Research shows that there are vast racial disparities when it comes to maternal health in the U.S. Pregnancy-related mortality rates are two to three times higher for Black and American Indian and Alaska Native women than White women, according to the Kaiser Family Foundation. Barriers for maternal health have only increased following the Dobbs v. Jackson decision, which overturned abortion access via Roe v. Wade.
However, at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held last week, two healthcare leaders from the Centers for Medicare and Medicaid Services (CMS) and CVS Health stressed that reducing maternal health disparities is a top priority, with several strategies at play.
At the CMS Innovation Center, the focus is on encouraging states to expand Medicaid postpartum coverage, said Dr. Dora Hughes, chief medical officer of the center. Under the American Rescue Plan Act of 2021, states have the ability to extend Medicaid postpartum coverage to 12 months through a state plan amendment. So far, 29 states (including Washington, D.C.) have extended coverage to 12 months, and another 9 states are planning to do so.
“[Postpartum] is a time when surprisingly we see a number of preventable deaths after delivery,” Hughes said. “Many of these moms are lost to care after the actual delivery of the baby.”
CMS also implemented the “Birthing-Friendly” hospital designationwhich is awarded to hospitals that responded “yes” to two questions on the Maternal Morbidity Structural Measure. The first question asks if the hospital participates in a Perinatal Quality Improvement (QI) Collaborative, which are state or multistate networks of teams that work together to improve maternal care. The second question asks if the hospital implemented patient safety practices into these quality improvement initiatives.
At Woonsocket, Rhode Island-based CVS Health, women’s health — along with mental health and heart health — is also a focus, said Joneigh Khaldun, chief health equity officer of the company. One strategy for CVS Health (which includes its insurance arm Aetna) is leveraging doulas in its care delivery. Doulas are professional labor assistants who offer physical and emotional support during pregnancy, birth and postpartum.
Mothers who receive support from doulas are four times less likely to have a low birth weight baby, two times less likely to experience a birth complication and more likely to be able to breastfeed with their newborn, according to a study published in the National Library of Medicine.
“There’s this theme that community health workers, peer support, doulas are really important,” Khaldun said. “It’s evidence-based, they work. People really need that social support and people to walk with them on their healthcare journey. I had a doula for my first child and it completely changed my birthing experience.”
When implementing health equity initiatives, Khaldun stressed that improvements are not going to be seen immediately.
“I think there’s kind of this perspective that, ‘Okay, we’re addressing health equity. What’s the program and are we going to see those outcomes three months after the program was implemented?’” Khaldun said. “The reality is that the inequities that we see took centuries to develop. It’s not just about the healthcare system and health insurance and hospitals. It’s about the educational system, employment, housing, transportation, access to clean air and water … I just hope that people continue to prioritize health equity when it comes to their data collection and being intentional when it comes to quality and equity.”
Photo credit: Andrii Shyp, Getty Images