Pregnancy-related deaths and maternal morbidity continue to rise in the U.S.
A major factor: large areas of the country—called "maternity deserts"—where little to no proper maternity care exists, officials say.
So 30 health systems are teaming up to implement digital tools and new care models to help close gaps in care for mothers and infants. Those digital solutions include screening tools to identify pregnant women with comorbidities like diabetes and hypertension to intervene earlier and using telehealth to connect expectant mothers to doulas.
“Our health system has experienced pockets of success in addressing this challenge, as have our peers across the country,” Janice Nevin, president and CEO at Christiana Care Health System, said in a statement.
The initiative is part of a larger effort called the Medicaid Transformation Project led by former acting Centers for Medicare & Medicaid Services Administrator Andy Slavitt and healthcare innovation network AVIA.
The project kicked off last summer with 17 health system members and has added 13 more since. The latest healthcare organizations to join are Children's Hospital of Wisconsin and the Veteran's Health Administration. The initiative has a targeted focus on four key issues facing Medicaid patients: behavioral health, women and infant care, substance use disorder and avoidable emergency department visits.
"The value of being in the Medicaid Transformation Project is that we break down information barriers and learn from each other’s successes—and failures—together. It will take a truly collaborative and innovative effort if we’re going to drastically improve prenatal and postpartum care delivery in our communities and nation—and quickly," Nevin said.
The U.S. is the only developed country in the world where maternal mortality rates continue to rise even though more than half of these pregnancy-related deaths are preventable, according to data from the Centers for Disease Control and Prevention.
"The key to a healthy baby is a healthy mom. Too often, needed healthcare services, including prenatal care, are not accessible," said Slavitt, who started a venture capital firm that invests in digital health technology, in a statement. "The health of the mother must be front and center before, during, and after delivery. The outcomes from absent or poor prenatal and postpartum care are catastrophic for both mother and baby. This is further compounded by cultural biases and barriers to quality care. There is no more important call to action than getting it right for a new mom and baby at the beginning of life."
At a conference in July, 70 executives from the 30 participating organizations identified nine digital tools and 15 clinically validated care models that could help improve overall care for mothers and infants.
The participating organizations plan to implement and scale these solutions including engagement platforms that can screen for social and clinical needs of mothers and remote monitoring for patients in rural areas or patients with high-risk pregnancies. The health systems also will develop coordinated care networks consisting of virtual lactation consultants, clinicians, doulas and midwives to address workforce shortages and access challenges experienced in urban and rural areas
Hospital leaders also will explore disruptive care models like group prenatal care to help address social needs such as mental health, sexual violence and food security, according to project leaders.
A central goal of the initiative is improving care coordination throughout the entire pregnancy journey, which is typically very siloed and fragmented. During pregnancy, coordination is missing between OB-GYNs, specialists and primary care providers who may be treating different aspects of high-risk pregnancies, according to project leaders.
During postpartum and infancy, coordination also is missing between pediatricians and the mother’s clinician. Connecting care teams across a health system can help identify preventable issues earlier and ensure patients don’t fall through the cracks.
The Medicaid Transformation Project, which consists of 30 health systems with 350 hospitals, has initiated 50 new solution adoptions across the U.S. since its launch in August 2018. Members are building off of the lessons from the first two phases of the initiative, focused on community-based care and mental health, and incorporating best practices as they accelerate this third phase around maternal and infant health, project leaders said.
There is a growing market for tech-enabled and digital solutions for maternity and infant health such as startups like telehealth company Pacify and Mahmee, which attracted investment from big names like tennis star Serena Williams and billionaire Mark Cuban.
Due to the surge in digital health solutions and the uptick in policy changes at the state and federal levels over the past six months, project leaders expect this phase of the Medicaid Transformation Project to extend into 2020.