By Romilla Batra / For The Herald
Parents understand that having a baby involves expecting the unexpected; adjusting to new sleep schedules, interpreting cries and embracing mess. What they don’t expect are dangerous complications from childbirth.
Unfortunately, too many pregnant patients experience unexpected delivery and postpartum complications, known as severe maternal morbidity (SMM) events. SMM events include conditions such as sepsis, acute heart failure, acute respiratory distress syndrome, acute renal failure, thrombotic embolism and eclampsia. These often land people back in the hospital and can result in short- and long-term health consequences.
Blue Cross Blue Shield of America recently released a report that found startling racial and ethnic disparities in patients experiencing these health complications.
Overall, Black and Latine patients experience higher rates of labor- and delivery-related SMM events compared to white patients. The disparity between Black patients and their white and Latina counterparts widens in the postpartum period. One third of SMM events occur in the six-week postpartum period following hospital discharge. During this time, the relative difference in SMM rates between Black and white patients increases from 71 percent to 87 percent.
We should not accept these racial inequities in maternal health care as normal. Many SMM events are preventable, but eliminating these disparities requires change and effort from all of us. Health plans, the government, providers and community groups must all work together to improve data collection, expand access to care, and address social determinants of health. We must do better.
State-level data collection on maternal mortality already exists. Establishing data standards at the federal level can lead to more accurate measurement of risk factors, allowing everyone across the health care system to better understand the root causes of unexpected birth complications and collectively predict and prevent SMM events.
We know access to high-quality, affordable health care during and following a pregnancy reduces the incidence of SMM events. It is recommended that patients have at least two appointments with a care provider within six weeks of delivering their baby. However, data from Blue Cross Blue Shield of America suggests this standard follow-up care might not be happening, or be enough, particularly for patients at higher risk of a SMM event.
Most Premera Blue Cross plans cover home health nurse visits after a baby is born. This type of access can help remove barriers in keeping up with postpartum care. The high-risk maternity case management team at Premera also helps members get the personalized care they need throughout and after their pregnancy. In addition to direct referrals from providers, Premera has tools through proprietary algorithms and risk assessments to identify potential high-risk pregnancies for proactive outreach. Our maternity specialists are licensed clinicians who help with education, care coordination, readmission prevention, and other tailored support services to stay engaged with care and identify issues that need to be addressed by their health care provider.
Maternal health disparities will never be fully resolved without also addressing social determinants of health, or nonmedical factors that influence a person’s health. These could include housing or food insecurity, a lack of reliable transportation, or exposure to violence or trauma. These complex factors can not only significantly affect a patient’s overall health but can also act as a barrier in accessing health care that can help prevent SMM events.
Recognizing and helping members address social determinants of health is a key part of the Premera case management program. Our clinicians are empowered to identify and help solve potential barriers a member might face when seeking care. This could include connecting them to community resources, helping with communication to their provider, and closing gaps in a member’s care. Payers should continue to invest in benefits like case management, while looking for ways to better partner with community groups that have long, solid histories of doing this kind of work.
The data is clear. Black and Latina patients are experiencing the unexpected — dangerous, post-birth complications — at much higher rates than white patients. It’s time for them to be able to expect better, which will take all of us working together to create a better health system for all.
Dr. Romilla Batra is senior vice president and chief medical officer at Premera Blue Cross.
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