Babyscripts addresses the problems of care fragmentation with a patient-centric risk identification model that integrates the diverse members of the care team, activating the delivery of wraparound care. Babyscripts enables a provider of care to identify risk, and also to surface that risk to the appropriate member of the care team.
For Healthcare Teams
Babyscripts gives clinicians — who typically have the highest amount of touchpoints with the patient — the opportunity to connect the patient to external resources to address the social or behavioral risks that may surface within their clinical appointment, which are the highest contributors to maternal health outcomes.
For Health Plans
Many risk-related benefits are available to patients through their health plan, but often are underutilized because the health plan is unaware of the risk. Frequently, a health plan may only learn of a member’s pregnancy after the fact. Babyscripts’ care collaboration model ensures that the health plan is receiving patient data as it’s being collected, including identification of pregnancy.
The Status Quo of OB Care
Issue 1: Narrow Focus
Traditional healthcare is designed to attend to clinical variables, which impact only 20 percent of county-level variation in health outcomes. Social determinants of health (SDOH) affect as much as 50 percent. Despite spending the greatest portion of its GDP on healthcare of any developed country, the United States fails to properly address some of the greatest contributors to health outcomes.
Issue 2: Fragmentation and care silos
Healthcare has many sectors — primary care, specialty care, mental health, and public health, to name a few — each with its own set of providers, protocols, and data systems that operate independently of each other, which can lead to redundancies and ineffective care. Adding payers and regulatory bodies into the mix triples the opportunity for missteps.
Issue 3: Discontinuity of care
Over the course of pregnancy, labor, and postpartum, a patient may 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.
Babyscripts keeps the patient at the center of the care experience, enforcing the relationships between stakeholders and also enabling connection between the various sectors to ensure that nothing gets lost in transition.
Care Collaboration in Action
SBH Health System in the Bronx serves one of the highest risk populations in New York state. A large percentage of their maternity population experience complications related to diabetes, which are aggravated by socioeconomic challenges, specifically lack of access to nutritional food. To combat this, SBH works with a food service that delivers nutritious meals to at-risk patients. The clinical care team at SBH uses Babyscripts to drive utilization of this resource, inform eligible patients about the benefit and connect them to the service through the mobile app.
MedStar Health in Washington, DC serves a majority Medicaid population, many of whom qualify for WIC benefits. Using Babyscripts, MedStar conducted a survey with their clinic population to identify how many of their patients were aware of their eligibility and making use of the benefits, and learned that the resource was being severely underutilized. They found that patients encounter misinformation about eligibility, difficulties applying for coverage, and confusion about WIC approved foods. In response to the results, Babyscripts created a survey that identifies WIC eligibility, educates patients about the importance of proper nutrition and the availability of resources, and connects them to the right support services.
Quote from Rosalyn Carr Stephens, RN, MSN, Corporate Clinical Director of Population Health Clinical Operations at AmeriHealth Caritas:
“One of the areas where we’re most interested in identifying risk are those things that impact the outcome of a pregnancy and that period thereafter that are beyond the medical visit...so...using tools such as Babyscripts to really connect not only our team of care managers and care coordinators to identify what that risk is and address that risk as early as possible, but also to make sure that there’s a pathway to providing that information to others in the care team, whether it's the Ob, the folks at WIC, whether it’s everyone else that’s part of the care team…for that individual. [...] Risk is dynamic…being able to say what risks are coming into a pregnancy, what risks may be developed or addressed through the pregnancy, and then following through thereafter as that individual journeys into another area of their lives…that we haven’t stopped assessing risk identification just because there’s been a delivery.”
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