for low-income patients, the challenges of pregnancy are only compounded by the challenges of prenatal care: a dozen doctor’s appointments, time off work or babysitting, the cost of parking and public transportation.
“Even just getting to an appointment can be a big hassle,” says Kathryn Marko, an ob-gyn at George Washington Health System in Washington, D.C. Care is fairer.
For years, Marko has been doing this work with Babyscripts, one of a handful of startups partnering with the health system to provide virtual maternal care for low-income patients, including those on Medicaid , who account for half of all newborns in the U.S., the companies have partnered 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 may affect maternal health.
Making maternity care more accessible can, in turn, prevent dangerous complications that lead to costly emergency treatment. Doctors say they have seen significant reductions in hospital admissions when they try out the techniques. But inconsistent Medicaid insurance policies that vary by state — and insurers’ reluctance to pay for the technologies — mean the services aren’t always available to the patients who need them most. In desperation, some health systems are shrinking operating budgets or turning to grants to continue providing patients with tools they believe may save lives.
“We do this because we’re passionate about doing the right thing for our patients,” says Kelly Leggett, obstetrics and gynecology and clinical translation officer at North Carolina health system Cone Health. “We really want insurance companies [see] That’s what their patients need to stay healthy. It may not be a brick and mortar store in the traditional sense. “
Without broader coverage, these already vulnerable patients may continue to be excluded from Babyscripts and other programs that purport to close the access gap.
The need for better care is clear: the maternal mortality rate in the United States exceeds that of other high-income countries, and black patients die disproportionately. Medically underserved patients also often live in reproductive health deserts, which, along with factors such as systemic and medical racism, put them at higher risk for certain complications.
Virtual treatment promises to address at least some of these structural challenges, starting with reducing the burden of traveling to and from the doctor. Recording their own data and sending it to providers could save patients some doctor visits without compromising their health, Marko said, and make it easier for them to take measurements more often. “You actually have more touchpoints with the patient.”
It may also enable clinicians to detect increases in blood pressure and weight gain or loss in closer to real time. A slow but steady rise in blood pressure, or rapid weight gain, may indicate gestational hypertension or preeclampsia.
When providers see these signs, they can push specific patients in if necessary, Leggett said. Over the past five years, Cone Health has provided thousands of patients annually with access to Babyscripts, an app that stores blood pressure, weight and other measurements and sends them to their electronic health records. Cone Health’s clinicians routinely monitor pregnant patient records, and Babyscripts’ app is trained to flag any outliers and prompt patients to retake measurements or answer follow-up questions about headaches or dizziness.
“What we found was that we could see that someone had a crescendo very early on,” she said. “You can see a gradual increase in blood pressure, and then we can increase the dose of the drug.”
The technology is not designed to replace all prenatal testing, nor is it a perfect substitute for in-person care. For example, some patients without constant access to Wi-Fi may only be able to upload their measurements when connected to the public Internet, limiting the timeliness of information received by their providers.
But without being able to measure it at home, for some patients, “we have zero insight into what’s going on,” Leggett said.
She explained that many of Cone Health’s patients — 80 percent of whom have Medicaid or no insurance — miss some of their scheduled appointments for structural reasons. Using the app allows the health system to safely schedule fewer in-person appointments for patients who may not be able to make an appointment, “but we’ll have a touchpoint every week. We get 30 points instead of 13, so we can do it faster.” Intervention,” she said.
Cost remains a challenge, as insurers have been slow to pay for new technology services. Health systems that purchase Babyscripts will typically provide their patients with an app and a digital blood pressure cuff, either from Babyscripts or elsewhere. Providers typically prepay for apps and remote monitoring services, but sometimes payers cover part of the cost of medical equipment such as blood pressure cuffs. Babyscripts previously said the app would cost about $300 per patient. When STAT asked about the current pricing range, the company said the cost information is proprietary and declined to provide further details.
George Washington Hospital provides Babyscripts to thousands of patients each year, and AmeriHealth, a DC Medicaid payer, covers the costs for its patients. “This cost is what we get [back as] return on investment,” says Marko.
Medicaid itself is a powerful tool for preventing serious pregnancy complications and improving infant outcomes. Research links public assistance to lower maternal and infant mortality. During the pandemic, states have the option to extend Medicaid coverage for pregnancy care for one year after delivery — an option that will remain in effect until 2027.
State lawmakers are pushing for a permanent extension, but it’s unclear whether those efforts will work at the federal level or whether states will choose to expand coverage. For example, the health think tank of the Congressional Black Caucus pushed legislation in April that would allow states to permanently extend Medicaid coverage a year after a patient gives birth. Democratic Reps. Robin Kelly and Lauren Underwood led the effort, who have pushed more broadly for more virtual care coverage.
Still, some states have been slow to embrace remote patient monitoring — about 20 of them don’t cover the technology at all, while many others cover only limited use, according to the Center for Connected Health Policy.
If health systems want vulnerable patients to have access to these technologies, they may need to work directly with payers, Marko said.
“We need to keep discussing and proving the value of this,” she said, adding that Babyscripts is most successful when deployed in conjunction with payers. But community clinics and health systems that don’t find people willing to pay, or can’t afford to pay themselves, “can’t really provide that for the patients you care for.”
This story is part of a series on Health Technology for Underserved Populations, supported by a national fellowship from the USC Annenberg Center for Health Journalism.