Inadequate maternal care is a national epidemic disproportionately affecting minority women and the 43 percent of U.S. births financed by Medicaid. To address the crisis, 30 large health systems are banding together to develop solutions. A central goal of the initiative, part of the Medicaid Transformation Project, is to improve care coordination throughout the entire pregnancy journey, which is typically very siloed and fragmented.
The Medicaid Transformation Project is a collaborative effort to transform healthcare and related social needs for the nearly 75 million Americans who rely on Medicaid and other vulnerable populations. To date, 50 new solutions are underway throughout the country across the Project’s first two phases in behavioral health and community-based care.
In May 2019, Healthcare Innovation Managing Editor Rajiv Leventhal interviewed Andy Slavitt, chair for the Medicaid Transformation Project, former acting administrator of CMS and general partner at Town Hall Ventures. “We need to change the way we invest in communities that are underserved,” Slavitt said, noting that the current healthcare system primarily focuses on and invests in commercial populations —"quite frankly, white, middle- and upper-class populations of people that are already pretty healthy and have very few issues accessing the healthcare system.”
Here are some of the grim statistics on maternal mortality in the United States:
• The United States is the only developed country in the world where maternal mortality rates continue to rise even though more than half of these pregnancy-related deaths are preventable.
• Black women and American Indian/Alaskan Native women are three to four times more likely to die of pregnancy-related causes than white women regardless of socioeconomic status.
• 50,000 women face severe maternal morbidity every year, a three-fold increase over the past 30 years.
• Women with Medicaid are 25 percent less likely to receive prenatal care and are more likely to have preterm births and low-birthweight infants compared to privately insured women.
The Maternal and Infant Health Initiative kicked off in July with an Action Forum in Philadelphia co-hosted by three Medicaid Transformation Project members: Jefferson Health, Geisinger, and Christiana Care Health System and led by AVIA. The launch signifies the start of a multi-month effort for participating health systems to identify, select, implement, and scale solutions that improve overall care for moms and infants.
At the Action Forum, 70 leaders from 30 health systems took the first steps toward expanding the capabilities necessary to close care coordination gaps and address some of the most common challenges that persist around pre-pregnancy, pregnancy, labor and delivery, postpartum, and infancy:
• How do you identify and engage pregnant women in the community early in their pregnancy to ensure adequate first trimester care and beyond?
• How can you use data to identify high-risk patients or co-morbidities like diabetes and hypertension more quickly and effectively to intervene with the right care at the right time?
• How do you create flexible care schedules for moms based on individual needs?
• How do you promote racial equity and eliminate disparities in birth outcomes between white women and women of color?
“Our health system has experienced pockets of success in addressing this challenge, as have our peers across the country,” said Janice Nevin, M.D., M.P.H., president and CEO at Delaware-based Christiana Care Health System, in a statement. “The value of being in the Medicaid Transformation Project is that we break down information barriers and learn from each other’s successes – and failures – together. It will take a truly collaborative and innovative effort if we’re going to drastically improve prenatal and postpartum care delivery in our communities and nation – and quickly.”
The Project analyzed more than 70 digital innovations in maternal and infant health to create a shortlist of nine solutions and 15 clinically validated care models, many of which were demonstrated at the Action Forum, including:
• Engagement platforms that can screen for social and clinical needs of mothers, initiate remote monitoring for patients in rural areas or patients with high-risk pregnancies, and collect self-reported outcomes to help monitor the health and well-being of mothers throughout the perinatal journey;
• Coordinated care networks that include virtual lactation consultants, clinicians, doulas, and midwives to address workforce shortages and access challenges experienced in urban and rural areas; and
• Disruptive care models like group prenatal care, which also addresses social needs like mental health, sexual violence, and food security.
Vikki Wachino, former head of the Center for Medicaid and CHIP Services at CMS, and Molly Coye, former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, as well as Slavitt, are lending their guidance to advance this work and are engaged in shaping the next steps of the initiative.