Certified Nurse Midwife Practice Financial Pro Forma Tool

Promoting Midwifery & High Value Care in Medi-Cal

Increasing midwifery utilization is a key strategy to improve maternal quality, affordability, and the patient experience. To explore opportunities to promote Medi-Cal access to midwives and high value care strategies in maternity, the Pacific Business Group on Health (PBGH) interviewed California Medicaid (Medi-Cal) plans across managed care models and geographies, evaluating payer contracting and reimbursement practices, network requirements, quality incentives, and value-based payment.

This issue brief explores the variation in midwifery contracting and reimbursement practices in California, and it explores how payers can drive improvements in maternal health through network requirements, quality incentives, and other value-based strategies.

This one page document recommends how payers can promote midwifery in commercial, Managed Medi-Cal, and Medi-Cal Fee-For-Service

Evidence demonstrates that midwives improve maternal and infant outcomes, while decreasing costs. In addition, the use of midwives creates more care options for patients while addressing a growing shortage of perinatal health providers. Yet, certified nurse-midwives (CNMs) are an underutilized resource in this country, delivering only 9% of babies nationally.

A midwife’s training and focus on physiological birth make them well equipped to address the social and environmental factors that contribute to premature birth, high maternal mortality and racial disparities. By demonstrating the success of midwifery-led care to a diverse range of stakeholders, PBGH intends to stimulate broader adoption of the midwifery model state and nationwide.

Blueprint for Action

Based on the barriers analysis and guidance from a steering committee of national experts, PBGH developed a Blueprint for Action that outlined five essential strategies to measurably increase access to midwifery services.


To achieve the top two strategies of the blueprint, PBGH developed as suite of products to support hospitals and physician groups establish, expand, or strengthen the use of midwives in their organizations.

Making a business case for midwifery

PBGH engaged actuarial consultant, Milliman, Inc, to develop a white paper that outlines the steps needed to develop a business plan for CNM integration in California and the financial considerations crucial for sustainability.

To assist practices in calculating expected revenues, expenses, and financial outcomes associated with hiring a CNM, PBGH engaged Milliman to develop the CNM Practice Financial Tool (Tool). The Tool is an interactive educational resource intended to help practices and hospitals estimate the financial value of adding a CNM into a maternity care practice in California. You can use the tool to develop a hypothetical pro forma projection associated with a CNM practice in five different settings.

Register here to receive a copy of the CNM Financial Tool.

Scaling best practices in collaborative care

The “How to Successfully Integrate Midwives into Your Practice: A Guide for Physician Practices and Hospitals” is designed to help medical groups and hospitals establish, expand, or strengthen the use of midwives in their organizations. The guide translates conceptual frameworks on midwife-physician collaboration into straightforward step-by-step actions developed based on real working models.

Register here to receive a free copy of the Guide.