MedCity News | David Fairbrothers

Apr 23, 2020 at 10:49 AM

Young African-American woman hugging and cuddling her baby boy or girl and nursing him. Mother embracing newborn son and expressing love and care. Modern illustration. Isolated. Vector.

For at least the past 20-plus years, live birth has been the leading cause of hospital admissions in the country. Even considering this fact, it wasn’t until 2019 that women’s health—maternity—finally became an area of focus for many sides of the healthcare sphere.

The ubiquity of smartphones has enabled a plethora of exciting developments on the consumer side. WildflowerMavenKindbodyOviaBabyscriptsBlooomlife, and others have developed phenomenally engaged and loyal followings. But the expectant mother is only one side of this coin. There is something about the face-to-face, doctor and patient relationship, that is extremely difficult to replace on a device.

Think about it. We are literally comfortable, within seconds, to share the most intimate (and often embarrassing) details about our health in the exam room. As Dr. Marty Makary says in his book, “The Price We Pay,” the physician’s “nudge” is an incredibly powerful influence on any patient. No matter how engaged and educated about the forthcoming events an expectant mother maybe, the words “it might be safer for the baby” when uttered by her obstetrician in the labor and delivery unit are tough for anyone to swallow. That type of news simply can’t be delivered on a screen.

Therefore, I believe 2020 is going to be the year when those building the infrastructure and tools that help women’s health providers improve their practice and performance are primed to take off.

Fueled by hundreds of millions of dollars in private equity, consolidation amongst formerly independent physician groups have placed the Ob-Gyn in a position of strength to both drive and participate in the upside created through improved outcomes for mothers and their babies while lowering the total cost of care. These organizations need technology, tools, and information to effectively manage their efforts. While incumbent electronic health record solutions may provide incredibly efficient mechanisms for running the day-to-day of the practice, they are woefully under-designed for the problems which these large organizations seek to solve. I believe it’s important to be relentlessly focused on the provider’s experience in the exam room while also tying together a precise plan of care for each patient.

Here are three areas where infrastructure is needed if we are to achieve the “holy grail” in maternity care:

  1. Assuring mothers are receiving the right amount of care.

Unnecessary testing inevitably leads to overdiagnosis. It’s a compounding problem. My wife and I saw this play out during her pregnancy. Non-indicated imaging led to an erroneous diagnosis (later confirmed to be false) which ended up increasing the overall cost of her pregnancy by over $2,500! The solution means incorporating evidence-based standards into every decision that providers are making and having visibility into the practice patterns of every provider.

  1. Helping providers and mothers make thoughtful decisions about where to receive care.

Variation in cost is wide. While some hospital visits may cost $8,000, others cost $40,000. Not only does this cost variation unnecessarily inflate the true cost of care, it places unnecessary onus on new mothers who have a health plan with a coinsurance requirement.

  1. Assuring mothers reliably receive preventative interventions to reduce the rate of catastrophic outcomes.

No mother should end up with a catastrophic outcome if steps could have been taken to prevent it. For example, not effectively managing a woman’s blood pressure or blood sugar during pregnancy can lead to catastrophic outcomes for both her and her baby. While bad outcomes can still happen even when everything has been done right, we certainly can do a better job assuring that 100 percent of mothers receive all applicable, preventative care.

The good news is peers in the industry are making positive headway in towards the “holy grail.” For example, Remedy Analytics and Clarify Health both help providers demystify the pandora’s box of claims data so that they can understand the impact of the care being provided to their patients outside of the walls of their clinic. Athenahealth continues to make investments to support partners, including Dorsata, who seek to build commercial models on top of the infrastructure used in hundreds of Ob-Gyn offices across the country.

UnitedHealth Group’s investments in both the Individual Health Record and their participation in the DaVinci project are steps in the right direction. Tools of this sort help providers with a more comprehensive view of the patient. Perhaps “Mary” has had a previous genetic screen ordered and resulted by another provider making a repeat order unnecessary. While the cost of genetic screening has plummeted in recent years, a repeat test that costs even $1 is unnecessary in this case. UHG providing access to the result benefits everyone – including the mother who likely carries a deductible and co-insurance.

For the gains we hope for to be realized, we must continue to support the business model for investing in these types of solutions. Sadly, unless there is a return on investment for delivering better quality and value, providers in the maternity space will struggle to adopt solutions that are effectively margin-eroding. Payers and employers must continue to innovate new payment models but as part of these efforts, must recognize the provider’s role and ability to drive transformation. For providers to deliver the kinds of results that our healthcare system needs them to, we need to make sure that they have the adequate incentives and financial wherewithal to acquire the necessary infrastructure to make these results possible.