This is what happens when a woman's health crosses seven specialties over three years. And what happens when someone holds the thread.
You're 34. You've been trying for eleven months. Your OB says give it time. But your AMH is 1.2, and time is the one thing a declining ovarian reserve doesn't give.
Six-week wait for RE consult. No AMH testing suggested until month 11. Insurance denies coverage after one failed cycle. You lose four months. $22,000 in out-of-pocket fertility spend before anyone reviews the protocol.
Expedited RE referral pathway. Protocol review before cycle 1. Fertility Rx navigation. Authorization managed proactively. RE consult in 9 days vs. national average of 47. (ASRM/ACOG referral timeline data)
IVF worked on cycle two. But you're now AMA with Hashimoto's thyroiditis and a borderline cervical length at 20 weeks. Your OB hasn't checked your TSH since transfer.
TSH not checked until week 12 — should have been week 6 post-transfer. MFM referral takes three weeks. Cervical surveillance starts too late. Progesterone window missed. Preterm delivery risk increases 34% with delayed cervical intervention. (March of Dimes, 2023)
Post-transfer thyroid protocol triggered automatically. MFM pathway activated for all IVF pregnancies. Cervical surveillance from week 16. MFM pathway: automatic vs. 3-week referral delay.
Preterm labor at 34 weeks. Betamethasone. NICU for eleven days. C-section for non-reassuring fetal heart tones. The clinical team was excellent. The billing was not.
No coordination from MFM back to OB for postpartum. NICU billing includes duplicate charges and unbundled services. Lactation support ends at hospital discharge. $71,000 NICU stay — $11,400 in billing discrepancies identified retrospectively.
Delivery-to-postpartum transition protocol. NICU billing reviewed in real time. Extended lactation support pathway activated. NICU billing accuracy: 94% with review vs. 67% without. (modeled from founder operational data)
Six weeks out. Exhausted. Joint pain. Brain fog. Your OB says it's normal. Your PCP says it's sleep deprivation. Four months later, a rheumatologist diagnoses rheumatoid arthritis.
Postpartum autoimmune flares are predictable but rarely anticipated. The 6-week OB visit catches nothing. PCP attributes symptoms to new parenthood. Rheumatology wait: four months. $14,200 — one ER visit and two urgent care visits while waiting for diagnosis.
Postpartum autoimmune surveillance protocol. Symptom-trigger screening at 8 and 16 weeks. Expedited rheumatology pathway. Detection at 8 weeks vs. 5 months.
Methotrexate for RA causes GI distress. Switched to a biologic. Symptoms persist. Colonoscopy reveals Crohn's disease — unmasked by the immune shift of pregnancy.
GI symptoms attributed to medication side effects for five months. Nobody connects the autoimmune cluster — Hashimoto's, RA, and Crohn's travel together. Biologic selected for RA alone doesn't cover Crohn's. $41,000 per year in redundant biologic therapy — two drugs where one would treat both.
Autoimmune comorbidity flag triggered. Shared biologic strategy — one agent covering both RA and Crohn's. GI expedited pathway. One biologic vs. two. $41,000 annual savings.
You're now on a biologic at $6,800 per month, thyroid medication, and an anxiolytic. Your specialty pharmacy doesn't coordinate with both prescribing specialists. The PA is denied. You go without treatment for two months.
Biologic prior auth denied. Appeal takes six weeks. Treatment gap causes flare. ER visit. Pharmacy doesn't synchronize refills across specialists. $8,400 ER visit from a preventable treatment gap.
PA pre-submission review. Pharmacy network alignment across specialists. Refill synchronization. Biologic switching protocol with both specialists consulted simultaneously. PA pre-clearance: 4 days vs. 6-week appeal cycle.
You now have five active specialists, a PCP, and a therapist. Your records live in four EMR systems. You spend six hours a month on healthcare administration. You are your own care coordinator.
Appointments conflict. Records don't transfer. Each specialist sees their slice. You burn out and stop going to rheumatology. The Crohn's flares. 6 hours per month of patient administrative burden. Missed rheumatology visits lead to $23,000 flare hospitalization.
One navigator who holds the full picture. Appointment coordination. Records synthesis. Provider-to-provider communication. Quarterly care plan reconciliation. Administrative burden: 1 hour per month vs. 6. Zero missed specialist visits.
In your book of 10,000 covered lives:
~650 women will use at least one Crescent module this year.
are managing conditions across multiple specialties — that's where fragmentation costs compound.
Net ROI: 2.3x–4.7x
For payers: Crescent reduces total cost of care through single-point navigation across 7 specialties. Fewer redundant consults, fewer ER diversions, fewer NICU days. It touches 7 HEDIS measures, 3 Star Rating categories, and the highest-cost DRG in your book.
45 days to implement. No integration required.
Includes employees, spouses, and adult dependents. Prevalence estimates: ~5% pregnancy (maternity), ~4% autoimmune, ~3% GI, ~2% pelvic floor, ~2% fertility, ~15% symptomatic menopause (age 45-55). Applied to ~4,500 adult women per 10,000 covered lives. Deduplication for overlapping conditions yields ~650 unique module users, of which ~340 (52%) are managing conditions across multiple specialties. Sources: CDC NCHS, AARDA, SAMHSA, ACOG.
See the model → joe.nalley@showyourwork.health