Visana’s care model functions as a centralized medical home. Visana designed the model to support women with a range of complex conditions to address interconnected gynecologic, hormonal, metabolic, and lifestyle needs to improve clinical outcomes and reduce costs. At the center of the model is a nurse practitioner (NP) trained in Visana’s women’s health protocols, who follows patients throughout the care journey and each life stage. The NP works closely with a multidisciplinary clinical team — including a primary care provider, endocrinologist, and ob/gyn — to align on appropriate treatment pathways for each patient. Through collaboration, the NP addresses multiple symptoms over a series of virtual visits, delivering longitudinal, evidence-based care that prioritizes conservative treatments first.

To evaluate the impact of the comprehensive women’s health and care navigation program, OA analyzed de-identified commercial claims data spanning from May 2023 to May 2025^.2 Women who used Visana’s program were matched to women receiving usual care based on their age and the state they lived in.

In addition, the matching process included pre-program care needs and costs, number of medications, use of behavioral health services, and high-cost condition burden.

The primary goal of the analysis was to measure the change in the total cost of care and assess how reducing fragmentation across women’s health services impacts spending. The total cost of care was segmented into outpatient services, hospitalizations, imaging, laboratory services, and gynecological services.

The analysis included the full Visana cohort and, within that cohort, subgroups of surgical and nonsurgical patients. The surgical subgroup included patients whose conditions are frequently treated with surgery, such as laparoscopy or hysterectomy, before more conservative management approaches can be tried. The nonsurgical subgroup consisted of patients whose conditions, such as menopause, are typically managed with long-term medical management, lifestyle intervention, and hormonal and metabolic optimization.

These results suggest that fragmentation is a significant source of avoidable women’s health spending, and a comprehensive women’s health model like Visana’s can reduce total cost of care by improving healthcare efficiency and optimizing utilization.

Fragmentation, when a patient doesn’t have a single clinician who delivers the bulk of a patient’s care, is both widespread and underacknowledged within U.S. healthcare.³ Patients with complex or overlapping conditions often navigate multiple specialists, site-of-care settings, and care plans. Because each individual provider can rarely see a patient’s full clinical picture, opportunities for coordinated care are frequently missed, while clinicians may be unable to see important connections among related conditions. Tests and procedures may also be unnecessarily repeated, adding avoidable spending without improving outcomes.

OA’s analysis reflects these broad patterns: Patients who received virtual, comprehensive care used fewer healthcare services and had lower costs than similar patients who did not. Specifically, Visana patients were less likely than the control group to use facility inpatient and outpatient services. This reduction was driven by fewer inpatient admissions, fewer visits to the emergency department (ED), and less use of services like labs, imaging, and specialty visits.

Visana patients had about three fewer outpatient claims per five Visana patients and 36 fewer  specialty-related claims. Finally, Visana patients had one more primary care visit than non-Visana patients, which may reflect how Visana’s model is structured to manage costs.

Overall, the data suggest that the comprehensive, virtual model helped patients avoid higher-cost settings and unnecessary specialty care, while slightly increasing primary care engagement.

Visana’s care model is designed to address multiple complex and costly conditions within one medical home. Patients often present with a single concern they believe explains their symptoms. By addressing multiple conditions in a single visit and then following patients longitudinally, the NP and clinician care team aim to move beyond symptom‑by‑symptom treatment and toward whole-person support for patients with overlapping or multifactorial concerns — including gathering a full history, identifying underlying causes, and creating a focused treatment plan.

Care is also coordinated to align providers, services, and clinical information across the patient’s care journey and stages of life. When care is coordinated, patients are less likely to experience fragmented pathways that lead to repeat testing, unnecessary specialty visits, or reliance on high-cost sites of service — ultimately lowering avoidable downstream spend.

Optum consulting's analysis indicates that this model leads to a more efficient use of care on a broad scale. The largest cost reductions occurred in nonsurgical, medically complex patients — such as those with menopause, PCOS, and weight-related conditions — where rates of misdiagnosis are typically high^4,5 and fragmented care drives repeated specialty visits and testing. Savings were more modest among the surgical cohort, but still significant. Visana patients had lower downstream utilization following procedures, which may reflect improved care coordination, medication management, and reduced reliance on repeat emergency department and specialty visits.

These results suggest that for women with preventive, hormonal, metabolic, and gynecologic health needs, earlier engagement with comprehensive healthcare is associated with fewer avoidable hospital visits and procedures, as well as more efficient care later in the treatment pathway.

Final thoughts

By emphasizing a conservative-first, whole-person approach early in the care journey, Visana’s model has influenced overall utilization patterns, lowering the total cost of care. The approach suggests a shift away from specialist referrals and outpatient services that may not be necessary, while placing greater emphasis on coordination and appropriateness of care. From a payer’s perspective, this model aligns with existing priorities related to utilization management, network optimization, and value-based care — and may offer a framework for addressing cost and efficiency considerations.

Visana is a comprehensive, in-network virtual women’s health clinic that delivers whole-person medical care for women from menstruation through menopause. Plan members get timely, accurate diagnoses and coordinated treatment without having to seek out costly specialty providers. By replacing fragmented point solutions with a clinical medical home model for women, Visana reduces avoidable surgeries and emergency department visits while improving outcomes and member satisfaction. Visana is available in all 50 states. Learn more at www.visanahealth.com.

This expert insight is sponsored by Visana, an Advisory Board member organization. Representatives of Visana helped select the topics and issues addressed. Advisory Board experts wrote the content, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.

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