Millie, a hybrid midwifery-led women’s health provider, is joining UCSF Health Medical Foundation’s clinically integrated network to partner on maternity care.
Millie and UCSF Health providers will work together as a clinically integrated care team with shared protocols and electronic health record integration. Millie is also tapping into UCSF’s payer contracts, streamlining in-network patient referrals. The collaboration initially focuses on the East Bay of San Francisco, with plans to expand across the Bay region.
Millie’s model involves midwife-led prenatal visits, 24/7 virtual support and wraparound services like miscarriage management, lactation support, mental healthcare and postpartum support. It has two in-person clinics, in Berkeley and San Jose, and partners with hospitals on labor and delivery. Millie claims it sees lower rates of C-sections, NICU admissions, preterm births and low-weight births.
“We can create change in maternity care, and it’s good for patients, it’s good for health systems, it’s good for payers,” Anu Sharma, founder and CEO of Millie, told Fierce Healthcare in an advanced interview.
Through the latest partnership, patients can receive prenatal care through Millie. Those who need to be seen by a specialist or have labs or imaging can be referred to UCSF Health’s ecosystem. This will be simplified not only by tech integration but also by payer overlap, ensuring in-network referrals.
“It’s hard to piece that together when you’re referring patients out to a whole bunch of other places,” Sharma noted.
Studies consistently show that midwives are the optimal providers for more than 80% of pregnancies that are classified as low-to-moderate risk, with lower C-section rates and higher patient satisfaction scores.
UCSF Health Medical Foundation is a multispecialty nonprofit physician group connecting docs and group practices. It is jointly operated by UCSF Health.
“The best maternity care happens when every member of the care team is working collaboratively around the patient," Talia Borgo, co-founder and clinical director of Millie, said in an announcement. "This collaboration enables our midwives and UCSF clinicians to work as one coordinated team throughout pregnancy, birth and postpartum. Families benefit from the continuity of a trusted care team while knowing specialized expertise is immediately available whenever it's needed.”
Founded in 2022, Millie has focused on scaling across California. Staffed by nurse-midwives and doulas, Millie can care for low-risk pregnancies at its clinics. Over time, it has expanded its offerings to include preconception counseling and gynecology services, plus perimenopause and menopause care.
“We have found that the Millie model seems to resonate with health systems that are all dealing with some version of wanting to expand access to care to more communities,” Sharma said.
While the midwifery model of care is a lot more prominent in other countries, which also have much stronger maternal health outcomes, it remains underutilized in the U.S. In the early days of Millie, people didn’t understand why Sharma was targeting midwifery. But acceptance has "significantly evolved” over the past few years.
“What has basically happened over this time is just the sheer force of the weight of the OB shortages the country is facing has essentially made midwifery inevitable,” Sharma explained.
Health systems facing provider shortages have to figure out how to staff differently to stabilize their service lines, Sharma added. At the same time, more patients are seeking holistic, less interventional maternity care as celebrities speak about positive midwife experiences. This has coincided with a national focus on closing the Black maternal mortality gap. “It’s led to a cultural mainstreaming" of midwives, Sharma said.
Reimbursement is also evolving. In a substantial update, starting January 1, 2027, maternity care CPT codes will move away from the traditional bundle and separate out prenatal care, labor management, delivery and postpartum services. These changes, determined by the American Medical Association, are intended to better reflect modern team-based obstetric care, per the organization.
Because the new codes will be structured around levels of care and complexity, per Sharma, they will allow for better parity between midwives and physicians. Millie works with all major payers in the Bay Area, including Medi-Cal, California's Medicaid program.
These maternity code changes are not without controversy and pushback. The Centers for Medicare and Medicaid Services has joined lawmakers who have questioned AMA’s role in CPT issues. The latest Physician Fee Schedule proposed rule included a call for public comment on the subject.
The CMS has already signaled it may choose to maintain the obstetric global codes and is currently in a public comment period. Some Republican lawmakers have pushed back on the dismantling of the maternity bundle, arguing it will drive up healthcare costs.