Lending Strength to Those Most Vulnerable
Kathryn Austin, Senior Manager, Healthcare Consumerism, AVIA
Nashville has earned a reputation as Nashvegas, with star-studded attractions and unique gathering spaces, like a smaller, southern version of Las Vegas. The annual conference of the American College of Obstetricians and Gynecologists (ACOG), held May 3 – 6 in Nashville, provided an opportunity for nearly 6,000 providers, payors, and policymakers to discuss trends in the field while enjoying the local scene. Despite Nashville’s festive environment, conference-goers faced up to the serious challenges of delivering high-quality care to the nation’s most vulnerable women.
We attended ACOG to share AVIA’s perspective on the shifting field of play in consumerism, the digital outlook for maternity care, and implications for Medicaid, the program that covers nearly half of all US births. Kathryn Austin, AVIA’s Senior Manager of Healthcare Consumerism, opened a half-day meeting, The Future of Obstetrics 2019, presented by Babyscripts, with insights from innovative health systems working to engage patients, optimize visit schedules, and reduce risk in complex pregnancies.
We also scoured the exhibit hall and clinical presentations, in search of fresh ideas and emerging consensus for providers to act in digital at scale. Our learnings will fuel upcoming conversations with 28 health system Members as the Medicaid Transformation Project (MTP) kicks off a Maternal & Infant Health Initiative today, May 13, 2019. Three themes that were frequently cited at ACOG will serve as a foundation for MTP’s collective action across the perinatal period and into the first year of life: building an informed, inclusive workforce; encouraging care continuity; and connecting care teams and social services.
Dr. Lisa Collier, ACOG’s immediate past president, opened the conference with a panel that encouraged providers to include community health workers (CHWs), doulas, and peer navigators on their care teams; listen to #EveryMomEveryTime; and turn data into actionable insights. Those practice changes delivered a 40% drop in ED visits among low-income women supported by CHWs and a 55% reduction in maternal deaths in California through a data-sharing collaborative.
Dr. Collier made maternal mortality her signature focus during her ACOG presidency. Conference participants were eager to address preventable deaths and near misses, motivated by a new CDC report indicating that 60% of pregnancy-related deaths could be avoided if “reasonable changes” occur at the patient, healthcare, or community levels.
Many new mothers, especially women using Medicaid insurance, neglect their own health while caring for their new baby. Thirty percent of mothers report a traumatic birth experience and up to 40% of new mothers experience postpartum depression, leading to bonding challenges. The field is encouraging more focus on the Fourth Trimester to coordinate care for the mother-baby dyad and integrate behavioral health services into medical practice.
If there was one theme woven into nearly every discussion, it was the challenge of delivering high-quality care to patients with complex needs in a siloed environment. Numerous speakers lamented the challenges of maintaining consumer trust due to high patient caseloads that limit time for deeper patient conversations. For the Medicaid population, continued attention to the social determinants of health, as well as trauma-informed care, will shift more provider-patient conversations from “what’s the matter” to “what matters” and “what happened.”
Payors and policymakers were actively engaged in these conversations as well and continue to introduce payment mechanisms that encourage care coordination to improve outcomes. In recent years, 16 states have introduced reimbursement structures to improve maternal and infant outcomes, including bundled and blended payments, performance bonuses, and sanctions for specific activities and procedures.
Participants left with a renewed sense of opportunity and urgency. We left encouraged by AVIA’s strategic direction, focused on the consumer, enabled by digital, powered by collaboration, and channeled through the Medicaid Transformation Project. Learn more about AVIA and the Medicaid Transformation Project at www.MedicaidTransformationProject.com or firstname.lastname@example.org.