NFP Midwifery Strategic Plan Dashboard

NFP Midwifery — Strategic Plan Dashboard

Last Updated: March 25, 2026

What's Working

Six strengths that form the foundation of the midwifery program's strategic value.

📈
Strong Volume Growth
Charge line volume grew from ~1,500/month in early FY2025 to over 3,000/month by late 2025—a ~31% volume increase. While revenue growth lagged at ~5%, this demonstrates market demand. Current visit budget target is 880/month; program is hitting ~425.
🔗
Active LARC/IUD Program
308 IUD insertions and strong Nexplanon volume over 26 months demonstrates a clear, high-margin device program strength. 340B pharmacy support likely subsidizes device acquisition costs, making this a net-positive revenue stream.
👶
Baby Retention & Referral Engine
80% baby retention rate with ~24 deliveries/month. Strong downstream referral volume to pediatrics, primary care, and other NFP departments supports the "loss-leader" argument for the program's strategic value.
👥
CenteringPregnancy Program
15-year history with established group prenatal care model. Group visits serve 8-12 patients per session vs. 1:1 in traditional models, providing a proven lever for utilization and throughput improvement.
⭐
Quality Modifiers in Use
Active billing with quality modifier codes supports CMC (CareMore Complete) program eligibility, generating both PMPM revenue and quality bonuses. This requires improved postpartum capture but demonstrates billing sophistication.
🏥
Expanded Scope of Practice
Midwives actively performing NSTs, IUD insertions, Nexplanon, and colposcopies—maximizing billable scope. Cleveland Clinic OB supervision contract (~$1,280/week) supports this expanded scope in a sustainable model.

Revenue Opportunities

Eight revenue improvement areas validated or identified during the March 20 meeting with Ivo and preliminary financial analysis.

✓ CONFIRMED
IUD Device Code Gap
Current State: 308 IUD insertions billed over 26 months, but only 167 device charges coded in billing system.
Opportunity: ~141 missing device charges = estimated $15,000–$25,000/year in uncaptured revenue.
Ivo Confirmed: The discrepancy exists in billing data; device revenue attribution requires audit of charge entry workflow.
✓ CONFIRMED
Postpartum Visit Capture
Current State: ~24 deliveries/month but only ~10 postpartum visits logged—40% capture rate.
Opportunity: Capturing the 2-week postpartum visit also triggers CMC quality bonus eligibility, multiplying the revenue impact beyond the visit itself.
Ivo Confirmed: Current 40% capture rate is well below quality threshold for CMC bonus qualification.
⏳ NEEDS VALIDATION
NST Underbilling
Current State: NST (Non-Stress Test) volume appears low relative to OB panel size and frequency norms.
Opportunity: Each NST is a separately billable encounter. Scaling NST volume with panel growth could add meaningful revenue.
Still Need: Billing workflow confirmation from clinical team on NST coding frequency and actual vs. billed volume.
⏳ NEEDS VALIDATION
LARC/340B Device Optimization
Current State: 340B pharmacy likely covers device acquisition costs, but margin attribution to midwifery is unclear.
Opportunity: Proper 340B tracking and attribution could demonstrate that midwifery is net-positive on device revenue, not net-negative.
Still Need: 340B attribution data from pharmacy and finance teams on device subsidy cost structure.
🔮 FUTURE OPPORTUNITY
Doula Services
Current State: NFP does not currently offer doula services. Beautiful Birthing Community flagged as potential partner.
Opportunity: Ohio Medicaid reimburses ~$1,200/pregnancy for doulas. With ~24 deliveries/month, potential ~$345K/year in new revenue.
Note: Not a current program. Flagged as future strategic conversation piece only; not included in baseline projections.
✓ CONFIRMED
Lactation Services
Current State: Lactation services ARE offered at NFP but billed under a different department, not midwifery.
Opportunity: Not a midwifery revenue leakage issue. Confirm whether lactation billing is properly optimized in its own cost center.
Ivo Confirmed: Lactation revenue is not in the midwifery P&L; this is not a midwifery billing gap.
⏳ NEEDS VALIDATION
Group Visit Billing (CenteringPregnancy)
Current State: 15-year Centering program in place, but unclear whether sessions are billed at group or individual visit rates.
Opportunity: Optimal group billing model could significantly improve revenue per session.
Still Need: Billing model details from clinical and revenue cycle teams to verify group-visit billing optimization.
⏳ NEEDS VALIDATION
Home & Virtual Visits
Current State: Not confirmed whether telehealth and home visits are being captured and billed.
Opportunity: Especially valuable for Spanish-speaking population (50–55% of caseload) with documented transportation barriers.
Still Need: Confirmation from clinical team on whether telehealth/home visits are part of current workflow and billing.

3-Year Projection

DRAFT — PRELIMINARY ESTIMATES ONLY
These projections are based on initial assumptions drawn from early conversations and publicly available data. They are NOT finalized forecasts. Actual projections will be developed once outstanding data is received from NFP and validated with the clinical team. This is intended to illustrate the range of possibilities based on revenue opportunities identified to date, pending answers from the client.

Multi-stream revenue projection: FY2026 (baseline) → FY2029, tracking four distinct revenue channels.

FY2026 (Current)
55% utilization
$1.49M
PPS Encounters $1.05M
CMC PMPM $230K
CMC Quality $0
Device/Billing $210K
FY2027 (Year 1)
65% utilization
$1.72M
PPS Encounters $1.24M
CMC PMPM $265K
CMC Quality $30K
Device/Billing $225K
FY2028 (Year 2)
75% utilization
$2.02M
PPS Encounters $1.43M
CMC PMPM $300K
CMC Quality $75K
Device/Billing $240K
FY2029 (Year 3)
80% utilization
$2.32M
PPS Encounters $1.53M
CMC PMPM $330K
CMC Quality $115K
Device/Billing $255K
Total Program Upside: ~$830K from FY2026 to FY2029
Note: All figures are preliminary and subject to revision upon receipt of actual financial data from NFP.

Key Assumptions

  • Staffing: 3 CNMs on staff, 22 working days/month, ~16 slots/day per provider
  • Capacity: Full theoretical capacity = 1,056 encounters/month (3 CNMs × 22 days × 16 slots)
  • Reimbursement Rate: Ohio Medicaid PPS rate ~$150/encounter (NEEDS CONFIRMATION from FQHC Rates 2026 document)
  • No-Show Rate: Current 20% (goal: 18% reduction worth ~$83K/year)
  • Translation Costs: ~$8,500–$9,000/month for 50–55% Spanish-speaking caseload
  • OB Supervision: Cleveland Clinic contract ~$1,280/week (~$66,560/year)
  • Payer Mix: Medicaid 49%, Commercial 40%, Medicare 52%, Self-pay 24% (NEEDS FULL BREAKDOWN by volume)

What Moves the Needle

  • Reduce No-Shows (20% → 15%): Worth ~$83K/year in recovered encounter revenue
  • Improve Postpartum Capture (40% → 70%): Triggers CMC quality bonus eligibility and unlocks $100K+ in annual bonus revenue
  • Expand CenteringPregnancy Throughput: Scale group sessions from 8 to 12 patients per session; optimizes per-visit revenue
  • Validate & Close Billing Gaps: IUD device charges, NST coding, group visit billing—combined impact ~$40K–$65K/year

Open Questions — Updated Status

15 critical questions tracked by category. Status badges indicate resolution stage as of March 25, 2026.

Billing & Revenue
1. What is the actual payer mix breakdown for midwifery visits?
🔴 OUTSTANDING
Why it matters: Changes the entire revenue model. Commercial pays 40% of billed, Medicaid 49%, Medicare 52%, Self-pay 24%. We have rates but not volume breakdown.
From Ivo (3/20): He provided reimbursement rates but not the volume split by payer type. This is the #1 missing data point.
2. How does NFP currently bill CenteringPregnancy — individual visit codes or group visit codes for pregnancy encounters?
🔴 OUTSTANDING / NEEDS VALIDATION
Why it matters: Could significantly understate or overstate per-session revenue. Determines whether group model is revenue-enhancing or revenue-neutral.
Status: Needs clinical and billing team confirmation. Not yet requested as of 3/25.
3. Are home and virtual visits being billed?
🔴 OUTSTANDING
Why it matters: Potential untapped revenue stream, especially valuable for the 50–55% Spanish-speaking population with documented transportation barriers.
Status: Needs clinical team confirmation. Not yet confirmed whether telehealth/home visits are in current workflow.
4. What is the actual IUD device cost vs. 340B acquisition cost?
🟡 PARTIALLY ANSWERED
Why it matters: Determines whether midwifery is net-positive or net-negative on device revenue. Affects long-term program profitability argument.
From Ivo (3/20): Confirmed the 308 insertions vs. 167 billing gap exists, but not the dollar amounts. Need device cost spreadsheet from pharmacy.
Data Requests
5. Full-year actuals through February 2026 by cost center
🔴 OUTSTANDING
Why it matters: This is the baseline for the entire pro forma model. Cannot build accurate projections without actual cost and revenue data.
Status: Requested from Ivo via email 3/25/2026. Awaiting response.
6. FTE budget for the midwifery service line
🔴 OUTSTANDING
Why it matters: Cost structure modeling—cannot build projections without staffing costs. Need compensation, benefits, and FTE detail.
Status: Requested from Ivo via email 3/25/2026. Awaiting response.
8. Actual patient encounter count per month (not charge lines)
🔴 OUTSTANDING
Why it matters: One visit = 4–8 charge lines. Need distinct encounter count to verify utilization math and validate efficiency metrics.
Status: Not yet requested. Critical gap in understanding visit-level capacity.
9. Ohio Medicaid PPS reimbursement rates (FQHC Rates 2026)
✓ REVIEWED WITH IVO
What was confirmed: Reviewed with Ivo — the reimbursement percentages shared (Commercial 40%, Medicaid 49%, Medicare 52%, Self-pay 24%) represent the expected payment rates based on the payer agency rate in the system. These provide the basis for revenue modeling by payer class.
Status: Confirmed from official rate schedule. Used for baseline projections.
10. Pharmacy & 340B revenue attribution to midwifery patients
🔴 OUTSTANDING
Why it matters: The cross-program subsidy analysis—how much pharmacy revenue does midwifery caseload generate? Critical for program defense.
Status: Not yet requested. Need to engage pharmacy operations and 340B coordinator.
11. New patient creation metrics & downstream revenue
🔴 OUTSTANDING
Why it matters: The "loss-leader" / halo effect argument for keeping program even if unprofitable standalone. Need data on referrals to pediatrics, primary care, etc.
Status: Not yet requested. Will require clinical operations and patient tracking analysis.
Operations & Strategy
12. Is CMC program revenue tracked at the department level?
🔴 OUTSTANDING
Why it matters: If CMC revenue isn't attributed to midwifery, the department looks less profitable than it actually is. Attribution model affects entire business case.
Status: Flagged during projection modeling; needs confirmation from finance.
13. What is the actual provider schedule template (slots/day/CNM)?
🔴 OUTSTANDING
Why it matters: This is the denominator of every capacity calculation. Need to verify the 55% utilization figure and validate staffing model.
Status: Not yet requested. Needs clinical operations confirmation.

Meeting Summary — All Project Meetings

Meeting 1: Onsite Strategic Planning Kickoff
Date: March 5, 2026 | Participants: Dave Worden, Stacy, Bgraber, Aabreu, Kmaistros, Llasko
  • Strategic context: NFP completed 5-year strategic plan 10 years ago. Added OBGYN services, ultrasonography, extra revenue services. Current model is unique but financially unstable. Focus on sustainability rather than volume-based metrics.
  • Team composition: 3 midwives (13, 13, 7, and 1 year tenure), high retention
  • Integrated lactation support: Midwives achieve breastfeeding initiation rates above state/national averages; Black population rates exceed white population rates at NFP
  • Provider-reimbursed lactation: RNs with CLC certification reimbursed at provider rates for Medicaid patients
  • Care model: Dyad care (mother-baby as single unit) with 48-hour postpartum BP checks
  • Operational metrics: No-show rate 20% (goal 18%)
  • CenteringPregnancy: 15-year history, rebuilding volume
  • Partnership expansion: Cleveland Clinic for higher acuity patients
  • Stakeholder engagement plan: Individual interviews planned, 30 min each, 6-week window. Internal focus group with all midwives, MAs, behavioral health, lactation, marketing, community outreach. Mid-April retreat to present findings
Meeting 2: Financial Deep Dive with Ivo
Date: March 20, 2026 | Participants: Dave Worden (Triumph), Ivo Omega (Controller, NFP Medical Center)

Key Takeaways

  • Program running at ~50% of visit budget target (425 actual vs. 880 target)—the primary headwind
  • Program is currently unprofitable but mission-critical to NFP's strategy
  • 340B pharmacy subsidizes midwifery operations; cross-department revenue sharing is not visible in P&L
  • Reimbursement rates: Commercial 40% of billed, Medicaid 49%, Medicare 52%, Self-pay 24%
  • Cleveland Clinic OB supervision contract: ~$1,280/week ($160/hr, ~8 hrs/week)
  • Translation costs: ~$8,500–$9,000/month for 50–55% Spanish-speaking caseload
  • IUD billing gap confirmed: 308 insertions over 26 months vs. 167 device charges billed—~141 missing charges
  • Postpartum visit capture at ~40%—well below quality threshold for CMC bonus eligibility
  • Lactation services confirmed as billed outside the midwifery department (not a midwifery gap)
  • Doulas are NOT currently offered at NFP—future opportunity only, not current program
  • 2027 budget not yet finalized; directors were still developing as of 3/20
Meeting 3: Project Status Touch Base with Stacy
Date: March 24, 2026 | Participants: Dave Worden (Triumph), Stacy (Gladegy)
  • Progress update: David met with Ivo (financial contact) — productive initial conversation
  • Current NFP budgeting approach: FTE capacity × average billing = budget. No deep dive into coding aspects or optimization opportunities yet.
  • Key constraint: CFO George out until early April
  • Data gaps confirmed: Payer mix breakdown, patient journey timeline
  • Post-pregnancy billing patterns: 25 births/month vs only 10 follow-up visits billed
  • Doula services opportunity: Potentially missing $1,200/pregnancy in Medicaid billing
  • Lactation coding: Done in midwifery but CPT codes not showing — confirmed billed outside department
  • Translation costs: $8,000/month for midwifery (agency total $50,000/month). Exploring tech solutions like AirPod Pro translation ($300 vs ongoing agency costs)
  • Political dynamics: Primary practitioner from Cleveland Clinic (also board member) blocks potential relationships with MetroHealth/University Hospitals
  • Key insight: Katie identified as strong quality-of-care advocate
  • Strategic question: Revenue vs fundraising balance needed to determine funding gap
  • Action items: Follow up with Ivo for payer mix, individual meeting with Katie to map clinical pathway, email Dominic/Andrea to confirm budget timeline, compile research foundation

Prepared by Triumph Business Solutions for Gladegy | NFP Midwifery Strategic Plan | March 25, 2026

This dashboard is confidential and intended for internal use by NFP Medical Center and Gladegy leadership only.