Working to bridge racial gaps in maternal care
BY NONA TEPPER
Year after year, it’s the same story: The maternal mortality rate rises and the number of deaths among pregnant women of color are disproportionately high. In the U.S., Black women are three times more likely to die from pregnancy-related causes than white women. Even in low-risk pregnancies, Black women are more likely to receive a C-section. Such procedures have been associated with increased rates of infection, bleeding and hospital readmissions. And infants born to Black women are more than twice as likely to die before reaching their first birthday compared to white babies. A new national focus on these disparities has led a number of insurers to unveil programs aimed at bridging the gaps. Many of the initiatives target increasing access to maternal care for Medicaid enrollees, and adding benefits that address social determinants of health. Humana, Anthem, Cigna and UnitedHealth Group have all invested in—and utilized the services of—the March of Dimes, a not-for-profit that provides maternal care services. This year, Cigna also launched a new payment model that rewards physicians who screen patients for the social determinants of health and create action plans to target disparities. Healthfirst, a New York City-based not-for-profit payer, sponsored a social worker and community health worker at Mount Sinai Hospital to care for its Medicaid patients. Combined with heightened member education services and rewarding the health system for every postpartum visit completed, a study published in the American Journal of Public Health in March 2020 found that the initiative increased postpartum visits to 90% three months after delivery. “It just shows that when a health plan and a hospital work together, we can eliminate disparities,” said Errol Pierre, senior vice president of state programs at Healthfirst. Across the Blue Cross and Blue Shield network, plans have unveiled an ambitious national strategy that aims to halve racial disparities in maternal care over the next five years through a combination of data collection, scaling existing local initiatives and lobbying for state and federal policy changes. The Blue Cross and Blue Shield Association aims to scale local programs like its B’More for Healthy Babies initiative, a partnership with the Baltimore Health Department that educates and engages the community about weight-loss programs and unsafe sleep conditions, and has led to a 28% reduction in infant mortality. At a broader policy level, the association plans to lobby for increased data collection on racial health disparities in maternal healthcare. It also supports the Black Maternal Health Momnibus Act, a package of 12 bills introduced in the Senate aimed at diversifying the maternal care workforce, funding community health organizations and investing in programs to meet social needs, like improving access to nutritious food. BCBSA’s initiative stems from a pledge the 35 Blues plans made in June 2020 to hold themselves accountable for addressing racial disparities in health, said Kim Keck, president of the not-forprofit association. Insurers aren’t the only ones zeroing in on the problem. The Biden administration in April announced its inaugural “Black Maternal Health Week,” which included a series of investments to address what the administration describes as a “Black maternal health crisis.” Investments include allocating $340 million toward the Title X Family Planning program to improve access to reproductive and preventive health services. While these initiatives should be lauded, most are aimed at increasing access for low-income women of color, which doesn’t address the foundational problem of racism in medicine, said Kimberly Seals Allers, the founder of Irth, a Yelp-like mobile app that allows people of color to rate and review their prenatal, birthing, postpartum and pediatric-care providers. Irth aims to convert people’s individual experiences into quantitative data that payers and providers can use as a quality measure. In April, the startup launched its first pilot program and partnered with Ascension St. John Hospital in Detroit. As providers undergo training on unconscious bias for the first time—often sponsored by insurers—Seals Allers said, “There’s been zero accountability. Nobody is checking in to see whether that training literally improves the patient experience of care.” “It’s not race, it’s racism,” she added. “White people need to know that this previous narrative of problematizing Black women, acting like it’s their fault that they’re dying, they don’t go to the doctor, they’re overweight, those conditions have already been taken off the table. Even with all of that, we still are dying at a disproportionate rate.” She noted that, when researchers control for income and education, Black women’s maternal care and outcomes still fall far short of white women. The Kaiser Family Foundation reported that Black women with at least a college education face a pregnancy-related mortality rate five times higher than white women. Seals Allers called for insurers to hold providers accountable through value-based payment arrangements, and to avoid limiting enrollees to narrow provider networks. “One of the things that insurers can really do is to make sure that every Black person has choices and that they’re not limited to one provider,” Seals Allers said.