How Parkland Hospital, digital health startups are supporting at-risk mothers using a device already in their pockets

As groundbreaking technologies abound, experts are looking to a not-so-revolutionary communication modality to address abysmal maternal health: SMS text messages.

The United Nations and the World Health Organization (WHO) recently released new data showing major setbacks for maternal health. In nearly all regions of the world, mortality rates either increased or stagnated. In Europe and North America, the maternal mortality rate increased by 17%, according to the U.N. and WHO data. A handful of U.S. providers and digital health companies have come to the same conclusion: To address the ongoing crisis, decades-old technology should be employed.

“Of all modalities, text messaging has the highest engagement rates that we've seen,” James Colbert, M.D., senior vice president of care delivery at Memora Health, told Fierce Healthcare. “A lot of clinicians may get excited about technology and apps and other ways of digitizing care, but the more complex it becomes, the more of a barrier you're potentially introducing between the clinical team and the patient. And the more likely that barrier is going to impact patients of lower socioeconomic status.”

Memora Health uses SMS text messages to answer parents’ questions any time of day, offer proactive education and reminders and triage patients to the right care. Through text message communications, Memora can flag patients who may struggle with food or housing insecurity, inform providers of barriers to care and provide resources. Memora can also facilitate patient transportation.

Simple communication backed by population health-informed AI 

The digital health company partnered with Penn Medicine to shepherd hopeful parents through the complex journey of artificial inception. Penn piloted Memora's SMS approach to guide patients undergoing fertility testing and treatment at Penn Fertility Care.  

A 2021 study of 1,944 global respondents found significant delays in seeking fertility treatment. As biological clocks ticked, patients reported an average wait time of 3.2 years to receive a medical infertility diagnosis. Those patients said they spent two years attempting to achieve pregnancy without assistance before treatment, while the industry standard is one year if the carrier is under 35 years old and 6 months if the carrier is over the same age. Patients then reported 1.6 years of treatment before successfully achieving pregnancy. 

Memora was chosen by Penn to help minimize the average wait time for a first fertility appointment, trim fertility workup time and optimize outcomes for patients. In its initial pilot program, with results published in NEJM Catalyst, UPenn increased annualized new patient access by 23.8%  and decreased wait time for initial treatment by a little over half. Proactive educational materials and text-based guidance helped to increase patient engagement by 20%, a trend seen across the industry. 

While patients may receive deceptively simple messages asking about blood pressure or postpartum depression, complex AI tools are working behind the scenes to craft the right message and direct patients to the right care. Memora partnered with PeriGen in December to improve AI insights in childbirth and better inform communications with patients.

“While the mom is in the hospital giving birth, PeriGen is able to improve monitoring and take in all of the different data points and surface the more concerning ones to the clinicians,” Colbert said. “Memora would then take over once the patient is discharged to optimize the postpartum experience and made sure that woman is very well supported after discharge.”

Colbert sees the next step for Memora to be crafting messages based on demographic data. This way, messages can be optimized to address population health issues.

Decreasing barriers to care with one-handed communication

Parkland Center for Clinical Innovation (PCCI) and Parkland Hospital in Dallas developed their own program enrolling at-risk patients in a text reminder program. The program’s main goal is decreasing preterm delivery in at-risk pregnant patients. PCCI determined which patients to enroll by using social determinants of health data.

Text messages varied from reminders to arrive at appointments with a list of questions, to take prenatal vitamins and to place seatbelts over the hips instead of the belly. Text reminders changed as patients progressed through pregnancy with notifications in the third month of pregnancy from informing parents that their baby was the size of a peach, to late-term reminders directing patients to ask their doctor about early signs of labor.

PCCI screened 13,000 women for social determinants of health, hypertension, diabetes and mental health risks. Of the enrolled women, preterm delivery decreased by 20%, prenatal doctor visits increased by 8% and costs decreased by 6%.

Yolande Pengetnze, M.D., a pediatrics specialist and program manager of the preterm prevention program, told Fierce Healthcare that 85% of participants preferred texts when receiving prenatal healthcare advice and 74% said the program made them better prepared for parenthood. “We needed a solution that patients could use with one hand because they have a baby in the other,” Pengetnze said.

“A lot of confusing and conflicting information is communicated on social media and that is where patients are going for advice,” Pengetnze said. “The social fabric has changed and people don’t have the same at-home support as they once did. New parents need all sorts of advice from how to feed their baby to what to ask their doctor.”

Low-income Medicaid patients were a special focus of the program with an understanding that socioeconomic factors and psychosocial stress are predictors of preterm birth. Black women are three times more likely than white women to die in childbirth while poverty across all U.S. demographic groups is associated with higher maternal mortality rates.

After a child is born, birthers are not out of the woods with half of maternal deaths occurring in the six weeks after birth. This window is when birthers with high blood pressure are likely to suffer a stroke or heart attack. As birthers recover from pregnancy, text-based pediatric care providers are also available. For $20 a month, parents can access Summer Health’s treatment, prescriptions and referrals for pediatric care.

When Summer founder and CEO Ellen DaSilva spoke with Fierce Healthcare, she was pregnant with her third child, scrambling to manage her health and the health of her two children while also working.

“Being a parent, you need to be ruthlessly efficient with your time,” DaSilva told Fierce Healthcare. “Our mission is to radically simplify access to care. In those fight or flight moments, you want to strip away all the complexity and do so in a way that is germane to how you live the rest of your life.”

Summer providers can offer immediate care, triage parents to in-person care or offer parents options for tackling challenges like sleep training.

Summer recently added the option for multiple caregivers to access the same account with the hopes that birthers are able to hand over some of the emotional burden of child-rearing to fathers or non-primary caregivers.