Bridging the gap: Uniting stakeholders through a digital ecosystem for holistic maternity care

Our mothers are dying. In 2021, the United States saw 32.9 maternal deaths per 100,000 live births. When stratified by race, those rates were two to three times higher for Black women.

Despite increased awareness and public dialogue, rates continue to rise. While our healthcare system allocates substantial resources towards healthcare, it’s designed to focus on clinical variables, which, according to some studies, impact only 20% of county-level variation in health outcomes. Social determinants of health (SDOH), however, affect as much as 50% (1).

How did we end up here?

Why is it that our system focuses on just part of what is needed to secure good health outcomes for our nation? To start, our health system is divided into different sectors — primary care, specialty care, mental health, and public health, to name a few — each with its own set of providers, protocols, and data systems.

These sectors typically operate independently, even though they share the same goal. It’s inefficient at best and destructive at worst, as lack of communication can result in conflicting diagnosis and treatment plans with detrimental consequences. Add healthcare payers and regulatory bodies into the mix, and the opportunity for missteps and duplicative procedures triples. Plus, misaligned incentives add an extra layer of complication. For example, payers are typically concerned about managing financial risk, while providers are primarily focused on clinical outcomes; regulatory bodies require lots of paperwork, while providers would rather focus their time on patients.

Maternal care: Expectant mother as centre of an interconnected ecosystem

Nowhere are the downstream negative effects of this fragmentation more observable than in maternity care. For decades, we’ve been hyper-focused on pregnancy as a clinical episode, without considering the unique individual involved and the context of their lives. The result is an over-medicalised system that is isolated from the social environment of patients and often rewards unnecessary utilisation and obsessive risk management.

We need to place the patient back at the centre of care, not just in a bi-directional relationship with each provider of care and healthcare stakeholder (OB/GYN, midwife, mental health specialist, health plan, care coordinator, etc.), but as the centre of an ecosystem that is interconnected.

Over the course of pregnancy, labour, and postpartum, a patient will see (or should see) multiple healthcare providers, and likely multiple kinds of providers (OB, nurse, midwife, lactation consultant, doula, mental health specialist, MFM, social worker, among others). Often, these providers of care exist in different medical groups or outside a single system of care, increasing the risk of communication issues and of vital information getting lost in transitions between providers.

The particulars of postpartum geography and the potential of technology

Continuity of care is especially an issue in the postpartum period, when the patient and new baby transition from maternity care to paediatric care, and Medicaid beneficiaries can be in danger of losing coverage depending on where they live.

This is where technology can make an impact. Connecting clinical, social, and environmental inputs through a single digital ecosystem can automate the hand-off from one professional to another, reducing friction and eliminating the coverage gaps that can occur with manual communication. The right technology can enable a provider of care to identify risk, and also to surface that risk to the appropriate member of the care team.

This solution can also automate interventions. Plugged into a single digital ecosystem, all stakeholders can input and access patient data, and can make better-informed decisions to improve quality of care. With data analysis tools, a digital ecosystem has the potential to sift through these inputs and surface actionable data to the appropriate member of the care team, closing the intervention loop by providing the necessary follow-through.

Imagine that a patient comes into an OB appointment and records a blood pressure reading outside the recommended thresholds. The OB might give them some literature and advice on managing BP and instruct them to self-monitor their BP from home, but their reach is limited — they can’t necessarily discover or address all of the factors that might contribute to high blood pressure.

When that data is inputted into the digital ecosystem, however, it becomes available to every stakeholder and can activate a targeted response. Many health plans have benefits to support their members, but identifying eligible members is difficult with care silos. A digital health ecosystem can automatically identify eligibility, and direct patients to the services available to them through their health plan.

Assisting an overburdened health system: The benefits of a digital health ecosystem

This doesn’t solve the lack of human resources to support these interventions, but technology can assist there as well. There is a vast network of digital health tools specifically designed to address risk asynchronously at scale, with limited human oversight.

Imagine the above example, but in this scenario the patient doesn’t make it to the OB appointment because they live too far away from the clinic or they can’t take the time off of work. Without identification, the risk that could have been treatable will worsen until it becomes a costly and potentially permanent issue.

Now, imagine that this patient has an internet-connected blood pressure cuff integrated with the digital health ecosystem. In this scenario, the BP data is still captured, and the response protocol can be activated, even without an in-person visit. They can be connected to digitally supported interventions or management programs, sidestepping the barriers of access that led them to miss their appointment in the first place.

Innovators have responded to the call for better maternity care tools with a national network of patient-facing, digital solutions that address issues of access to care and labour shortages. Without integration with providers and health payers, however, these solutions are only compounding the problem of care silos. We need a digital bridge to connect the supply to the demand in a way that is sustainable, cost-effective, and scalable.

By creating a unified digital ecosystem that connects all stakeholders, including healthcare providers, payers, and patients, we can bridge communication gaps, automate interventions, and deliver a more holistic, responsive, and communal approach to maternity care.

About the authors

Loral Patchen, PhD, MSN, MA, CNM, IBCLC, is scientific director in health services research at MedStar Health Research Institute and a senior faculty midwife attending at MedStar Washington Hospital center. Dr Patchen leads several innovative research programmes to promote improved health decision making, address social drivers of maternal health outcomes, and optimise use of digital technology in healthcare.

Anish Sebastian co-founded Babyscripts in 2014 with the vision that internet-enabled medical devices and big data would transform the delivery of pregnancy care. As the CEO of BabyScripts, Sebastian has focused his efforts on product and software development, as well as research validation of their product.