At a glance, it's difficult to understand how the U.S. can have such deplorable maternal mortality and morbidity rates. The U.S. healthcare system has so many sectors and services -- primary care, specialty care, mental health, and public health, to name a few -- not to mention myriad health plans and regulatory bodies, and the greatest portion of its GDP is spent on healthcare.
Yet despite this, maternal health outcomes are consistently worsening.
Part of the issue is fragmentation that is preventing true patient-centric care. Yes, there are dozens of sectors focused on individual health, but they all operate independently, with different providers and protocols. Under this model, their impact is lessened, frequently producing redundancies or, worse, operating at cross purposes. Under this model, the patient is not at the center of care, they are the endpoint of many divergent lines of care.
To improve the poor maternal health rate in the U.S., the model needs to change. It needs bring these diverse sectors together, into a network or ecosystem with the individual patient as the organizing principle. That ecosystem must be responsive to the range of variables that impact health and well-being -- not just clinical variables that only affect about 20% of outcomes, but the social and behavioral issues that impact more than 50%.
This ecosystem vision invites a diversity of roles, decentralizes the power of traditional health care silos, and elevates the need for greater connectivity with ease in communication around the individual.
Of course, it's easy to envision but harder to accomplish. The U.S. is suffering from a massive shortage of healthcare providers and staff, making care coordination more difficult than ever. A non-clinical risk might be identified by an OB/GYN in an appointment, but communicating that risk to the appropriate care provider is more difficult ― with no guarantee that the resources are available to address that risk for the patient. With the traditional healthcare workforce crumbling, the urgency of providing maternity care within communities has never been more apparent.
Over the course of pregnancy, labor, and postpartum, a patient will see (or should see) multiple healthcare providers, and likely multiple kinds of providers (OB, nurse, midwife, lactation consultant, doula, mental health specialist, MFM, social worker, among others). Often these providers of care exist in different medical groups or outside a single system of care, increasing the risk of communication issues and of vital information getting lost in transitions between providers.
Continuity of care is especially an issue in the postpartum period, when the patient and new baby transition from maternity care to pediatric care, and Medicaid beneficiaries can be in danger of losing coverage depending on where they live. The patient themselves tends to be less engaged with their own health in this period, as the stress and responsibilities of new parenthood can be all consuming. And yet the data show that this period is the most crucial, with an estimated 60% of maternal deaths occurring the year following delivery.
Technology removes some of the barriers to continuity of care. Connecting clinical, social and environmental inputs through a single digital channel like Babyscripts automates the handoff from one professional to another, reducing friction and eliminating the coverage gaps that can occur with manual communication. Babyscripts enables a provider of care to identify risk, and also to surface that risk to the appropriate member of the care team.
Significantly, Babyscripts gives clinicians — who typically have the highest amount of touch points with the patient — the opportunity to connect the patient to external resources and address the social or behavioral risks that may surface within an appointment — some of the most urgent and impactful contributors to their health.
These resources include benefits available through the health plan, which are often are underutilized because the health plan is unaware of their member's risk or even the fact of their pregnancy. Babyscripts’ care collaboration model ensures that the health plan is receiving patient data as it’s being collected, including identification of pregnancy. It offers a pathway of communication between clinician and payer that enables the payer to engage with their member and make sure they are receiving available resources.
In addition to improving quality of care, this type of ecosystem functions as a data repository, relieving the patient of some of the burden of being their own record-keeper, and the tedium of repeatedly detailing their medical history to each new provider. Importantly, by offering information plus connectivity, digital technology fosters personal agency within this complex system and provides more space for people to engage at the time and cadence they choose.
Read more from these authors on this topic: To Improve Maternal Health Outcomes, We Need Collaborative Care