Red tape restricts access to pregnancy tech for Medicaid patients

debtOr for low-income patients, the challenges of pregnancy are only exacerbated by the challenges of prenatal care. Dozens of doctor’s appointments, work and parental leave, parking and public transport costs.

“Even just getting an appointment can be a big problem,” said Kathryn Marko, an obstetrician-gynecologist at George Washington, a Washington, DC-based health care system. more fair.

For years Marko has worked with Babyscripts on that effort. Babyscripts is one of a handful of startups working with the health system to provide virtual maternal healthcare, especially for low-income patients, including those on Medicaid, who account for half of US births. These companies partner with several large healthcare systems to provide patients with their own blood pressure cuffs and vital signs, weight, mental health, and other factors that can affect maternal health. An app that monitors the is being delivered to your home.


Making maternal care more accessible can prevent dangerous complications that lead to costly emergency treatment. Doctors say that piloting the technology has significantly reduced hospitalizations. But the inconsistent Medicaid coverage policies that vary from state to state and the reluctance of insurers to pay for these technologies means that the patients who need them most may not always have access to them. In desperation, some health systems have either run into thin operating budgets, or run out of money in order to keep providing patients with the tools they believe have the potential to save their lives. I rely on subsidies.

Kelly Leggett, OB-GYN and Clinical Transformation Officer at Cone Health, North Carolina’s health system, said: “We really want insurance companies. [see] This is what the patient needs to be healthy. This may not be traditional brick and mortar. ”


Without broader coverage, these already vulnerable patients could continue to be excluded from programs such as Babyscripts, which said it aims to fill access gaps.

The need for better care is clear. Maternal mortality in the United States exceeds that of other high-income countries and is disproportionately high for black patients. Medically underserved patients often live in the obstetric care desert and are at increased risk of certain complications, along with factors such as systemic and medical racism.

Virtual therapy promises solutions to at least some of these structural challenges, starting with easing the burden of traveling to and from physicians. By recording and sending their own data to providers, patients can save several visits without affecting their health, making it easier to take measurements more frequently, Marko said. We actually have more touchpoints with patients.”

It also has the potential to enable clinicians to detect increases in blood pressure and weight gain or loss in near real-time. A slow but steady increase in blood pressure, or rapid weight gain, may indicate gestational hypertension or pre-eclampsia.

When providers detect these signs, they will prompt certain patients to come to the clinic as needed, Leggett said. For the past five years, Cone Health has provided access to her Babyscripts to thousands of patients annually. Babyscripts’ app stores your blood pressure, weight, and other measurements and sends them to your electronic medical record. Cone Health clinicians routinely monitor their pregnant patient records, and the Babyscripts app flags outliers and prompts patients to repeat the measurements or answer follow-up questions about headaches and dizziness. are trained to direct

“What we’ve found is that you can see someone start crescendoing early,” she said. can be increased.”

This technology is not designed to replace all prenatal visits, nor is it a complete alternative to in-person care. In some cases, such as limiting the timeliness of the information your provider receives, you may only be able to upload your readings when connected to the public internet.

But without the ability to measure at home, for some patients, “you’re going to have no insight into what’s going on,” Leggett said.

Many of Cone Health’s patients, 80% of whom have Medicaid or no insurance, miss some of their scheduled appointments for structural reasons, she explained. With this app, healthcare systems can safely schedule visitation appointments for patients who may miss their appointment. We get 30 points instead of 13, so we can intervene quicker,” she said.

Cost remains a challenge as insurers lag behind in paying for new technology services. Medical systems that purchase Babyscripts typically provide their patients with an app and a digital blood pressure cuff. This may come from Babyscripts or elsewhere. Providers typically prepay for apps and remote monitoring services, but they may cover a portion of the cost of medical equipment such as blood pressure cuffs. Babyscripts previously said the app costs about $300 per patient. When STAT asked about the current price range, the company said cost information is proprietary and declined to provide further details.

George Washington Hospital provides Babyscripts to thousands of patients annually, with DC Medicaid payer AmeriHealth covering the patient’s costs. “That cost is what we get [back as] It’s a return on investment,” Marko said.

Medicaid itself is a powerful tool for preventing serious pregnancy complications and improving baby outcomes. Research shows that public assistance is associated with lower maternal and infant mortality. During the pandemic, states were given the option to extend Medicaid coverage for pregnancy care for up to one year after giving birth. This is an option valid until 2027.

National lawmakers are seeking permanent extensions, but it is not clear whether those efforts will take hold at the federal level or whether states will choose to expand coverage. In April, the Caucus Health Brain Trust pushed a bill that would allow states to permanently extend Medicaid coverage for patients one year after giving birth. Democratic Rep. Robin Kelley and Rep. Lauren Underwood, who are pushing for greater coverage of virtual health care, have led the effort.

Still, some states have been slow to adopt remote patient monitoring. About 20 of those states have no technology coverage at all, and many others have limited use coverage, according to the Center for Connected Health Policy.

Health systems may need to work directly with payers if they want vulnerable patients to have access to these technologies, Marko said.

“We need to keep talking about this and demonstrating its value,” she said, adding that Babyscripts is most successful when implemented jointly with payers. However, local clinics and health systems that cannot find anyone willing to pay, or cannot afford to pay out-of-pocket, “cannot offer this to the patients you care for.”

This article is part of a series on Health Tech for Underserved People and was supported by a National Fellowship from the USC Annenberg Center for Health Journalism.

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