The maternal health crisis: Challenges, opportunities and solutions for moms, infants and families

October 12, 2021 SmartBrief Season 1 Episode 3
The maternal health crisis: Challenges, opportunities and solutions for moms, infants and families
Show Notes Transcript

The COVID-19 pandemic cast a spotlight on socioeconomic health disparities in this country, but those disparities have been evident and especially acute for years among mothers and infants in this country.  And poor maternal and infant health outcomes are especially pronounced in populations of color. Venicia Gray, senior manager for maternal and infant health for the National Partnership for Women and Families, and Dr. Sandhya Gardner, chief medical officer of Wellframe discuss the drivers of poor maternal and infant health outcomes, the outsized impact of systemic racism, what moms and babies need for good health and solutions to the maternal and infant health crisis. 

This episode is brought to you by Wellframe.


Learn more about this issue from the National Partnership on Women and Families

Melissa Turner  0:03  

Hello and welcome to touch points, a conversation about care connection and costs in US healthcare. I'm your host Melissa Turner. I'm content director for health care and life sciences at SmartBrief. SmartBrief is a publisher of digital newsletters for professionals and creator of this and other shows in our series of smartpod podcasts. In addition to overseeing production of SmartBrief healthcare content, I'm of course also a consumer of health care just like those of you listening. Together in each Touchpoints episode, we'll explore the issues that make health care hard for all of us, and we'll discuss how health plans, health care providers and their partners in the health care ecosystem can make it easier. Thank you for joining us.

Melissa Turner  0:55  

Touchpoints is sponsored by Wellframe. Wellframe works with health plans to reimagine member relationships. Their team believes that health plans are in the best position to lead the charge into the world of digital health management. Let Wellframe be your partner in improving member engagement and outcomes. Learn more at

Melissa Turner  1:15  

Today our topic is health equity with a special focus on maternal and infant health. We have a great team here for this discussion. First, I'd like to welcome Venicia Gray, senior manager for maternal and infant health with the National Partnership for Women and Families. Venicia has also served as associate director of federal and state affairs at the March of Dimes, and she brings a wealth of additional policy expertise and experience at the federal and state levels to her work on these issues. Welcome to Venicia. 

Venicia Gray  1:43  

Thanks for having me. 

Melissa Turner  1:44  

I'm also pleased to welcome Dr. Sandhya Gardner, who is Chief Medical Officer at Wellframe where she leads Wellframe's health equity initiative. Dr. Gardner also served as a practicing OB/GYN physician in the Boston area, where she spent more than a decade working with low income mothers. Welcome, Dr. Gardner. 

Sandhya Gardner  2:01  

Thank you, Melissa. Delighted to be here. 

Melissa Turner  2:03  

Well, really excited to jump into this conversation. Certainly it was a conversation that was ongoing prior to the pandemic, when the maternal health crisis was getting an increasing level of attention. Maternal and infant health outcomes in this country are substantially worse than in other affluent nations, women and children of color are especially at risk. I'm curious to start us off, what has the pandemic meant for these families? And these statistics? Venicia, why don't you start us off? 

Venicia Gray  2:32  

Sure. Thanks, Melissa. So you know, our countries spend hundreds of billions with a B yearly on maternal and infant care. And the crisis disproportionately impacts the lives of black and indigenous people and families. So even before the pandemic, right, our communities were faced with multiple crises, it was economic, there was escalating racial violence, and really COVID-19 really compounded those existing concerns. So for families, it means that now more than ever, decision makers really have to work to rebuild a better health care system, an economy and a nation that really ensures that the needs of mothers and babies, particularly babies of color, and women of color, are placed front and center. So while there's like a spotlight and growing interest to combat, the maternal health crisis, there are still key strategies we believe remain largely overlooked. It includes addressing really their structural based inequities and unmet social needs, and really working to dismantle the racism, misogyny that drives them. 

Venicia Gray  3:38  

So yes, we should absolutely continue ensuring that maternity care is equitable, and accessible and respectful. But that only takes us so far. So we really believe at the partnership that attaining optimal and equitable outcomes that all birthing people and their babies really deserve, has to include addressing the structural drivers that really undermine all of our health. So, for us, it's meant really literally life or death

Melissa Turner  4:05  

We will continue talking about those drivers in a moment. Dr. Gardner, I want to ask your perspective on the situation for women and infants through the pandemic 

Sandhya Gardner  4:15  

Thank you, Melissa, and thank you Venicia for those comments. Obviously, this had been a crisis for years before, pre COVID and, and we were drawing attention to it, rightfully so. But as you all know, we've seen it amplified even further by the pandemic, particularly around some of the issues involving social determinants of health and mental health. And it's raised some new challenges, you know, whether it's medical and social needs that are arising. At the same time, we're asking people to isolate from community and family support. You know, when we look at statistics from our own company at Wellframe, when there was the first wave of COVID back in April of last year, we saw almost a tenfold increase in the number of messages that members were sending to their care managers around coronavirus related social determinants of health barriers like food insecurity, access to childcare, or worries about unemployment and issues and concerns around social isolation and things like loneliness. 

Sandhya Gardner  5:13  

Even still, as we've kind of, you know, progressed through the last 18 months, and we look at more recent data from Wellframe, we're finding that one in five patients are still reporting that they have social determinants of health concerns since the pandemic, these are impacts that have, you know, kind of compounded the issues that existed. But I would also say on the flip side, what the pandemic has done in terms of, you know, maybe the silver lining is that in the midst of all of the adversity that we've been facing, it's kind of spurred on some creative solutioning when it relates to things like rapid innovation about how we might think about reaching and serving patients, and addressing some of the fundamental issues like access that Venicia was pointing out. So looking forward to talking a little bit more about those.

Melissa Turner  5:54  

Yeah, absolutely. I think we will dig into a lot of the points that both of you raised as we continue this conversation, I do want to just sort of pause and take a moment to define health equity. So according to the CDC health equity is achieved when every person has the opportunity to attain his or her full health potential. And no one is disadvantaged from achieving this potential because of social position, or other socially determined circumstances. So I want to ask each of you to dig into this conversation now about the drivers of health inequity, and I'm particularly interested in do the drivers differ for women, moms and infants, relative to other populations? Surely there are some crossover, but let's really try to zero in on this population. Dr. Gardner? 

Sandhya Gardner  6:38  

It's a good question. And, you know, clearly the answers is complex, the factors that are driving these disparities, you know, like many things in healthcare are not easy to solve for. But in maternal health, specifically, I would say that, you know, the experience and the outcomes of this population are shaped by sort of the confluence of race and gender, you know, poverty and other social factors. But, you know, sort of summarizing what I see as some of the key issues that are driving these disparities, they really centered around four main themes. The first is social determinants of health and some of the barriers to accessing care. The second is around access to both care, but also to adequate information. Third, is around bias and some of the systemic racism that we see. And then the fourth is just around insurance and access to insurance and equitable access to insurance. Sort of double clicking on the race and bias issue, even when you start to control for some of the issues that we've talked about around in insurance status, or income level, or age or pre existing conditions, people of color are still like less likely to receive routine medical procedures and they experience the lower level of care and quality of care. And when you talk to majority of women, they report feeling that they've been treated unfairly because of their race. And well, many of the drivers and the issues that we've you know, sort of raised are they do span across populations, it is particularly harmful and poignant, given the risk, the acuity and the downstream implications that mothers and babies have during this particular phase of their health care. 

Melissa Turner  8:11  

Thank you, Dr. Gardner. Venicia, I want to ask if you'd like to add to that in terms of drivers of health inequity, you already spoke eloquently about a number of them, what is most important in your view for women and infants? 

Venicia Gray  8:23  

Yeah, I believe, you know, Dr. Gardner stated so well, but it's really interconnected issues that impact our health. So it's nothing inherently different about communities of color that explain these devastating outcomes. You know, these inequities are the foreseeable consequences of historic and ongoing structural racism that has really fed the social and economic factors that increase the risk of illness and death. So some social drivers of health include anything and pending a person's ability to attain their full health potential. It's a broad scope, where you live if you have consistent access to nutritious food, reliable transportation, access to paid and sick leave, housing, freedom from racism, and racist acts, they all directly impact a person's health. And there's a long well documented evidence in history that these drivers impact the health of communities of color far more than other populations. So it's, I think, both for the National Partnership and along with one of our partners, the National Equity Collaborative, we recently released a series that was really drilling down on saving the lives of moms and babies that specifically spoke about addressing both racism and socio economic influence of health that really connect the dots between how social drivers and their factors really affect maternal and infants and the outsized impact these factors have on black and brown bodies in particular. So I think there is kind of like a no one size fits all thing, but just across anything that's impacting our health, it's really important to address and really kind of think about a little bit more more closely. 

Melissa Turner  10:06  

Thank you Venicia. I think we will come back to some of those solutions in a moment. I want to shift our conversation for a moment and talk about what is needed to support optimal health outcomes for moms and babies. And you know, this could be across populations. And then in particular, the populations we're talking about today. Venicia, what's most important? 

Venicia Gray  10:27  

Yeah, I love this question. So recently, the Raising the Bar expert advisory group released a statement that defined and created and sustaining optimal maternal health and in it, the group says that optimal maternal health is rooted in good health status prior to pregnancy, and is anchored in health communities and healthy families that are enabled by health supportive structures, policies, programs and practice. So that's a big mouthful, right? But really, optimal health includes the health and the wellbeing of a birthing person and their infant. So it includes their entire body, their physical health, their mental health, and their social well being, which really means that where they're born, where they grow up and live, work and play and age, those community structures that are supporting directly, their physical and mental health is promoting their agency, their autonomy and their ability to thrive. So all of this applies before, during, and after the process of childbearing. And really also, I think it's really key to include that it extends to productive justice and bodily autonomy that's free from bias, racism and discrimination. But that also means that you know, there's no one size fits all solution. So many industries have a part to play. So for instance, federal and state and local decision makers really should think about maybe providing, you know, funding that support the establishment of community based and leading models of reproductive health care, thinking about respectful and trusted and culturally congruent care that really supports and is grounded in a reproductive justice framework. And also, when you think about incorporating non clinical providers such as doulas, and community health representatives, and other community health workers, including their peers, so requiring and thinking about just some of those things, just like a touch point. And I'll just stop there. I think I'll stop there.

Melissa Turner  12:25  

That's, that's plenty to work with, for sure. And I think, you know, as you were talking, all I could think was it, it takes a village, and I think the picture that you paint is, is before, during, and after pregnancy, it takes a village and all of these stakeholders that you mentioned. Dr. Gardner, what would you add? 

Sandhya Gardner  12:41  

I so appreciate Venicia's answer, you know, particularly around supporting sort of the whole person and all of the multitude of factors that make up our health, you know, clinical, social, emotional, etc. So, that really resonates. So I would echo that. But in addition, I think, you know, any kind of effective solution, while this is, as Venicia said, not a one size fits all, and certainly multifactorial, I do believe that we have to look at a solution that's more convenient, and accessible, to be able to support these populations and really improve outcomes. And I think that's where digital health really has the opportunity to start to improve access for populations like this, it gives them more of an opportunity, you know, to have that integrated care model that we're speaking about the ability to ask questions, you know, privately and discreetly through a tool that is actually, you know, very familiar and intuitive to this particular population and age group, and also to be able to sort of own their own time when they are working and balancing the, you know, the competing demands of life and family, and be able to reach out to caregivers, it opens up a communication and care channel that is incredibly valuable for this community. This third thing that I would add is just that the healthcare system itself can oftentimes feel really difficult to navigate. Sometimes, you know, even for people that are familiar with the system, it is incredibly complicated. You know, when we look at statistics from the CDC, they report that only one in 10 adults in the US actually feels that they have proficient health literacy skills. So delivering the right kind of health education that, you know, maybe we can make available through smartphone or some other digital tools can really help people start to feel empowered and informed about their health conditions and what kind of resources and rights that they have access to within our healthcare system. But that takes you know, making sure that we have culturally competent information and content that's written at a reading level that is appropriate for all demographics, and really allows people to start to understand their own conditions their own rights, and become better self advocates for their health and for their care going forward. 

Melissa Turner  14:49  

Thank you, Dr. Gardner. I want to ask, you know, thinking about what, what is needed to support moms infants, I want to talk a little bit about where that breaks down for low income populations, populations of color so we can start to sort of spin this forward and think about where are the different points of intervention. Dr. Gardner? 

Sandhya Gardner  15:09  

As we've been discussing, I think, you know, a major issue contributing to these poor outcomes for for mothers and babies is around access and barriers to care. And it becomes, you know, even more pronounced for low income women of color during their pregnancies. As we've talked about, many are working to balance multiple different priorities and social, you know, precarious social circumstances and then at times will find themselves having to make decisions around holding off from sometimes what seems like very basic routine prenatal care, necessary procedures and testing. And I know from personal experience, when women push off prenatal care to later in their pregnancy or not at all, we start to see increasing complications and worse outcomes for mothers and babies, whether it's preterm birth or avoidable maternal complications. So it's really incumbent that we have a solution in place that can meet them where they are, instead of having sort of that traditional care path of, of, you know, patient comes to access care, we should be coming to them, you know, and finding a way of meeting them where they're at, and identifying, you know, those social determinants of health issues, barriers, concerns that they have, and start to really proactively address and remove some of these obstacles. The other thing that I spoke to in the previous question was around health literacy and awareness. And, you know, really kind of helping patients to start to understand how to navigate and access health care. It's a critical piece of solving this equation for this population. When women don't understand their own health conditions, and the kinds of benefits and the healthcare rights that they have access to, and aren't able to advocate for those, then they're at a real disadvantage. So again, making information that's easy to access and understand and bringing it to them in a way that's intuitive. I think it's a critical piece of, you know, addressing this problem. 

Melissa Turner  16:54  

Thank you, Dr. Gardner. Venicia, I want to ask you the same question, you know, thinking about the needs of moms and babies. And where that breaks down in the populations that we're discussing today. 

Venicia Gray  17:05  

Yeah, absolutely, Melissa, so let's just maybe drill down on one particular driver. So I decided to think about housing instability. So on any given day, more than 560,000 people experience homelessness in our nation. So if we add to that 11 million households who are severely cost burdened, which basically means they're spending more than half of their income just on housing, they could be on the brink of homelessness at any second. So compared to white people, people of color are more likely to be homeless. Gender heavily influences housing access and stability, and opportunity yet, for most housing, just in data, and legislation, they don't really kind of consider the gender discrimination and misogyny as a contributing factor. So women who identify as a person of color face hurdles when trying to find and secure housing. So we looked into a systemic review of health impact assessments on housing from the National Center for Healthy Housing and National Housing Conference. And we found access to stable housing is one of the most important predictors of one's health. So this kind of harrowing statistic that one in five people who experience homelessness in the year prior to giving birth had an infant with low birth rate, and nearly 50% increase in risk compared to consistently house people with other similar characteristics. And newborn infants of people experiencing homelessness had longer stays in the hospital, and were more likely to require intensive care than infants who are were born to people who are consistently house so we could probably spend all day talking about the harsh realities that people of color and mothers of color in particular face across stole many drivers of health, and in nearly each and every one, you will find that they face the most adverse income. So particularly for moms of color and low income moms. Every kind of social driver that impacts their health always winds up seeing them at the very bottom of the totem pole, and always, almost always with an adverse health outcomes. So it's really disappointing conversation that we're having to have, but I'm really glad that we get to really shine a light on it. 

Melissa Turner  19:25  

Yeah, absolutely. And before we move the conversation forward to the next point, we want to cover Venicia, I just want to ask a follow up here. Thinking about that one issue of housing with respect to moms and infants. Where are the solutions? 

Venicia Gray  19:41  

Oh, Melissa, there's so many. I think even if we were just to think about ensuring that there's safe housing, making sure that moms who may be in need of a safe space in getting away from maybe an unsafe partner, internet partner violence, I think it's really ensuring that we removed gender bias and gender identity from our housing structures. I think it's important to remove the kind of historical redlining that we find many communities of color at able to access good housing you know, that really is also directly tied to green spaces you know, access to a park access to being able to put your feet on grass and be grounded. You know, being able to have access to a farmer's market for instance, really where you live kind of directly impacts all those things, even just thinking about living in DC having access to you know, transportation that's not completely crazy and reliable. So I think there are multi-pronged efforts. I think specifically for housing. Number one, I would say just remove just basic gender and racist discrimination. When we think about our local and state housing policies, even federal.

Melissa Turner  20:52  

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Melissa Turner  21:28  

Well, I want to zero in on access to care now. More than 2 million women live in maternity care deserts another 4.8 million live in areas where maternity care is limited. Meanwhile, a Forrester analysis found that lowering barriers to care was critical to easing disparities in maternal health. I'm curious how each of you would reconcile those two points. Dr. Gardner?

Sandhya Gardner  21:52  

So it's a really important point. On the one hand, you know, we know, as you point out that it's critical to increase access points in order to improve outcomes. But at the same time, you know, as you call out, we're facing a shortage in those traditional kind of brick and mortar healthcare facilities, particularly in rural and low income communities. So you know, I might answer this by calling out that I think one of the silver linings of the pandemic is that in the face of the risk and adversity that we were facing, we've actually become more creative and have started to reimagine, and really scalably operationalized, non traditional ways of delivering health care support and guidance to people versus that sort of single threaded overreliance on traditional face to face interactions. And technology is at the core of this and has the real potential to not only improve access, but it offers a window into patient's health needs at home. And in those frequent periods of time when they're just not able to access the provider or go to an appointment, you know, for whatever the reason is, there are digital solutions, health management solutions that are out there, whether it's telehealth or remote patient monitoring, or digital care and health management. But that many plans and providers are using to increase options for accessing care and having ongoing touch points. And that kind of connectivity to vulnerable patients like the populations that we're talking about, lower income maternal health populations, we've seen that in this particular demographic and age group, they are not only comfortable and receptive to communicating digitally, but they really are adopting these remote care options and embracing them. So I think that is where, you know, you can sort of reconcile some of the shortage that we're experiencing and traditional models of care delivery and started to advance and move towards more digital solutions and new ways of thinking about this.

Melissa Turner  23:39  

Thank you, Dr. Gardner. Venicia, I'm curious what you would say to thinking about maternity care deserts in this country and and how we improve access. 

Venicia Gray  23:48  

Yeah, for sure. I'm sure your listeners will kind of notice that I'm really beating the drum around the interplay of racist discrimination and healthcare system and the structural racism and discrimination faced by people of color more broadly. But it's really manifested not only in poor birth outcomes, but also in an increasing sense of mistrust and the medicalized healthcare community. You know, access to care, while really important, really isn't the only indicator of healthy pregnancy, for many birthing people of color, equitable quality health care throughout their pregnancy is a really important piece of their journeys. And we've heard you know, these really harrowing stories of pregnancy tragedies, even from high powered wealthy women like Beyonce and Serena Williams, who with all their influence nearly lost their lives by giving birth. So what we have found particularly in communities of color, and as a black woman, I can speak to those personally having given birth prematurely, regardless of wealth and education or fame. Some communities, particularly black women are four times more likely to lose their lives giving birth, and that's before we even considered where they are. So I think active solutions really require require other approaches that understand and then embrace the complexities of these inequities and their root causes. And that really would mean developing and implementing and then evaluating any new policy has to be grounded in reproductive justice, which specifically places value on the collective power of community based leaders and community centered policy and programmic solutions. And I think when we're looking in the frame of rural people in particular, is really important that you know, us big city folks aren't coming in and saying what you should be doing, it's probably already happening in your communities or community knows, potentially where the need could be. So overall, I really believe that employing an intersectional approach that creates a framework to factor in more than one access of lived experience, including race and class and gender identity and geographic location, sexual orientation, all other characteristics into diagnosing the multiple barriers that people face and crafting more effective, tailored solutions. And I think we'll get into some of that a little further in our conversation.

Melissa Turner  26:09  

Yeah, absolutely. I want to ask a follow up, Venicia. Just I'm curious, in the past year and a half or so, have you found more willingness to engage in these conversations about the impact of systemic racism on healthcare? Is there more room for progress than before? Or where are we in your view?

Venicia Gray  26:27  

I think where we are right now is that, as we mentioned at the beginning of the conversation, that we're really looking at maternal and infant care. And it's taking a spotlight more, even more. So now, during the pandemic, I think we saw a lot of misinformation at the beginning of the pandemic about what populations are being affected and impacted, and eventually found that for a while, but people were dying, and way more disproportionate amounts than any other population. I think where we are now is that there's conversation. I think policymakers, decision makers, communities and plans and providers are coming together to listen to each other to kind of start to think through some of these solutions and policies. So I think where we're at right now is that the health of burden people and their babies are rightfully so taking center stage, and I think conversations and then eventually, hopefully better practices and policies and opportunities for those folks to really thrive. I think overall, it ultimately leads to a stronger economy and a stronger nation entirely when the people who are having the children and the children themselves are able to be healthy, and free from all the other extra social drivers that directly impact their health. So yeah, I think we're in a conversation. 

Melissa Turner  27:46  

All right, well, I want to zero in on some points that Dr. Gardner raised earlier. Certainly the the pandemic dramatically shifted our sense of what is possible with respect to digital health and remote care. Inevitably, digital access, the digital divide is a concern when we talk about this in underserved populations. Dr. Gardner, I'm curious how much of a concern is access to digital resources when working with expectant mothers?

Sandhya Gardner  28:14  

Yeah, so there is somewhat of a myth, I think, that underserved communities won't use digital health. And we definitely have a different experience. I think the reality is when you look at the the data, Medicaid beneficiaries are just as likely as members of the general population to own a smartphone. And then when you look at you know, sort of smartphone only usage, one in four low income adults, lower income adults actually are smartphone-only internet users, and so they don't have access to broadband connections at home, and the smartphone is their only access in that case. So there is access in that way to digital, and there's comfort with the usage. However, you know, having said that, I think what we often see, you know, with other digital health solutions and vendors in the space is that they're not doing a great job of designing or even making those solutions available to Medicaid populations. And there are various reasons for this. Sometimes it's because it is incredibly challenging to adhere to the variable state by state regulatory standards. Sometimes there's a deficit in the expertise or the resources that vendors have to creating culturally competent content and linguistically appropriate resources and solutions for these members. And so they shy away from it. But that kind of mindset and complacency is really holding us back from progress. And it's some, you know, and our ability to solve for issues of equality, and equity. So my own experience at Wellframe is showing that we absolutely can address and support this population incredibly effectively if we're motivated to do it. So more than 40% of the members that we support on our digital health management solution are on Medicaid, and health plan care managers that we're working with who are using this solution have shared repeatedly with us that having that digital option to communicate and provide care has opened a door to conversation and support that might otherwise have remained shut. And then when we look at maternity populations that they are caring for, they are actually some of the most engaged of all of our members. And because of this additional option, this communication channel, they're able to receive, you know, a better experience and commensurate outcomes, you know, because of having access to somebody on the other side, who is really invested in them and starting to help care through a very vulnerable time.

Melissa Turner  30:26  

Thank you, Dr. Gardner. Venicia, what's your take on digital health remote care as tools for supporting mothers and infants? 

Venicia Gray  30:35  

I think telehealth is and will continue to be really integral to the future of healthcare. And you know, it offers promise for improving access to care addressing health inequities, and helping to make care more equitable. But for women, it can offer options to meet the myriad of healthcare needs we have in our overall life course, including reproductive and maternal health, and really can get individuals the care they need without exposure to unnecessary health risks, especially during the pandemic. But also, you know, worries about transportation or who will watch the baby while we're, you know, at the doctor in person, but it does have its pitfalls and unintended consequences. The digital divide has shown significant gaps in access to broadband Internet, and digital services due to lack of infrastructure from any places in the country, you know, broadband simply isn't available. So for low income, rural and many people of color, they've been affected by what's been termed digital redlining. So including affordability, and accounting for privacy trends, safety and trust, there would need to be some clear parameters on information sharing and protections for patient privacy, to really facilitate that trust between the patients and providers. So for mothers being able to have access to tools to take and monitor their own vitals like blood pressure, for instance, during telemedicine visits, or being able to have a quality digital connection and care system that listens to their concerns is critical. And all this while keeping the financial impact of the cost to patients. And its providers has to remain at the forefront as well, you know, we think about smaller community providers, but you know, your everyday provider, too, for example, may need investment in their services to support their communities digitally. And there's so many factors that enter play. So I think that there are some concerns around telehealth. But it's definitely, I think, a tool to use in our tool belt, particularly when we're thinking at it through the lens of birthing people seeking care during the pandemic.

Melissa Turner  32:44  

Absolutely. Dr. Gardner, would you like to react to some of that now? 

Sandhya Gardner  32:47  

I really appreciate Venicia's perspective on it. I think all of that rings true, particularly with the access to broadband, I think beyond just telehealth, you know, there are other digital options, you know, in particular, you know, as I was calling out with, where health plans can get involved and you know, really start to support through their care, management's clinical services, sort of digital health management, and again, this is offered through access with their smartphones, where they can download an app and start to engage and be cared for outside of those traditional provider-centered telehealth visits, and help to monitor during that time. So there are a multitude of options as well, that digital opens up, in addition to telehealth. I do know that there are limitations and most certainly that I think the entire healthcare system can start to invest in those things. As Venicia was pointing out to bring greater access to patient to patients. But there are a multitude of options that we can start to explore and really push forward, I think to sort of bridge that that access divide.

Melissa Turner  33:46  

Continuing to think about solutions. Clearly healthcare coverage is an important aspect of this conversation. Thinking now about our health plan listeners, I want to just ask you to think about a health plan leader who's really committed to improving maternal and infant health outcomes. And of course, we know, many health plan leaders are particularly focused on the Medicaid space. What should my immediate priorities be if I'm in this situation? And then I'm curious, you know, once those are taken care of, what does the longer term strategy look like? Venicia? 

Venicia Gray  34:19  

Yeah, sure. And I think we were thinking about this question, which I absolutely love. Really, I think there can be happening now and then could maybe be strengthened or deepened, long term. So first of all, just say that health plans are valuable partners in the effort to improve maternal and infant health outcomes. You know, plans can maybe consider supporting and elevating high performing models of care including midwifery birth centers, doulas, and community based perinatal health workers. You know, they can think about contracting with birth centers and list available midwives, for instance, and an up to date planned directory and consider paying for doula support. We've heard from many finding people that that something that they would like their plans to consider, you know, thinking about them in some non traditional models of care plans can also invest in community based organizations and partners by developing contracts with those that can help pregnant people and new parents with needed services, and a plug and play platform for them to connect with and developing and deepening their relationship with community based organizations to provide wraparound service support. And services really should be like a continuing relationship. That's a two way street and then investment and nurturing communities. Another opportunity for plans to consider out there is to invest in an interoperable race and ethnicity platform so that they're working to make it workable for providers. It can lead to plans being able to readily identify pregnant plan members as early as possible to collect and track data, especially on outcomes and performance based on race, and ethnicity. We hear all the time, like day to day, data, data is so important, but I think it's really important to really disaggregate that data and understand really what's happening both at race and ethnicity levels. Because there there are no one kind of monolith of people, you know, an African American woman in Louisiana, my home state, we have a totally different outcome in California. And that's just with one kind of a race blend. So thinking about Latinx women, for instance, or Asian Pacific Islanders are so many opportunities there. And then finally, we know that maternity care episode payment is a priority for plans, and benefits are encouraging members of the team to work together toward shared goals and accountability for outcomes. So whether it's in an alternate payment model or regular, you know, fee for services, we should be thinking about using those measures that can impact the health of his population versus some people at the margin. So I think this is both maybe like a right now thing and then down the road kind of strategy that plans can maybe consider adding to the wealth of benefits that they already offer their members.

Melissa Turner  37:04  

Thank you Venicia. Yeah, that's a great list. Dr. Gardner, what would you add?

Sandhya Gardner  37:07  

I agree with what Venicia said, there's so much opportunity for our health plan partners to get engaged and to really be a part of the solution here. So I would maybe start with on the shorter term things that they can invest in and push forward. I think it's really promising that many plans are starting to lobby for more the important legislation that we have on the table, things like the you know, Black Maternal Health Omnibus Act of 2021, and the expanded Medicaid coverage to 12 months postpartum. These are the kinds of really big changes that are needed to address the urgency of the crisis and start to provide solutions against those drivers that we were talking about that are fueling it. On the second piece regarding that extended postpartum coverage, because we know that a significant percentage, roughly 13% of of the core, maternal health outcomes and infant outcomes that are occurring are happening after six weeks delivery and before the end of the year. These are the kinds of legislative expansions that can really have an enormous impact. So advocating for this type these types of policies and changes is one area that health plans and leaders can really lean in on in the near term. Regarding more of the longer term priorities and strategies, you know, we've been discussing at length, you know, some of these virtual health options, but really making that a priority. And a strategic initiative is a good way to impact you know, some of these vulnerable communities that have limited access, whether it's again, you know, patients that are living in rural communities or in communities where obstetrical care is just unavailable, or under resourced health plan, leaders are in a position to start to push for these types of solutions for their members. But, you know, as we've discussed, they can't leave certain populations behind when they're evaluating new vendors and strategies. Every population deserves the same convenient tools and access, you know, doesn't just because it's Medicare Advantage, or commercially insured members, our Medicaid populations also should be taken into account. And they should be looking at vendors that are supporting all of those populations.

Melissa Turner  39:08  

Thank you, Dr. Gardner, you've both given us a lot to think about, I want to close our conversation by just acknowledging that you both work in a space that can be difficult at times and have likely seen some heartbreaking situations in your careers. I'm wondering what keeps you going. Dr. Gardner?

Sandhya Gardner  39:25  

I really appreciate the acknowledgement and just the conversation today and the discussion with you Venicia as well. So yes, I did, you know, see situations in practice that were you know, very hard to witness and, you know, sort of difficult to process at the time, where I think much of what we've discussed today that variation and care and quality that was being provided was was very evident. And there were issues of core accessibility and dismissiveness that we've just called attention to where I know that it is addressable. If we can identify it. But in part, I would say that one of the reasons that I transitioned from being a practicing OB/GYN to working in the health tech space was in part fueled by that recognition, I knew that I could control my own practice and the care of my patients and to some extent, influence those who were caring for women around me. But my ability to do that, you know, more systemically and at a scale that was needed really did elude me. And so the promise of working with healthcare tech solutions that can really improve the system in that way, and at scale, motivates and inspires me, I believe that and I still do that we can make the system better for everyone. If we could just start to identify those pockets of variants and inequity and really start to address the behaviors and the factors that are driving them and hold people accountable, then I believe that we can make a difference. I strongly believe that leveraging technology and some of the innovative solutions and thinking that we're talking about today is going to go a long way in addressing some of these gaps.

Melissa Turner  40:59  

Great message to close on. Venicia, what would you say?

Venicia Gray  41:01  

That was just so beautiful, Dr. Gardner, and I really appreciate the conversation as well. I think for me, I've always really been really intentional about working for and vulnerable populations, which somehow always wound up being people of color, and the most vulnerable among us, which are babies. So for me, it's always been very personal. Regardless of what terrible situations could happen. You know, I've actually had friends who have passed on while they were pregnant. So you know, maternal mortality as a black woman really directly impacted me. I mean, preterm birth directly impacted me, I think I mentioned earlier I gave birth to my son, six weeks prematurely, just totally out of the blue. So personally, it's always kind of been a driving factor of mine, but also being able to work in a industry that is addressing the issue, and really being able to work with other brilliant minds and people who are working to dismantle the problem from every angle, having the ability to look at it well from policy and practice, working with community organizations, working with providers, and even plans to really say, hey, how can we together really think about what it looks like to have optimal health? Is it making sure that people can have access to a car and then when they get in the car does it have gas or does it have air conditioning? Are you in unsafe working conditions, all of these things really, together, I think keeps me going. Because eventually the problem has to be solved, right? And I want to be a part of that solution. So I'm really thankful and grateful for the opportunity to talk about it even in this platform. So thank you.

Melissa Turner  42:39  

Thank you, Venicia. Thank you, both of you for your perspectives, your candor, your wisdom and your solutions. Venicia Gray of the National Partnership for Women and Families, Dr. Sanjay Gardner of Wellframe. It's been a pleasure speaking with both of you. 

Venicia Gray  42:54  

Thank you. 

Sandhya Gardner  42:54  

Thank you so much. 

Melissa Turner  42:58  

Thank you for listening. I hope you enjoyed today's conversation and learn something too. You can check out SmartBrief's healthcare newsletters by going to and hitting the blue subscribe button, be sure to spread the word and subscribe to the touchpoints podcast. Finally, a huge shout out to our friends at the Shift.Health content network.

Melissa Turner  43:23  

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