In the past five to 10 years, there has been an explosion in digital solutions in maternal health. And it’s not by coincidence – this is a space in desperate need of innovation to help providers turn the tide of worsening outcomes.
Since the 1980s, maternal mortality has more than doubled in the U.S., at-risk pregnancies have reached nearly ~30%, and costs have exploded to more than $118 billion. Today, the No. 1 surgical procedure in the U.S. is the c-section.
The digital evolution of women’s health is a major trend today. Technology is transforming obstetrical care by empowering clinicians, families and communities.
Veronica Adamson, head of the general care solutions business and maternal health champion at Philips, talked with Healthcare IT News about the evolution and its benefits, obstetrics and remote patient monitoring, and more.
Q. How can obstetrics and maternal health benefit from the digital evolution of women’s health?
A. Digital solutions offer hope in our maternal health crisis – they are an enabler for providers and payers to address both the clinical and economic aspects of this issue, not to mention patient experience for this important population.
There are three areas where I believe digital health solutions benefit obstetrics and maternal health.
Empowering expectant mothers with information they trust. One way to empower expectant mothers is to share with them information they need, from a source they trust, so they can follow their gut and act when something feels wrong. Too often, tragic outcomes are the result of moms not being heard, being heard too late or being afraid to ask a question.
Today there are a wealth of apps and telehealth services providing anonymous information and access to diverse communities – both of which play a key role in ensuring moms and their advocates are armed with the facts to act and have alternative pathways to seek care when needed. Some of these apps can also let a new mom know they qualify for care, opening the door to earlier preventative care – for example, for something like an undiagnosed ectopic pregnancy.
Lastly, apps enabling moms to tap into reimbursement for and find care from an ecosystem of caregivers – doulas, lactation consultants, mental health professionals are also transforming access to care. For providers and payers, partnering with these apps to provide access to their patients is a way to improve outcomes and patient satisfaction while addressing the underlying causes of systemic bias.
Empowering clinicians with the tools to meet moms where they are. New technologies, like remote fetal monitoring in the home, mobile low-cost hand-held ultrasounds, and apps that provide access to patients’ on-the-go blood pressure measurements are game-changers for at-risk pregnancies.
By meeting moms where they are, clinicians and payers can reduce this tension, improve outcomes and even lower costs by increasing their ability to predict and proactively treat at-risk patients. This has been particularly true during the COVID-19 pandemic, where bringing pregnant women into the hospital creates both risk and additional anxiety.
While these solutions do take effort to adopt, the same can be said for ambulatory ECG of continuous glucose monitoring, which are now both widely accepted.
Empowering clinicians, payers and legislators to advocate for maternal health innovations. Data is key to understanding the underlying causes of our maternal and neonatal outcomes and to demonstrating the clinical and cost benefits of innovation.
By providing these groups with the data they need to understand this, they can better advocate for maternal health. This is one of the key bills in “Omnibus.” Increasing adoption of obstetrics information management systems and patient-facing apps is generating massive amounts of data that researchers are just beginning to process. This data has already played a key role in providing essential information regarding the increased risk of COVID-19 to pregnant moms and their babies.
Q. Increased clinical risk with obstetrics and maternal health patients can lead to unpredictable visits, which you say leads to the need to continue innovating ways to touch more patients with remote monitoring capabilities. Please elaborate.
A. Today, an estimated one-third of women report they don’t make it to all of their prenatal visits, which can quite literally have dire consequences for both moms and their babies.
You may be asking, why would anyone miss their visits knowing how dangerous it is? But some mothers may not have a choice. About 50% of U.S. counties lack a single OB-GYN, which leaves many at-risk moms with an agonizing tradeoff – should they put their family’s livelihood at risk by taking time off from an hourly job, sometimes multiple times a week, to make their scheduled appointments? Or should they hope for the best and skip the perilous conversation with work, hours-long bus ride while heavily pregnant, and childcare expenses?
When these women can’t make their appointments, they miss the opportunity for preventative care, which can translate into many different things – emergency visits, unbilled sessions despite a long waitlist, unplanned c-sections that could have been prevented, days-long hospital stays in early labor, or in-patient care for preeclampsia and other complications.
With the remote monitoring solutions – whether it’s analyzing the fetus’ heart rate, a wearable that measures respiration of the mom, or in the near-future a patch that directly measures the fetus’ oxygenation – clinicians have another tool in their bag.
These solutions provide options for clinicians to monitor patients who live hours away who have fetal growth concerns, a postpartum hypertensive patient that is complaining of shortness of breath, or a patient in pain who shows up at a community center and may have ectopic pregnancy. Remote monitoring can also help isolated practitioners scale – something that has been a key problem as at-risk pregnancies increase unpredictably in rural areas.
Remote monitoring can also mean giving patients more space when they’re in early labor. Instead of strapping high-BMI moms to the bed and hovering over them to re-position the belt and cords as we’ve done in the past, clinicians can now opt to use cableless monitoring and control the fetal monitor from outside of the room, which can encourage typically faster and less resource-intensive natural labor.
Q. You say there is an increased need to monitor post-partum patients – mothers and babies alike – on the back of new reimbursement policies within the U.S. You add that the technology exists and is getting stronger every day. How can the industry encourage physician adoption and implementation and ensure payer support?
A. To help encourage adoption and implementation, it comes down to helping physicians afford to innovate with an ecosystem of both public and private partners to support them. Clinicians know better than anyone the importance of innovation, and in my experience, are very open to embracing it if they see the benefit to the patient.
That said, they must cope with the reality of a particularly cash-strapped, resource-short, litigation-heavy environment. If we can get these innovations reimbursed so that they help versus hurt their bottom line, make them easy to implement technically, and can demonstrate the impact on patient groups that look like theirs, we’ve won half the battle.
For example, monitoring blood pressure postpartum has been shown to be effective and well accepted by physicians. So, how can we help clinicians overcome the costs?
First, we must ensure they know about and can tap into reimbursement – such as 1115 waivers, state programs like in California or Texas, and new state telehealth laws that would require private payers or Medicaid to cover telehealth services, including remote patient monitoring, which were enacted in numerous states this year like Virginia, Kentucky, Oregon, etc.
About half of U.S. states have some form of private payer or Medicaid coverage for remote patient monitoring, which I expect will be expanded to postpartum hypertension in the coming years as Momnibus gains momentum.
Second, how can we ensure clinicians have the tools to advocate for reimbursement in their practice? One way is to partner to help them investigate their data to understand the compliance of their hypertensive patients. Ensuring they can speak to the benefit of the program on women’s patient satisfaction – often a central focus for the C-suite given their lifetime value – is another key area.
Lastly, it’s easy to forget just how time-strapped our providers are. Even if they can afford it and have buy-in, we need to ensure they can put it into place. We need to make these solutions scalable, simple to implement with EHRs, intuitive to use, as minimally disruptive to clinical workflows as possible, and “Lego-block” in nature since many patients have multiple comorbidities.
Regarding payers, most are already aware of the need and power of these digital innovations, and also actively starting to develop their own. For the approximately 50% of pregnancies covered by Medicaid, the state must be convinced of the clinical and cost benefit, which then cascades to the other payers. For employer payers, it’s a bit different. Demonstrating improved turnover, satisfaction and costs is what can swing the needle.
Payers also need an ecosystem of partners with expertise in the target population and technology to move from interest to execution. The United Healthcare, March of Dimes, Department of Health and Human Services partnership is a great example of this. In the future, I see room for established technology partners to also provide added benefits here.