Red tape restricts access to pregnancy tech for Medicaid patients

For low-income patients, the challenges of pregnancy are only compounded by the challenges of prenatal care: dozens or so doctor’s appointments, time off from work or childcare, the cost of parking and public transportation.

“Even getting to appointments can be a big hassle,” said Katherine Marco, an OB-GYN at the George Washington, Washington, D.C.-based health system. Seeking technology like the blood pressure cuff to provide more equitable care.

Over the years, Marco has collaborated on that effort with BabyScripts, one of a handful of startups working with health systems to provide virtual maternal health care specifically for low-income patients, including Medicaid also covers about half of all births in the US. These companies have partnered with several large health systems to send patients home with their own blood pressure cuffs and apps that monitor their vital signs, weight, mental health, and other factors that affect maternal health. Huh.

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Making maternal care more accessible could prevent dangerous complications that lead to costly emergency treatment. Already, physicians say, they’ve seen significant reductions in hospitalizations in the wake of the technologies. But inconsistent Medicaid coverage policies that vary by state — and insurers’ reluctance to pay for these technologies — mean that the patients who most need these services can’t always get them. In desperation, some health systems are dipping into thin operating budgets or resorting to grant funding to continue giving patients equipment they believe could potentially be life-saving.

“We do this because of a passion for doing the right thing for our patients,” said Kelly Leggett, OB-GYN and clinical change officer for Cone Health, a North Carolina health system. “We really want the insurance companies [see] This is what his patients need to be healthy. It may not be traditionally brick and mortar.

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Without broad coverage, these already vulnerable patients could be left out of programs like BabyScript and others, which said they aim to close gaps in access.

The need for better care is clear: The maternal mortality rate in the US trails other high-income countries, and is disproportionately high for black patients. Medically underserved patients also often live in obstetric health deserts, which, along with factors such as systemic and medical racism, puts them at higher risk for certain complications.

Virtual treatment promises to address at least some of the structural challenges, starting with reducing the burden of traveling to and from doctor visits. Marko said recording their own data and sending it to a provider could save patients a handful of visits without affecting their health, and make it easier for them to take repeated measurements. “You’re really getting more contact points with a patient.”

It could also make it possible for physicians to track rising blood pressure and weight gain or loss in near real time. A slow but steady increase in blood pressure, or a rapid increase in weight, may indicate gestational hypertension or preeclampsia.

When providers see those signals, they prompt specific patients to come in when needed, Leggett said. For the past five years, Cone Health has offered thousands of its patients a year access to BabyScript, whose app stores blood pressure, weight and other measurements and sends it to their electronic health records. Cone Health physicians regularly monitor pregnant patients’ records, and the BabyScripts app is trained to flag any abnormal values ​​and prompt patients to retake measurements or ask follow-up questions about headaches or dizziness. prompts you to answer.

“What we’ve found is that we can see that someone started climbing early,” he said. “You can see this gradual increase in blood pressure and then we increase the medication.”

The technology is not designed to replace all prenatal visits, and it is not an ideal substitute for individualized care. Some patients who do not have constant access to Wi-Fi may only upload their measurements when connected to the public internet, for example, limiting the timeliness of the information their providers receive.

But without the ability to measure at home, for some patients, “we would have zero insight into what was going on,” Leggett said.

Many of Cone Health’s patients — 80% of whom are Medicaid or Aimard — miss some of their scheduled appointments for structural reasons, she explained. Using the app allows the health system to safely schedule short in-person appointments for patients who can’t have them, “but we’re getting one touchpoint every week. We get 30 points instead of 13, so we can intervene much faster.

Cost remains a challenge, as insurers have been slow to pay for new technology services. Health systems that buy BabyScript typically provide their patients with an app and digital blood pressure cuffs, which may come from BabyScript or elsewhere. Providers typically pay upfront for the app and remote monitoring service, although sometimes payers cover some of the cost for medical equipment such as blood pressure cuffs. BabyScripts has previously said the app costs about $300 per patient. When asked by STAT about current pricing ranges, the company said the cost information was proprietary and declined to provide more details.

George Washington Hospital offers BabyScript to thousands of patients a year, and DC Medicaid payer AmeriHealth covers the cost for its patients. “That cost is something that we get [back as] return on investment,” said Marco.

Medicaid itself is a powerful tool for preventing serious pregnancy complications and improving outcomes for babies. Research has linked public assistance to lower rates of maternal and infant mortality. During the pandemic, states were given the option of expanding Medicaid coverage for postpartum pregnancy care by one year — an option that remains in effect until 2027.

National lawmakers are pushing for a permanent expansion, but it’s unclear whether these efforts will happen at the federal level, nor whether states will choose to expand coverage. The Congressional Black Caucus’ Health BrainTrust, for example, pushed for legislation in April that would allow states to permanently expand Medicaid coverage for patients one year after giving birth. Reps. Robin Kelly and Lauren Underwood, Democrats who have pushed more broadly for more virtual care coverage, led that effort.

Still, some states have been slow to adopt remote patient monitoring — about 20 of them don’t cover the technology at all, and several others only cover limited uses, according to the Center for Connected Health Policy.

Marco said health systems may need to work directly with payers if they want vulnerable patients to be able to access these technologies.

“We need to continually talk about it and demonstrate value,” he said, adding that BabyScript is most successful when deployed jointly with payers. But community clinics and health systems that haven’t found willing payers, or that can’t pay for it themselves, “really won’t be able to provide that for the patients you care for.”

This story, part of a series on health tech for disadvantaged populations, was supported by a National Fellowship from the USC Annenberg Center for Health Journalism.

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