The maternal health crisis remains unresolved in most of the US. Our nation has the highest maternal mortality rate of any developed country in the world, and we are the only developed country where the maternal mortality rate has increased in recent years, according to the World Population Review. In addition, unhealthy mothers and families can lead to unhealthy infants and children and exacerbate the cycle of morbidity and mortality.
As a pediatrician, I have personally witnessed the emotional and physical toll poor pregnancy outcomes, such as preterm birth, take on infants and their families. I have treated premature babies whose families could not hold them for weeks after birth. I have witnessed the stresses of caring for a child with lifelong disabilities due to premature birth or pregnancy complications. It is agonizing to know that many of these consequences could have been prevented with better prenatal and maternal health care.
Despite these grim statistics and real-world experiences, two positive maternal health changes are afoot for mothers and their newborn children. Expansion of services and advances in technology are poised to deliver better maternal outcomes and healthier pediatric populations.
This article provides a brief overview of recent legislative changes that have been shown to impact maternal health. Additionally, two specific use cases for health data are explored as effective ways to identify, treat, and connect at-risk mothers with maternal care providers to enable better maternal health outcomes and healthier children.
Postpartum Medicaid and CHIP coverage is expanding
On April 1, CMS announced an extension of postpartum Medicaid and CHIP coverage from 60 days to 12 months under the American Rescue Plan (ARP). CMS also applauded four states for accepting the expansion last month. While it is up to each state to operationalize the expansion, this administrative step bodes well for improving maternal health in the United States
Expanding coverage is a huge step in addressing the maternal health crisis. Since 42% of all births in the US are covered by Medicaid and more than 50% of all maternal deaths occur within 12 months after birth, a significant number of mothers and babies now have better access to robust insurance and care services when they need it most.
Extending the length of coverage after childbirth is a critical step in the right direction, but there are lingering issues that are being exacerbated by an influx of patients interacting in a fragmented healthcare system. Technological advances are playing a crucial role in addressing some of the long-term issues contributing to the maternal health crisis.
Data close maternal health gaps
Improving access to perinatal care, ensuring early detection of pregnancy and complications, closing health disparities and eliminating maternal care deserts are the top tactics for states and health organizations (HCOs) to pave the way to better maternal health to go. Participation in a structured state or national Perinatal Quality Improvement (PQI) Collaborative is another valuable approach. All these strategies are based on the need for data.
Healthcare data is fragmented, and obstetrics and pediatric team members often don’t have access to their patients’ data when they need it most. For example, a pregnant patient with a headache may visit a hospital, but her elevated blood pressure reading and diagnosis of preeclampsia may not reach the family doctor quickly enough, if at all.
The above improvement efforts cannot be accomplished without high-quality, timely, and actionable data that enables patient care team members to quickly know who needs help, where to allocate resources, and how to focus efforts for greatest impact be able. Here are two specific ways technology can help.
Increase data interoperability during the prenatal period
Inadequate prenatal care, consisting of late start of visits and/or fewer prenatal visits, is associated with a higher risk of preterm and low-birthweight infants, premature rupture of membranes, non-nursing, and rapid or rushed labor. Ensuring adequate and timely prenatal care helps reduce the risk of preterm birth, pregnancy-related complications and death, and leads to better maternal and child health outcomes.
Ensuring patients receive appropriate prenatal care requires the ability to collect, aggregate, and share relevant data points. This includes the pregnancy status, the number and timing of preventive medical check-ups and the insurance coverage of all women giving birth. Once maternity patients are identified, real-time data sharing and alerting technology can be used to notify clinicians across the care team of new and high-risk pregnancies, allowing those clinicians to triage and intervene in real time.
Insurance data is valuable in identifying patients who do not have adequate insurance coverage and may qualify for Medicaid to ensure access to prenatal services. Data from clinics, doctor’s offices and hospitals tells a story for each setting and together paints the big picture of maternal health. This allows care teams to quickly reach the highest-risk patients and provide the support they need.
It is also important for obstetric and gynecological providers to be aware of changes in a patient’s clinical condition that may increase her risk of poor patient outcomes. These risk factors include new diagnoses or labs suggesting conditions such as preeclampsia or gestational diabetes. In addition, behavioral health conditions and socioeconomic or environmental factors are important risk factors that need to be assessed and shared with appropriate care team members. For example, insufficient access to transport is one reason many mothers are unable to access prenatal care in both urban and rural areas.
Interoperable data systems capture these risk factors in real time and ensure access to the right resources exactly when they are needed. It is imperative that care teams are aware of the risk factors that significantly affect pregnancies and outcomes. The time after the birth is just as crucial for the health of the mother, as the above-mentioned extension of the postpartum insurance cover shows.
Access postpartum data over time
According to the Commonwealth Fund’s 2020 Maternal Mortality Report, 52% of pregnancy-related deaths in the US occur after childbirth. In addition to expanding Medicaid coverage, both clinical care teams and public health professionals need high-quality and timely data to provide patients with the best possible care.
Common gaps are team members not knowing when patients are delivering, which can delay important services. In addition, they may have visits to the emergency department or complications that require more intensive intervention, such as B. postpartum depression or postpartum hypertension, not known. Access to these types of data in the postpartum period is required to monitor postpartum populations at highest risk for poor outcomes.
Electronic medical records and other systems should ensure that postpartum data is accessible and shared by all members of the care team. Everyone needs to know about high-risk mothers so that the right services can be provided in a timely manner.
Expansion of maternal health care, health information technology, and access to timely pregnancy data are needed to coordinate care and address maternal health in the United States. Now is the time to bring patients and providers together through digital infrastructure and break down the silos of maternal health information that negatively impact maternal health.
By working together, we can improve maternal health outcomes by identifying patients and their risk factors in real time, and ensuring appropriate care team members are alerted in a timely and frequent manner throughout pregnancy and beyond.