Safer Births: How Maternal Health Is Changing

Maternal health is appearing at the forefront of healthcare policy change, digital innovation, and health equity efforts. With the maternal mortality rate in the United States exceeding every other high-income country, many healthcare providers and government officials are seeking solutions to this crisis. Subsequently, there's significant change in this field, crossing funding sources, care access, specialized training, health outcomes, and more. Below, we review some of these notable trends and key topics in maternal health.

Legislative activity

Several legislative measures have impacted the current and future state of maternal health funding, both at the federal and state level.

Omnibus bill

The omnibus bill, signed into law December 2022, included several healthcare provisions ranging from telehealth extensions to Medicaid coverage. This legislation allocates significant funding to support improved maternal health outcomes in FY 2023-2027. These allocations include the following:

• $45 million for improved data collection and care networks
• $50 million to support integrated health services in states and tribal organizations
• $15 million for accreditation for schools to train healthcare professionals on bias
• Funding for grants to provide training and telehealth resources for rural maternal and obstetric care
• Addition of pregnant and post-partum identification as part of public awareness campaigns
• Support to develop best practice guidance for maternal health
• Establish a permanent option for states to provide 12 months of postpartum Medicaid and Children's Health Insurance Program (CHIP) coverage, rooted in the findings revealed in a recent study where Medicaid expansion was found to reduce avoidable post-partum hospitalizations

Abortion access

Since the Supreme Court decision in Dobbs v. Jackson Women's Health Organization (2022), abortion access measures have varied greatly across the country. This month, South Carolina's Supreme Court voted to overturn its six-week abortion ban, citing a state constitutional violation of privacy. As states evaluate their abortion access, more court decisions such as these may occur.

These decisions are also impacting pharmaceuticals, as the FDA announced the unprecedented decision to approve the sale of the “abortion pill" in retail pharmacies as of January 2023. For the first time, retail pharmacies like CVS and Walgreens can apply for the ability to provide patients with medication, such as Mifeprex and Mifepristone (and generics), via a certified prescriber.

Mail-order pharmacies in states where the medications are legal are another channel for some. This channel will increase access to the medication locally and domestically—women may cross state lines to obtain the medication if they reside in states where the prescriptions are inaccessible.

Government reports show future priorities

In December 2022, CMS leaders held a convening to discuss priorities and strategies for addressing the country's maternal health crisis. Here, the birthing-friendly hospital designation and a doula care report were released.

Health Resources & Services Administration administrator Carole Johnson said,“Today's event reinforces the critical need for the investments included in the President's Budget to improve maternal and infant health outcomes and equity. We must continue to build a maternal health workforce that reflects the communities and voices of those it serves, support pregnant people not only in their clinical care but also in the community, and continue to strengthen federal-state partnerships in this work."

Digital health

The growing digital health sector continues to fluctuate, as the investment frenzy of 2020 and 2021 tapers. Clearer pictures emerge as applications with the strongest business case take lead. Among those are some mobile apps that focus on reproductive health and maternal health.

Cell-cultured breast milk

BIOMILQ is a biotech startup that produces human breast milk from cultured cells. The product is slated to reach the consumer market in 3 to 5 years as it seeks to enter the $52 billion infant formula industry. Possible benefits of BIOMILQ include:

• Proportions of protein, fats, and carbohydrates equal to organic breast milk
• Dairy-free option for sensitive diets
• Increased production, to nurture the 2 out of 3 babies who receive less than the recommended amount of breast milk in their first 6 months

Mobile apps

Emerging digital health platforms, such as the NURX app, LactApp, and Maven, make women's health more accessible on individual terms while eliminating the need for traditional in-person appointments. Among the benefits are:

• Ability to connect with licensed providers to support condition management for symptoms associated with PCOS, pregnancy, post-partum recovery, lactation support, and fertility treatments
• Support/therapy/coaching (privately and separate from medical insurance limitations) needed to navigate breast feeding, mental health, gynecological cancers and conditions, and changes encountered through menopause
• Medications, contraceptives, and treatment plans are accessible through digital mediums and can be sent via mail-order or directly to local pharmacies
• Increased access to care for those who are un/under insured and/or in care desserts where traditional in-person care is challenging to acquire

Quality transformation

Improvements to quality measures and evaluations can have a significant impact on maternal health outcomes. Recent updates are contributing to greater provider accountability.

Updated maternal health measures

Aligned to CMS's Birthing Friendly distinction, there are now new maternal health electronic clinical quality measures (eCQMs) introduced for the Inpatient Quality Reporting (IQR) Program. The measures will have a gradual effect, with voluntary reporting in CY 2023 and mandatory reporting in CY 2024. The services at the focus of the eCQMs are Cesarean Birth and Severe Obstetric Complications.

New Joint Commission maternal levels of care verification

Northside Hospital, Atlanta was the first hospital in the country to receive the Maternal Levels of Care (MLC) Verification. This verification, produced in collaboration with the Georgia Department of Health and the Joint Commission, requires a comprehensive on-site review of a hospital's maternal capabilities and policies, as well as a level of maternal care determination.

Modern maternity centers

Oula, a New York City-based maternity care center, recently secured over $19 million in Series A funding, indicating the urgency surrounding maternity care. Oula is in-network with major insurance providers and offers full-service pregnancy care, including prenatal, delivery, and postpartum services. In the first year of opening, Oula outperformed national, state, and city quality standards.

Oula's collaborative care model, which merges midwifery and obstetrics, could be a blueprint for future birth centers across the country. Multiple studies show that increasing midwives leads to decreases in maternal deaths, preterm births, cesarean births, and childcare costs.

Maternal health equity

Health equity is a main priority for the federal government, payers, and providers throughout the nation. Some of the recent and forthcoming changes in maternal health seek to close health inequities for current and future mothers.

CMS birthing-friendly hospital designation

CMS released a Maternity Care Action Plan with initial results to be published/available Fall 2023. This plan is a coordinated approach to reduce inequities during pregnancy, childbirth, and the postpartum period. Among its many goals, the plan will:

• Support equitable, high-quality care for all pregnant and post-partum patients
• Publicly display a designation on a CMS website to provide information to consumers on hospitals demonstrating a commitment to maternity care quality by implementing best practices advancing healthcare quality, safety, and equity for pregnant and postpartum patients

New platform for Black mothers

She Matters is a new digital health platform designed to support Black mothers that functions as both a telehealth resource and enterprise solution. On the consumer level, it connects women to certified therapists and culturally competent providers. She Matters accepts major health insurance and Medicaid. In addition, the platform is a learning management system (LMS) for whole hospital networks and physicians that offers coaching, certification, and continuing medical education (CME) credit, to make labor and delivery departments culturally competent.

Looking ahead, maternal health will continue to influence policy, innovation, and practice as the healthcare industry works to achieve a more equitable system and better outcomes.

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RTI Health Advance works with healthcare providers to design culturally competent solutions and improve maternal healthcare options. Contact us to learn how our consultants can support you.