For low-income patients, the complications of pregnancy are only compounded by the complications of prenatal care: a dozen or more doctor visits, time off from work or child care, the cost of transportation and public transportation.
“Even just getting to appointments can be a big challenge,” says Kathryn Marko, an OB-GYN in George Washington, Washington, DC who focuses on technology like video calls, apps, and blood pressure cuffs to improve maternal health. treat it fairly.
For many years, Marko has been involved in this project with Babyscripts, one of the few startups working with health systems to provide health care for low-income women, including those on Medicaid, who account for half of all births in the US. The company has partnered with several major medical systems to send patients home with their blood pressure cuffs and apps that monitor their vital signs, weight, general health, and other factors that may affect women’s health.
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Making maternity care more accessible can help prevent complications that lead to expensive emergency care. Doctors say, they have seen a significant decrease in hospitals in testing the technologies. But inconsistencies in Medicaid laws that vary by state — and insurers’ reluctance to pay for these technologies — mean patients who need these services can’t always get them. Desperate, some health care organizations are running into tighter budgets or using grants to continue providing patients with what they believe could be life-saving equipment.
“We do this because we’re passionate about doing what’s right for our patients,” said Kelly Leggett, OB-GYN and chief medical officer at North Carolina Health System Cone Health. “We really need insurance companies [see] that this is what their patients need to be healthy. It may not be what is usually built with bricks and mortar.
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Without more disclosure, vulnerable patients may continue to be excluded from programs like Babyscripts and others that claim to close access gaps.
The need for quality care is clear: Maternal mortality rates in the US are higher than in other high-income countries, and are higher for black patients. Patients with medical conditions often live in maternal deserts, which, along with factors such as racial and medical discrimination, put them at greater risk for other complications.
Cognitive therapy promises solutions to some of the structural problems, starting with reducing the burden to and from the doctor. Recording their data and sending it to a provider can save fewer patient visits without harming their health, and make it easier for them to take regular measurements, Marko said. “You’re getting more information about the patient.”
It can also allow healthcare providers to see rising blood pressure and obesity or weight loss in near real-time. Slow but persistent high blood pressure, or obesity, can lead to severe gestational diabetes or preeclampsia.
When providers see those symptoms, they push patients to come in when needed, Leggett said. For the past five years, Cone Health has given thousands of its patients a year access to Babyscripts, whose software tracks blood pressure, weight and other measurements and sends them to their electronic health records. Cone Health’s doctors monitor the patient’s pregnancy history regularly, and the Babyscripts app is trained to highlight what is wrong and encourage patients to try again or answer questions about headaches or dizziness.
“What we’ve found is that we can see someone start falling early,” he said. “You see a gradual increase in blood pressure and we can increase the medication.”
This technology is not intended to replace all prenatal visits, and is not a substitute for personal care. Some patients who do not always have access to Wi-Fi can set their measurements when connected to the public Internet, for example, to prevent the time dependence of the receiver’s reception.
But without the ability to test at home, for some patients, “we would have no idea what’s going on,” Leggett said.
Many of Cone Health’s patients — 80% of whom are on Medicaid or uninsured — miss some of their scheduled appointments for a reason, he explained. Using the program allows healthcare providers to process fewer patients than they otherwise would, “but we’re finding a way to help us every week. We get 30 points instead of 13 for early intervention,” he said.
Pricing remains difficult, as insurers are slow to pay for new technology. Health systems that buy Babyscripts often provide their patients with the app and blood pressure cuffs, which can come from Babyscripts or elsewhere. Providers usually pay up front for the software and the remote monitoring service, although sometimes payers pay for some medical equipment such as blood pressure cuffs. Babyscripts previously said the program costs about $300 per patient. When asked by STAT about the pricing models available, the company said pricing information is proprietary and declined to provide details.
George Washington Hospital offers Babyscript to thousands of patients a year, and DC Medicaid payer AmeriHealth covers the cost for its patients. “That price is what we get [back as] return money,” said Marko.
Medicaid itself is a powerful tool for preventing serious pregnancy complications and improving infant outcomes. Research has linked humanitarian aid to reducing maternal and infant mortality. During the pandemic, states were given the option to extend Medicaid coverage for pregnancy care for one year after delivery – a plan that runs until 2027.
Lawmakers in the country are pushing for a permanent extension, but it’s unclear if that will happen at the state level, or if states will decide to extend coverage. The Congressional Black Caucus’ Health Braintrust, for example, pushed for legislation in April that would allow states to extend Medicaid coverage to patients a year after birth. Rep. Robin Kelly and Lauren Underwood, the Democrats who pushed for better coverage, led the effort.
However, some states have been slow to embrace remote patient monitoring — about 20 of them do not cover the technology, and many others only use it to a limited extent, according to the Center for Connected Health Policy.
Marko said health systems may need to work directly with payers if they want at-risk patients to have access to these technologies.
“We have to constantly communicate and show the importance of this,” he said, adding that Babyscripts is most successful when used in conjunction with payers. But community hospitals and health systems that haven’t found willing payers, or that can’t afford to pay for it themselves, “can’t really afford to provide this to the patients you care for.”
This article, which is part of the health technology coverage for underserved populations, was supported by the USC Annenberg Center for Health Journalism’s national fellowship.
