The landscape of care has changed dramatically since 2020. Increasingly, healthcare is being delivered through a blended model of virtual and in-person models, and the change has been far from seamless. In times of transition such as this; those with low health literacy, limited opportunity, and other socio-economic vulnerabilities are the ones who will get lost through the cracks.
It’s more important than ever for payers and providers to take responsibility for Medicaid populations. Babyscripts works with over 30 Medicaid plans, and the majority of our provider network serves a high Medicaid population — in developing our offering to respond to the unique needs of these beneficiaries, we’ve learned a lot.
The Medicaid population is heterogeneous, and “barriers of access” cannot be reduced to a simple matter of finances or geography.
Medicaid covers a disproportionate share of women in underserved populations. In 2020, Medicaid covered 16% of nonelderly adult women in the United States, but coverage rates were higher among certain groups, including women of color, single mothers, and mothers who had not completed a high school education (1). These factors should inform product development.
Anxiety and a lack of trust can be a barrier of access — and the traditional solutions that work for some might not work for all.
Women of color are at greater risk of white coat syndrome: a condition in which a patient's blood pressure readings are higher when taken at the doctor's office compared to other settings, often due to discomfort, fear, or anxiety associated with doctors or the healthcare setting. Women of color — especially mothers — have less trust in doctors and hospitals than their white counterparts.
For Babyscripts, that means offering a product that captures accurate data outside of the office, and also establishes and strengthens the bonds of trust between patient and provider. It’s not enough to have accuracy in reporting — the patient also needs to be secure in the knowledge that their data is taken seriously and acted on. With Babyscripts blood pressure monitoring, patients can record their blood pressure from the comfort of their own space, and when that reading is outside the normal range, they receive a call from our call center, and a follow-up from their care team.
In a study using Babyscripts products, when BP was measured in-office, Black patients logged BP at rates 30 points lower than White patients. When BP was measured at home (ie, without having to worry about potential racial bias in the healthcare system), the rate of ascertainment for BOTH groups jumped to nearly 95%. Both groups had significantly higher rates of ascertainment, the gap between them was wiped out, and patients liked remote monitoring and found it easy to use. This was a primarily Medicaid population.
Digital health can also improve quality of care, which strengthens trust in the system. In-person care is limited by time and resources, especially under current staffing and physician shortages. Supplementing with remote patient monitoring can improve the patient’s perception of as well as the actual quality of care, and with a trigger system structured to catch adverse events, delivers equitable care in that the trigger response is totally objective.
“Holding a job” does not come with the same benefits for everyone, and earning wages versus earning a salary can be the difference in ability to access in-person care, especially if a woman lacks a traditional support system.
Single mothers often face unique challenges to accessing care — frequently they are the sole provider of their family, making finding childcare or taking time off of work a much bigger hurdle, especially if they are working a low-wage, hourly job. Rather than compromising job security, they might choose to miss routine appointments — especially if their financial risk is greater than their pregnancy risk. Missing these critical milestones for pregnancy readiness and postpartum recovery can lead to poorer birth outcomes and have long term effects on the health of mother and baby.
Remote patient monitoring is a critical safety net for these women who might be no-shows at appointments, allowing care providers to monitor for risk and keep mothers adherent to care guidelines and informed about their pregnancy, even if they aren’t able to come into the office. Through education accessible at any time through the myJourney app, and mental health and blood pressure risks monitored through our RPM solution, Babyscripts opens access to care for these patients. It also opens appointments for the provider team to be able to treat the most acute patients, reducing the wasted time and money represented by a no-show.
Access to technology is only useful if the information is user-friendly.
Against the prevailing narrative, access to technology or broadband is not the greatest barrier to digital health. Medicaid recipients access the internet at the same rates as other insured populations, and in many ways are more engaged with their smartphones, because they are disproportionately dependent on them.
However, Medicaid recipients are at high risk for low health literacy, which complicates delivery of care, even for something as simple as enrollment and understanding coverage and where to receive care. Simplifying content, providing content in multiple languages, offering live support to help patients navigate the system, and providing audio and visual supplementary aids are ways to address this barrier.
Babyscripts has a dedicated clinical content manager to ensure ongoing evaluation and improvement for the resources in our myJourney app, reviewing content for accessibility and inclusivity. Our content is written at a 5th grade reading level, avoiding common idioms that may not be accessible to lower reading levels or users with ESL, and all content is updated according to ADA requirements, to ensure that all of our users have access to our content regardless of their processing capabilities.
Loss of coverage leaves women vulnerable at a period of high risk.
There are some barriers that are tied to legislative and payer support, but digital health still has a role. In pregnancy, in many states, women are at risk of being dropped from coverage 6-weeks postpartum, leaving them without insurance in one the most vulnerable periods (when a large percentage of postpartum deaths or complications with long-term negative consequences occur).
However, there are reasons to feel positive. Many states have implemented extension of postpartum coverage, and policy makers at the state and federal level are advocating to expand it up through one year postpartum in states where it hasn’t been implemented. Maternal mortality review committees and data captured by companies like Babyscripts are a big part of pushing forward these legislative efforts by showing the benefits of extended coverage.
Babyscripts technology is affordable for providers and payers. For patients, it’s free and easy to use, as we’ve invested time and money into creating culturally competent and user friendly design and content. It has the potential to eliminate racial disparities in care, and save lives by uncovering complications before they occur.
1. Ivette Gomez , Usha Ranji , Alina Salganicoff, & Brittni Frederiksen. "Medicaid Coverage for Women." KFF (17 Feb 2022).