It’s widely known that the U.S. has one of the highest maternal mortality rates in the developed world, with minority women suffering the most from these statistics. As a country, we spend millions of dollars on healthcare, but the outcomes don’t even come close to reflecting that investment. Something has to change, because what we’re doing isn’t working.
Technology can’t solve every problem — but we really believe it can be a huge player in solving access to care issues. The smartphone has been almost completely adopted across the board. So how do we address technology in a clinical and scalable way to start addressing these issues of access?
Fifty percent of counties in the U.S. don’t have practicing OB/GYNs — that’s an obvious problem. What’s less obvious is that these problems of access exist in urban environments as well as rural. Just because there isn’t a 50 mile distance between a woman and her closest provider doesn’t mean there aren’t issues of access, we have a maternity care desert.
U.S. Maternity Care Desert
There’s a stark divide in U.S. cities in terms of availability of care, and when you start looking at the patients who need the help the most — Medicaid beneficiaries and enrollees — they’re mostly on the impoverished side, where there are no maternity wards and very few care options. The clinical problems, the poor outcomes — preterm birth, infant mortality, maternal mortality — these statistics are coming out of the areas where the facilities and infrastructure do not exist.
Obviously we can build new hospitals and train up new providers, but that’s a years-to-decades-long process. The question that led us to create OB Connect, a virtual solution for maternity care, was what we could do today, right now, to start solving these issues.
The Potential of Technology
What are the specific issues that technology can help address? It can circumvent logistical problems like transportation, for one thing. But it can also help manage complications like preeclampsia and gestational diabetes. If a woman isn’t attending her prenatal appointments — a major problem in the U.S. where as high as 30% of women don’t receive adequate prenatal care. She isn’t being monitored for blood pressure complications. At-home monitoring can begin to solve the problems of women slipping through the cracks because they aren’t able to attend prenatal appointments.
Blood-pressure monitoring also holds enormous benefits for the postpartum period, the time when most maternal deaths occur. The majority of these deaths come from blood-pressure related complications that manifest in the 6 weeks before a woman has her postpartum follow-up appointment. Remote monitoring can identify these complications as soon as they surface, and with this, OB Connect will eliminate the percentage of readmissions for postpartum hypertension from the national average of 3% to 0%.
Beyond Video Visits
We tend to think of virtual care only in terms of telehealth or video visits, but there are in fact many different kinds of virtual healthcare. Video visits are tethered to human contact — there needs to be another person on the other end of the phone. They don’t address the problems of the physician shortage. Supplementing human interaction with remote patient monitoring and mobile digital engagement is a way to circumvent the problem — to provide asynchronous care that doesn’t rely on the presence of the provider.
Any provider that works with Jollitot gets access to our customized mobile experience, which delivers educational materials and practice-specific content to the patient through the convenience of a mobile app. We also provide our OB Connect Kit, which include medical devices that allow the patient to capture their biometric data from home. This is a crucial efficiency right now, as providers and patients are trying to limit in-person interaction as much as possible due to COVID concerns.
OB Connect and Health Care Providers
Health care providers wanted to see how moms engaged with a mobile platform and remote patient monitoring, and what they found was patients had high satisfaction when using the app with remote blood pressure monitoring.
“I feel empowered by being able to see my data. I feel more comfortable/relaxed getting to track my stats week after week rather than having to wait for an appointment.”
These results directed them forward: how could we use OB Connect to reimagine prenatal care? What are the redundancies in prenatal care and what would happen if we used OB Connect technology to reduce the patient visit schedule? They found that not only did patient engagement and satisfaction increase, but that the reduced schedule was successful — there was no difference in patient outcomes from the traditional in-person prenatal visit schedule.
A Solution for the Underserved
Health care providers wanted to make sure that this platform would be successfully used by all of their patients — not just a small subset of low-risk patients, but also their most vulnerable patients. Providers had incredible success with screening for and identifying high-risk patients who otherwise might not have access to care.
Formerly, a lot of their prenatal appointments served as a way to check in with the mom, to provide her with evidence-based resources, and to ensure that she was getting the screening that she needed. Unfortunately, a lot of their vulnerable patients weren’t showing up to those visits. Now with the reduced visit schedule — and these visits are targeted around the main events of pregnancy such as the anatomy ultrasound and glucose screening — these prenatal care visits are more intentional. Because of remote monitoring and the app, they have biometric data at hand and they’ve already shared resources — the provider can concentrate on more high level conversations with their patients.
As part of the provider’s response to COVID-19, they’ve been enrolling all patients onto OB Connect at the beginning of their pregnancy, regardless of risk. Now, even though they’re not seeing as many patients in person, the provider can be assured that the patient is receiving the right resources, and the patient is able to monitor their biometric data to make sure the provider is not missing anything like preeclampsia.
Providers also used the app as a means of pushing out new resources related to the pandemic, like information on their visitor policy, which is constantly changing. They’re able to give their patients information about the reduced prenatal care visit schedule and assure them that it won’t affect outcomes. The provider is able to discuss the things they need to think about when the baby comes now with COVID. They have been able to push out a lot of new information about mental health and resources for domestic violence, as providers have seen a surge in those issues due to the pandemic.
This universal enrollment will continue even after COVID, as both patients and providers have experienced the benefits of keeping a closer eye on the patient through remote monitoring — we’re able to allow the patient to engage in her own care to an extent she couldn’t before.
Patient Case Study
Providers are sold on the potential of the platform from the very beginning, but it was patient case studies that really solidified their belief in the program. This patient was enrolled very early on in her pregnancy — she was taking at least weekly, sometimes more, blood pressure readings (patients take at least one a week) — and every reading was normal. She had an uncomplicated, repeat C-section, with a normal discharge. On postpartum day 4, she was noted to have increased swelling and elevated blood pressure. With the elevated blood pressure, a trigger alert was sent through the OB Connect cloud to the provider. The patient was instructed to return to the hospital, ultimately diagnosed with preeclampsia with severe features, and received postpartum magnesium for 24 hours and hypertension medication. She was discharged and her providers were able to titrate her blood pressure medication remotely through telehealth and OB Connect. At 11 weeks postpartum, the patient was normotensive, and her providers were able to wean her off of hypertension medication.
“OB Connect helped me control my anxiety; I knew I had the tools to keep track of my health. Without OB Connect, I may not have realized I was having serious issues and delayed getting the care that I needed. OB Connect potentially saved my life.”
This is one of several similar case studies that providers have collected through their research in precision prenatal care.
Incorporating the Payer to Provide Virtual Care
As providers look forward to where they want to go, it’s not only identifying high-risk conditions, but also targeting where in pregnancy patients need interventions — that is, moving towards precision care. Providers plan to use the OB Connect platform more extensively to reduce disparities in their counties, to ensure access to universal monitoring for high-risk conditions, and anticipate which patients need resources much earlier, which is where the relationship with payers comes in.
Providers are committed to solving disparities in care by making technology available to anyone regardless of payer — regardless of commercial, Medicaid, uninsured — but not every health organization has the budget to invest in these initiatives and provide these tools to their patients.
At the end of the day, these virtual tools help deliver care but also reduce cost and dramatically improve outcomes, at a huge benefit to the payer. So we plan to involve large Managed Care Organizations (MCOs), like Aetna and UnitedHealth, that work with the provider customers to subsidize or sponsor the cost of OB Connect for their members.
We plan to create a program called Joint Deployment, which pulls the payer, the provider and the patient onto the same tech experience. We think this is the future of how digital health gets integrated into the delivery of care, and that care coordination is one of the best things that can happen to move outcomes. There are many resources out there, but right now they’re not delivering the impact that they should because they’re functioning in siloes. The insurance companies have social workers and people on the ground, but they’re not talking to the provider teams and getting the point of care data and insight that they need to really address patient risk.
Through the Joint Deployment Program, the payer partners have subsidized the cost of:
• High-risk remote patient monitoring to identify and triage complications
• Bi-directional chat to screen for social determinants of health
• Mental health surveys and depression screening
• Connection to community resources (provided by the payer) to address environmental risk
• Substance use disorder experiences focused on opioid addiction, with connection to community support and interventions.
The benefits of these social, clinical, and mental health risk identifications are immediate and obvious — better attendance to prenatal care appointments, identifying at least 2 social risks or barriers to care, improving outcomes, and so forth. When you empower a patient with a program like this, you give them more ownership over their care.
The importance of innovative solutions such as OB Connect and others is becoming increasingly clear across the country, and policy-makers are starting to wake up to what they can do to accelerate adoption. The Washington DC Council just passed the Postpartum Expansion Act — a really big step for the space. The bill expands the coverage possible in the postpartum time period beyond the one visit, six-week timeframe to really give moms more support after they deliver.
One of the other innovative approaches is a digital health mandate that mandates reimbursements for digital interventions at the point of care. This is a huge step for those who have been waiting for the day that telemedicine would have parity with in-person visits — American College of Obstetricians and Gynecologists (ACOG), for example, has long specified that giving women options in their care is incredibly important, especially during the postpartum time period.
Now these changes aren’t just happening on the innovative practice side, but also legislators are recognizing that digital health tools can impact outcomes and solve many disparities in their respective geographies. It’s a really exciting time for the space, and an encouraging move forward for the wellbeing of mothers around the country.