Improving Pregnancy Care & Outcomes for Low-Income Patients Through Technology

“For low-income patients, the challenges of pregnancy are only compounded by the challenges of prenatal care: the dozen or so doctors’ appointments, the time off work or childcare, the cost of parking and public transit.

“Even just getting to appointments can be huge trouble,” said Kathryn Marko, an OB-GYN at George Washington, a Washington, D.C.-based health system looking to technology like video calls, apps, and digital blood pressure cuffs to make maternal health care more equitable.

For years, Marko has collaborated on that effort with Babyscripts, one of a handful of startups working with health systems to deliver virtual maternal health care specifically for low-income patients, including those on Medicaid, which account for half of all births in the U.S. These companies have struck partnerships with several large health systems to send patients home with their own blood pressure cuffs and apps that keep tabs on their vital signs, weight, mental health, and other factors that can influence maternal health.

Making maternal care more accessible could in turn prevent dangerous complications that lead to expensive emergency treatment. Already, physicians say, they’ve seen significant reductions in hospitalizations in piloting the technologies. But inconsistent Medicaid coverage policies that vary by state — and a reluctance from insurers to pay for these technologies — means the patients who need these services the most can’t always get them. In desperation, some health systems are dipping into thin operating budgets or resorting to grant funding to continue giving patients tools that they believe could be potentially lifesaving.

“We do it because of the passion we have for doing the right thing for our patients,” said Kelly Leggett, an OB-GYN and clinical transformation officer for North Carolina health system Cone Health. “We really want insurance companies to [see] that this is what their patients need to be healthy. It may not be what’s traditionally brick and mortar.”

Without broader coverage, these already vulnerable patients may continue to be excluded from  programs such as Babyscripts and others that said they aimed to close the gaps in access.

The need for better care is clear: The maternal mortality rate in the U.S. outpaces other high-income countries, and is disproportionately high for Black patients. Medically underserved patients often also live in maternity health deserts, which, along with factors like systemic and medical racism, puts them at higher risk for certain complications.

Virtual treatment promises solutions to at least some of those structural challenges, starting with easing the burden of getting to and from the doctor. Recording their own data and sending it to a provider could save patients a handful of those visits without impacting their health, and makes it easier for them to take measurements more frequently, Marko said. “You’re actually getting more touchpoints with a patient.”

The technology isn’t designed to replace all prenatal visits, and isn’t a perfect substitute for in-person care. Some patients who don’t have consistent access to Wi-Fi might only be able to upload their measurements when they’re connected to public internet, for instance, limiting the timeliness of the information their providers receive.

But without the ability to measure at home, for some patients, “we’d have zero insight into what was going on,” Leggett said.

National lawmakers are pushing for permanent extensions, but it’s not clear if those efforts will take hold at the federal level, nor if states will choose to expand coverage. The Congressional Black Caucus’ Health Braintrust, for instance, pushed for legislation in April that would allow states to permanently extend Medicaid coverage for patients a year after they’d given birth. Reps. Robin Kelly and Lauren Underwood, Democrats who have pushed for more virtual care coverage more broadly, led that effort.

Still, some states have been slow to embrace remote patient monitoring — about 20 of them don’t cover the technology at all, and many others only cover limited use, according to the Center for Connected Health Policy.”

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Originally published by STAT News