Here's how startup Zaya Care got insurers on board with its European-style approach to maternal care

When the team at Zaya Care was designing its maternal healthcare marketplace, they looked to the countries with the lowest maternal mortality rates to reimagine care with experts like lactation consultants, pelvic floor therapists and maternal mental health therapists.

Zaya Care announced last week a partnership with Zocdoc to bring its network of pregnancy and postpartum care specialists to the healthcare marketplace platform. Through Zocdoc, patients can book in-person and virtual care across over 200 specialties covered by more than 12,000 insurance plans, according to the companies.

Zaya Care sees the collaboration as an opportunity to decrease barriers to payer-covered maternal care. Zocdoc founder and CEO Oliver Kharraz, M.D., experienced this first-hand when his wife gave birth to their twins. The couple learned the difficulties with accessing maternal care, he told Fierce Healthcare.

“Looking for a lactation consultant was very difficult. We were even willing to do cash pay, but it was hard to find,” Kharraz said in an interview. “It’s a great example of how complicated and arcane and really obsolete the healthcare system frequently is for patients, particularly when they have an acute problem. If you just had your baby, you're probably exhausted and you don't want to spend hours and hours researching how to get the help you need.”

Both Kharraz and Zaya Care founder and CEO Leoni Runge are from Germany, where the Commonwealth Fund measured 3.2 maternal deaths per 100,000 live births, compared to the much higher rate in the U.S. of 23.8 maternal deaths per 100,000 live births for the total population and 55.3 deaths for Black Americans.

When Runge was designing Zaya, she looked to countries like Germany and France to answer two questions: Which specialists were a standard part of maternal care, and how can they be covered by insurance?

The answer to the first question was pregnancy acupuncturists, maternal mental health therapists, dietitians, pelvic floor therapists and lactation consultants, all specialists part of routine care in many European countries. The answer to the second was more complicated, she said.

“What we found is all these providers exist in the U.S.; they're super well trained, but they don't participate in the insurance network, so it remains a luxury,” Runge said in an interview. “It remains for those affluent enough or those who happen to be educated about these providers. If you happen to overcome the stigma that some of these providers have. So those are all the access hurdles. We focused in on this insurance piece, make them affordable; otherwise, they can never become part of the routine care.”

Before the Affordable Care Act (ACA) was passed, there was no mandate to cover care like lactation counseling, meaning it was up to payers whether to offer the care. While the ACA created a mandate that payers provide breastfeeding support without any out-of-pocket costs, gaps in care remain.

ACA requirements are not detailed, allowing wiggle room for payers to wriggle through. Insurers may determine frequency, method, treatment or setting for care. Even the definition of what constitutes a “trained” lactation consultant remains vague.

The highest credential of a lactation consultant is an International Board Certified Lactation Consultant or IBCLC, but many payers require a state license. But in many states, there is no license yet. Several federal and state bills are currently in the works to address the issue.

Plus, if there are not in-network providers available, a likely scenario considering the scarcity of state-certified lactation experts, out-of-network reimbursements are left to the insurers.

“Payers have certain rules that they only accept providers who have these state licenses,” Runge said. “So that can be this gray zone. It depends on how progressive the payers are, and whether they accept IBCLCs. They often do want to cover lactation consulting so that's when we help educate payers and make sure that all the IBCLCs we have are strictly reviewed and have necessary certification so that they can be covered by insurance and people can access them.”

Zaya Care grouped up providers and advocated on their behalf to insurance providers. The organization handles the administrative side of care while gaining better reimbursements for maternal care providers.

The startup has successfully worked to negotiate coverage for the various maternal care specialists common in Europe with Aetna, Centivo, Emblem Health, Empire BlueCross BlueShield, Oscar, Oxford Freedom and United Healthcare, according to company executives.

For Zaya Care, partnering up with Zocdoc means further expanding care, reaching into maternal health deserts and providing new parents with options. In France, it is very normal to meet with a physical therapist helping to treat pelvic floor recovery. Most Americans don’t know to type in physical therapist when looking for pelvic floor care, Runge said. But now, on Zocdoc, you can search for pelvic floor specialists.

“That’s what Zocdoc sets out to solve for you, ‘tame the complexity of the system,’ and make it so that you can easily find the care you need,” Kharraz said.