term savings projections can be difficult to justify when the impact isn't yet visible in claims.

But that doesn't mean there isn’t useful evidence in the meantime. The key is understanding what different types of data can tell you, when they become available, and which decisions they can reasonably support. From early engagement metrics to risk-adjusted claims analysis, here's how to evaluate maternity program performance at every stage.

Stage 1: Look for early indicators 

Ask: Is the program reaching members and changing behavior?

Timeline: Within the first weeks and months of implementation

The earliest evidence of a maternity program's impact comes from engagement and adherence to evidence-based care protocols. These measures help answer two important questions: are eligible members accessing the program, and are they taking the actions that could improve their health outcomes?

For example, a maternity program might track how many members complete birth preparation, receive appropriate screening, engage with a care provider, or follow recommendations for managing pregnancy complications.

For members at elevated risk of preeclampsia, low-dose aspirin use is one particularly relevant measure. When clinically indicated, aspirin can help reduce the risk of serious hypertensive complications during pregnancy. Maven's preeclampsia prevention program has reported aspirin uptake of 71.8%, compared with a national average of 65.6%. This provides an early indication that members are following recommended preventive care.

These metrics can be particularly useful during implementation reviews. If engagement is low, a health plan and vendor can investigate whether members are being identified and reached effectively, or whether there are barriers to accessing care.

What this evidence can tell you: Whether a program is reaching its intended population and supporting recommended care behaviors.

What it can't tell you: Whether those behaviors have translated into fewer complications or lower total healthcare costs.

That distinction matters. Strong engagement is a promising early signal, but it shouldn't be presented as proof of financial savings.

Stage 2: Evaluate member-reported outcomes

Ask: What savings can be estimated before claims mature?

Timeline: Approximately six months after the performance year closes

As members progress through pregnancy and postpartum care, vendors can begin evaluating reported outcomes against relevant benchmarks or internal comparison groups. This approach combines member-reported data with aggregate claims information to estimate the financial value of changes in outcomes.

For example, a vendor might compare outcomes among members who received maternity support during pregnancy with those who didn’t. Differences in reported outcomes — like postpartum mental health, NICU utilization, and hospital readmissions after birth — can then be translated into estimated savings using relevant claims-based cost assumptions. 

This type of analysis identifies the specific outcomes expected to influence healthcare spending. It can also provide useful evidence much sooner than a comprehensive claims study — often within six months of the performance year's close — and may be feasible with a smaller population. Maven's methodology, for example, uses a minimum threshold of approximately 200 program completions.

For health plans and employers, these estimates can help inform renewal discussions, assess whether a program is progressing toward its goals and identify areas where further investment or improvement may be warranted.

That said, the limitations should be transparent. Member-reported outcomes may be subject to reporting bias, and comparisons against benchmarks or internal controls cannot account for every difference between populations.

What this evidence can tell you: Whether reported outcomes are consistent with the program's intended impact and what those improvements may mean financially.

What it can't tell you: The actual difference in total cost of care between comparable participants and non-participants. That requires a more comprehensive claims-based evaluation.

Stage 3: Run a claims-based analysis

Ask: Has the program reduced the total cost of care?

Timeline: Approximately 15–18 months after the performance year closes

For a more rigorous assessment of financial impact, health plans can compare the total cost of care for members who participated in a maternity program against a clinically comparable group who did not. This is where risk-adjusted, claims-based analysis becomes particularly valuable. 

Rather than simply comparing average spending or complication rates, the analysis uses techniques such as propensity score matching to account for differences in clinical risk between the two populations. 

It also considers the full cost of care throughout pregnancy and postpartum, including costs associated with both mother and baby. This matters, because maternal and neonatal costs are closely connected. In Maven's evaluation framework, maternal care accounts for approximately 70% of total costs and infant care around 30%. An intervention that increases spending on prenatal monitoring, for example, could still reduce overall costs if it helps prevent a costly NICU admission.

Claims-based analysis can also capture outcomes that may not be visible through vendor-reported data alone, including readmissions, healthcare utilization and episode-level spending. The trade-off is time and complexity. Claims need to be complete enough to reflect the care journey, and both the vendor and health plan must have the resources and data-sharing arrangements needed for analysis.

Maven's framework typically requires at least 500 enrolled members for this type of evaluation, with results available approximately 15–18 months after year-end. For a decision involving substantial healthcare spending, that wait can be worthwhile. A well-designed claims study provides stronger evidence of financial impact and can help distinguish genuine savings from differences in the populations being compared.

What this evidence can tell you: Whether program participation is associated with lower risk-adjusted total cost of care across the maternity episode.

What it can't tell you: With complete certainty, that the program caused every observed difference. Even well-matched observational studies have limitations that should be acknowledged.

Keep in mind that not every claims analysis is created equal. Maternity care presents several challenges when it comes to risk factors, hospital variation, measurement period, and more that buyers should look out for when reviewing vendor results.

Better data collaboration means better evidence

The quality of a maternity program's reporting depends on the data available and how it's used. Vendor-collected data can show how many high-risk members have been identified, screened and engaged, alongside reported delivery and NICU outcomes. Sharing claims data provides a more complete picture, including prenatal and postpartum visit completion, readmissions for mother and baby, and costs throughout pregnancy and postpartum.

For health plans and employers, it's important to understand how outcomes are measured, how complete the data is and what reporting will be available beyond the first year. It's also worth asking how electronic health record (EHR) integration and other data-sharing arrangements could improve reporting over time.

Ultimately, vendors and their partners should work together to establish a clinically appropriate, risk-adjusted evaluation methodology, with clear assumptions and transparent reporting.

Questions to ask any maternity benefits vendor

Before selecting or renewing a maternity program, health plans and benefits consultants should be clear about what evidence they can expect and how it will be produced.

1. What evidence will we have at six months, 12 months and 18 months? Ask which measures will be available at each stage and what decisions they can support.
2. How do you account for risk? Understand which risk factors are included, how comparison groups are matched, and how match quality is assessed.
3. Are maternal and infant costs evaluated together? A total cost of care analysis should reflect the full maternity episode, not isolated components.
4. What sample size is needed? Check whether your covered population is large enough for analysis and what alternatives are available if it isn't.
5. What data do you need from us? Clarify the options for claims sharing, clinical data integration and collaboration with existing analytics partners.
6. What are the limitations of your analysis? A credible vendor should explain what its findings demonstrate, what remains uncertain, and which assumptions influence the results.

Ultimately, evaluating maternity benefits shouldn't come down to choosing between immediate reporting and long-term proof of ROI.

Both have a role. Early indicators help buyers understand whether a program is reaching members and supporting appropriate care. Member-reported outcomes provide an interim estimate of potential savings. Risk-adjusted claims analysis offers a more comprehensive assessment of financial impact.

The strongest evaluation strategy uses all three, matching the evidence available to the decisions health plans and employers need to make.

Download Maven's Maternity Cost Crisis guide to explore the costs driving maternity care and opportunities to improve outcomes.