The maternal health crisis remains unsolved across most of the U.S. Our nation reports the highest maternal death rate of any developed country in the world, and we are the only developed country to see maternal death rates rising in recent years according to World Population Review. Further, unhealthy mothers and families can lead to unhealthy infants and children, exacerbating the cycle of morbidity and mortality.
As a pediatrician, I have personally witnessed the emotional and physical toll that poor pregnancy outcomes such as prematurity has on infants and their families. I’ve treated newborns who are born early, and their families are unable to hold them for weeks after birth. I’ve witnessed the burdens of caring for a child with lifelong disabilities due to a premature birth or complications of pregnancy. It is excruciating knowing that many of these outcomes could have been prevented with better prenatal and maternal healthcare.
Despite these gloomy statistics and real-world experiences, two positive changes in maternal health are underway for mothers and their newborn children. Benefits expansion and technological advancements are poised to deliver better maternal outcomes and healthier pediatric populations.
This article provides a brief update on new legislative changes making a demonstrable impact on maternal health. In addition, two specific use cases for healthcare data are explored as effective ways to identify, treat, and connect at-risk mothers with maternal care providers to facilitate better maternal health outcomes and healthier children.
Postpartum Medicaid and CHIP coverage expands
On April 1, CMS announced an expansion of postpartum Medicaid and CHIP coverage from 60 days to 12 months under the American Rescue Plan (ARP). CMS further applauded four states for adopting the expansion last month. While it is up to each state to operationalize the expansion, this administrative move bodes well for improving maternal health in the U.S.
Extension of coverage is a tremendous step in addressing the maternal health crisis. Since 42% of all births in the U.S. are covered by Medicaid, and more than 50% of all maternal deaths occur in the 12 months after birth, a substantial number of mothers and babies can now have greater access to stable insurance and care when they need it most.
Increasing the duration of coverage postpartum is a critical step in the right direction, but there are persistent issues that will be exacerbated by an influx of patients interacting in a fragmented healthcare system. Technological advancements play a critical role in addressing some of the long-term problems contributing to the maternal health crisis.
Data closes maternal health gaps
Increasing access to perinatal care, ensuring early identification of pregnancy and complications, addressing health disparities, and eliminating maternal care deserts are primary tactics for states and healthcare organizations (HCOs) to take in the journey toward better maternal health. Participation in a structured state or national Perinatal Quality Improvement (PQI) Collaborative is another valuable approach. Undergirding all these strategies is the need for data.
Health data is fragmented, and members of obstetric and pediatric care teams often don’t have access to their patients’ data when they need it most. For example, a pregnant patient with a headache may visit a hospital, but her elevated blood pressure reading and diagnosis of preeclampsia may not reach the primary obstetrics physician quickly enough, if at all.
The improvement efforts mentioned above can’t be executed without high quality, timely, and actionable data that allows members of the patient’s care team to quickly know who needs help, where to allocate resources, and how to target efforts for greatest impact. Here are two specific ways technology can help.
Increase data interoperability during prenatal period
Inadequate prenatal care, consisting of late onset of visits and/or fewer prenatal visits, is associated with higher risk of prematurity and low-birth-weight infants, premature rupture of membrane, not breastfeeding, and rapid or precipitous labor. Ensuring adequate and timely prenatal care helps reduce the risk of prematurity, pregnancy-related complications and deaths, and leads to better health outcomes for mother and baby.
Ensuring patients receive adequate prenatal care requires the ability to collect, aggregate, and share relevant data points. This includes pregnancy status, the number and timing of prenatal care visits, and insurance coverage status of all people giving birth. Once maternity patients are identified, real-time data sharing and alerting technology can be used to notify clinicians across the care team about new and high-risk pregnancies, allowing those clinicians to triage and intervene in real time.
Insurance data is valuable to identify patients who do not have adequate coverage and might qualify for Medicaid to ensure access to prenatal services. Data from clinics, doctors’ offices, and hospitals tell a story for each setting, and when aggregated, paint the whole picture of maternal health. This enables care teams to quickly reach out to the highest risk patients and provide any necessary support.
It is also important for obstetric and gynecological providers to be aware of changes in a patient’s clinical status that may increase their risk for poor outcomes. These risk factors include new diagnoses or labs that indicate disorders such as preeclampsia or gestational diabetes. In addition, behavioral health conditions and socioeconomic or environmental factors are important risk factors to capture and share with appropriate members of the care team. For example, inadequate access to transportation is a reason that many mothers cannot access prenatal care in both urban and rural areas.
Interoperable data systems capture these risk factors in real time and ensure access to the right resources exactly when they’re needed. It is imperative that care teams are aware of risk factors that significantly influence pregnancies and outcomes. The postpartum period is equally crucial for the mother’s health, as indicated by the extension in postpartum insurance coverage mentioned above.
Access postpartum data over time
According to the Commonwealth Fund’s 2020 report on maternal mortality, 52% of pregnancy-related deaths in the U.S. occur postpartum. In addition to expanding Medicaid coverage, both clinical care teams and public health professionals need high quality, timely data to provide the best possible care to patients.
Common gaps include team members not knowing when patients deliver, which can cause delays in important services. Further, they may not be aware of visits to the emergency room or complications that require more intensive intervention such as postpartum depression or postpartum hypertension. Access to these types of data in the postpartum period is needed to monitor postpartum populations at the highest risk of poor outcomes.
Electronic health records and other systems should ensure postpartum data is accessible and shared by all members of the care team. Everyone must be aware of mothers at high risk so the right services can be delivered in a timely manner.
Expansion of maternal healthcare coverage, health information technology, and access to timely pregnancy data are needed to coordinate care and address maternal health in the U.S. Now is the time to bring patients and providers together through a digital infrastructure and break down the maternal health information silos that negatively impact maternal health.
Working together, we can improve maternal health outcomes by identifying patients and their risk factors in real time and ensuring appropriate members of the care team are alerted to intervene early and often throughout the pregnancy and beyond.