We understand more about the drivers of maternal health outcomes than we ever have before, yet women today are more likely to die of a pregnancy-related complication than their mothers were.
This is one of many salient points made by Dr. James L. Madara, a representative of the American Medical Association, in a letter sent to HHS Secretary Xavier Beccara in April 2024. The letter outlines the outcomes of the AMA's extensive year-long initiative to bolster the Administration's maternal health efforts. This involved working closely with a diverse group of healthcare professionals within the Federation of Medicine, including specialty societies, state medical associations, and rural physicians, to craft a comprehensive set of recommendations aimed at enhancing maternal health outcomes in the United States.
The recommendations reflect the reality that maternal health statistics are driven by many factors -- spanning biological, socioeconomic, structural, and political dimensions -- and that quick fixes or a single-faceted approach will not address the underlying problem.
In this month of May, which is hypertension awareness month, we're drawing particular focus to the section addressing hypertensive disorders of pregnancy (HDP). HDP are some of the leading causes of pregnancy-related deaths that occur in the first six weeks after delivery, and they disproportionately affect Black women, who are more than twice as likely to suffer from hypertension than their White peers.
Leveraging technology is the cornerstone of AMA's strategy for addressing HDP. Remote patient monitoring of blood pressure has been shown to effectively reduce complications related to HDP, but getting those solutions into the hands of patients is another story. Here's our breakdown of the AMA's key recommendations for expanding remote monitoring for hypertension:
SUPPORT TELEHEALTH Infrastructure
Reliable broadband connectivity has always been a barrier to standing up telehealth services. While digital health innovators have been creative about circumventing the need for broadband (Babyscripts uses Bluetooth technology and cellular chip devices that connect to the cloud to reach patients, eliminating the need for broadband), it can be still present a barrier, particularly in very remote areas. Initiatives like the Connected Care Pilot Program, which funds broadband and network services, to be expanded and made permanent, focusing particularly on improving access in rural areas.
EXPAND COVERAGE FOR MATERNAL SOLUTIONS
In recent years, Medicaid has expanded coverage for telemedicine more broadly, but maternal and postpartum virtual care are not always included in these policies. The government needs to support policies that extend Medicaid coverage to include all aspects of virtual maternal health care, and hypertension specifically. The AMA has developed programs like AMA MAPTM for hypertension, which have improved blood pressure control through tools and resources for clinical management. Expanding Medicaid coverage for self-measured blood pressure devices (SMBP) is critical, especially after childbirth.
As a part of this initiative, policies should support broader access to SMBP devices that are clinically validated and come with a variety of cuff sizes. Additionally, integration of these devices with healthcare systems should be improved to facilitate better patient monitoring and care.
Improve Clinical Infrastructure and Quality
There should be increased support for technological integration that allows patient data, like blood pressure readings, to be easily shared with clinical teams. Also, there should be more funding for physician-led care teams, which play a crucial role in managing complex conditions like hypertensive disorders during pregnancy. Policies should promote the use of standardized data for quality improvement and support research to identify effective interventions for hypertension and cardiovascular diseases during and after pregnancy.
To address concerns about physician bandwidth and enhance care in rural and underserved areas, the government should support hub-and-spoke models that connect primary care providers with specialists at larger hospitals, ensuring that pregnant women receive high-quality care without needing to travel far from home.
Managing hypertension is a critical piece of improving maternal health outcomes, but also overall women's health. Women with HDP have seven times the risk of developing chronic hypertension in the two years following childbirth. They’re also three times as likely to experience heart failure in that time frame. These risks alone are reason enough to promote education and monitoring of blood pressure.
And monitoring should not be confined to women with chronic hypertension or women that have already experienced pregnancy-induced hypertension. One in 10 women who develop hypertension as a result of pregnancy might not experience it until more than six weeks after childbirth, the typical end of standard postpartum care.
With these recommendations, the AMA is validating the essential role that technology generally, and remote patient monitoring specifically, has to play in addressing maternal health outcomes in the United States.
In addition to calling on the Administration to promote telehealth and home monitoring during pregnancy and postpartum, and address barriers to providing remote patient care, the AMA listed six other priorities for HHS to forward better maternal health outcomes:
- Ensure feasibility and implementation of Core Alliance for Innovation on Maternal Health patient-safety bundles and checklists
- Expand evidence-based programs to treat substance use disorder in pregnancy and postpartum (PDF)
- Address social determinants of health among patients who are pregnant or postpartum by enhancing medical-legal partnerships
- Ensure the acquisition of the right type of data
- Address physician workforce needs in maternity care
- Use new payment models to prevent maternal deaths.
Read the full letter here.
Interested in learning more about how Babyscripts addresses HDP and other maternal health risks? Join Babyscripts and the Privia Health team for our webinar Recognition & Response for Comprehensive Patient Care on June 5 at 12PM ET. Learn how the Privia team leverages their custom workflows, assessments and integration for seamlessly incorporating risk recognition and response into their maternity care workflow. Plus, Babyscripts offers a look into their new partnership model that provides intervention support for risks across the maternity care spectrum through assessment and referral.
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