For low-income patients, the challenges of pregnancy are only compounded by the challenges of prenatal care: dozens of doctor appointments, time off from work or childcare, the cost of parking and public transportation.
“Even just getting to appointments can be a big hassle,” said Kathryn Marko, an OBGYN at George Washington, a Washington, D.C.-based health system that uses technology like video calls, apps and digital blood pressure cuffs to improve the mother’s health. the fairest care.
For years, Marko has partnered in this effort with Babyscripts, one of several startups working with health systems to provide virtual maternal health care, specifically for low-income patients, including those on Medicaid, which account for half of all births in the US. These companies have partnered with several major health systems to send patients home with their own blood pressure cuffs and apps that keep track of their vital signs, weight, mental health and other factors that may affect in maternal health.
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Making maternal care more accessible can prevent dangerous complications that lead to expensive emergency treatment. Already, doctors say, they have seen significant reductions in hospitalizations in piloting the technologies. But inconsistent Medicaid coverage policies that vary by state—and a reluctance by insurers to pay for these technologies—mean patients who need these services most can’t always get them. In desperation, some health systems are dipping into tight operating budgets or using funding to continue giving patients tools they believe could be potentially life-saving.
“We do it because of the passion we have to do 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 the insurance companies [see] that this is what their patients need to be healthy. It may not be what is traditionally brick and mortar.”
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Without broader coverage, these already vulnerable patients could continue to be excluded from programs such as Babyscripts and others that said they aimed to close gaps in access.
The need for better care is clear: Maternal mortality rate in the US it exceeds other high-income countries and is disproportionately high for patients of color. Medically underserved patients they often also live in maternity health desertswhich, along with factors such as 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 data and sending it to a provider can save patients a fraction of those visits without affecting their health and makes it easier to get the measurements more often, Marko said. “You’re actually getting more touch points with a patient.”
It could also make it possible for clinicians to spot escalating blood pressure and weight gain or loss closer to real time. A slow but steady rise in blood pressure, or a rapid increase in weight, may suggest gestational hypertension or preeclampsia.
When providers spot those signs, they push specific patients to come in when needed, Leggett said. For the past five years, Cone Health has offered thousands of its patients a year access to Babyscripts, whose app stores blood pressure, weight and other measurements and sends them to their electronic health records. Cone Health clinicians routinely monitor data on pregnant patients, and the Babyscripts app is trained to flag any abnormal values and prompt patients to retake measurements or answer follow-up questions about headaches or dizziness.
“What we found is that we can see someone starting to grow early,” she said. “You can see this gradual increase in blood pressure, and then we can increase the medication.”
Technology is not designed to replace all prenatal visits and is not a perfect substitute for personal care. Some patients who do not have stable Wi-Fi access may be able to upload their measurements only when connected to the public Internet, for example, limiting the time frame of information their providers receive.
But without the ability to measure at home, for some patients, “we would have zero knowledge of what was 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 structural reasons, she explained. Using the app allows the health system to safely schedule fewer in-person appointments for patients who might otherwise not make them, “but we’re getting one point of contact every week. We get 30 points instead of 13, so we can intervene much faster,” she said.
Costs remain a challenge, as insurers are slow to pay for new technology services. Health systems that buy Babyscripts typically give their patients an app and digital blood pressure cuffs, which may come from Babyscripts or elsewhere. Providers generally pay up front for the app and the remote monitoring service, although sometimes payers cover a portion of the cost for medical equipment such as blood pressure cuffs. Babyscripts has said before the app costs about $300 per patient. When asked by STAT about the current price range, the company said the cost information was proprietary and declined to provide further details.
George Washington Hospital offers Babyscripts to thousands of patients a year, and DC Medicaid payer AmeriHealth covers the cost for its patients. “That cost is something we take on [back as] a return on investment,” Marko said.
Medicaid itself is a powerful tool to prevent serious pregnancy complications and improve outcomes for babies. Research has linked public assistance to lower rates mother’s and infant mortality. During the pandemic, states were given the option to extend Medicaid coverage for pregnancy care for up to a year after delivery — an option that remains in effect until 2027.
National lawmakers are pushing for permanent extensions, but it’s not clear whether those efforts will be sustained at the federal level, or whether states will choose to expand coverage. The Congressional Black Caucus’s Health Braintrust, for example, pushed legislation in April that would allow states to permanently extend Medicaid coverage for patients a year after they’ve given birth. Representatives Robin Kelly and Lauren UnderwoodDemocrats who have pushed for more virtual care coverage more broadly led that effort.
However, some states have been slow to embrace remote patient monitoring — about 20 do not cover the technology at all and many more cover only limited use, according to Center for Related Health Policy.
Marko said health systems may need to work directly with payers if they want vulnerable patients to have access to these technologies.
“We have to constantly talk about and show the value in this,” she said, adding that Babyscripts is most successful when co-located with payers. But community clinics and health systems that haven’t found willing payers, or that can’t afford to pay for it themselves, “really won’t be able to provide that for the patients you care for.”
This story, part of a series on health technology for underserved populations, was supported by the USC Annenberg Center for Health Journalism’s national fellowship.
