COVID-19 infections are growing exponentially by the day, giving expectant parents three more things to worry about: receiving safe and adequate prenatal care, laboring by themselves in a capacity-constrained hospital, and maintaining or improving mental health in the precarious weeks around birth.
The United States was already well behind its peers in giving every baby and new mother a healthy start. The U.S. ranks 55th, just behind Russia, in maternal mortality, and 33rd out of 36 developed countries in infant mortality. The Medicaid Transformation Project (MTP) launched its Maternal and Infant Health Initiative last year in response to this national maternal health epidemic. More than 30 large health systems banded together to find and put forward solutions to this crisis in their communities. Those solutions are more important now than ever before, since the COVID-19 public health crisis is forcing providers to make quick moves to improve safety and the experience for expectant and new parents.
MTP found that there are several digital capabilities in the marketplace now that can sustainably improve the maternity experience and outcomes. Virtual care, remote monitoring, and digital navigation are examples of solutions that have strong results and can address the three biggest challenges that expectant and new parents are facing right now. They can also release the pressure valve for health systems and clinicians that are struggling to deliver high-quality care to everyone as the surge of coronavirus patients continues to rise.
Safe and adequate prenatal care. The days of 12 or more in-person prenatal visits are gone, at least for the foreseeable future. Expectant moms are seeking care that keeps them safe at home rather than in high-risk settings where germs are prevalent. Several companies now offer on-demand virtual care, available 24/7, for access to OB/GYNs, doulas, lactation consultants, and other specialists, as well as doctor-approved content and peer support.
Others offer chat- and text-based navigation services to answer patient questions, provide social support, and deliver care coordination support to clinicians. These types of solutions are increasingly important as quarantine and other isolating measures are put into place more commonly. Having a resource to answer questions and provide emotional support for expectant and new moms is so important for mental and physical well-being.
Remote monitoring is another solution gaining momentum. The ability to capture and relay critical data, such as blood pressure and weight, from internet-connected medical devices is a powerful engagement tool when combined with self-care education. Remote monitoring also removes access issues such as transportation and child care, barriers that may be even higher right now.
Safe and supportive labor and delivery. Birth, as we all know, is not a deferrable event, and every woman wants to be assured that she will not be alone when labor occurs. The surge of COVID-19 patients means that hospitals are beginning to plan for fewer available providers to attend to laboring patients as OB/GYNs and nurses are sidelined by illness or pulled into triage to care for patients with COVID-19.
Remote monitoring can play a big role here as well, by allowing caregivers who may themselves be working remotely (either while recovering from illness or as a result of quarantine) to assist with the monitoring of patients on Labor & Delivery. These "remote caregivers" can assist providers who are working on the front lines to ensure that laboring moms and their babies continue to receive optimal care.
Clinical decision support tools can also help by enabling fewer clinicians to monitor entire labor and delivery units and focus attention on the sickest and most urgent patients, while adhering to evidence-based practice guidelines. They can also provide support for those providers who do not regularly practice obstetrics (due to retirement or practicing in a sub-specialty, such as fertility) - but who are nevertheless asked to "step in and help" in an emergency.
Perinatal mental health. Parenthood is fraught with physical and emotional challenges in the best of times. Today’s patients face the compounding stress of living through a pandemic. They may be additionally stressed by higher unemployment rates, resulting in more families without insurance or moving to Medicaid. New parents are prone to be among the "worried well" as they adapt to life at home with their newborns and new realities.
Market-leading behavioral health solutions can support perinatal mental health by providing asynchronous care support, enabling virtual behavioral health visits, and managing care coordination between the care team and patient. Certain solutions offer online evidence-based stress management strategies, parenting tips, and other emotional support tools to support expectant mothers and their families in between visits with their providers. Other behavioral health platforms enable virtual psychiatry and therapy sessions, which are critical given the sweeping behavioral health provider shortage that disproportionately impacts rural communities. Finally, behavioral health care management solutions allow different members of the care team to seamlessly collaborate if necessary, including PCPs, behavioral health specialists, health coaches, the patient, and caregivers.
Sarah Carroll is the Director of the Medicaid Transformation Project at AVIA
