As payer and provider organizations look to improve health outcomes around the far-reaching impacts of the pandemic, they must consider the unique needs of some of our most vulnerable populations, such as new and expecting mothers and their infants.
As a byproduct of the COVID-19 pandemic, the healthcare industry is faced with a formidable challenge—how to safeguard long-term health when in-person preventive care is reduced, and has been for most of the year. Fewer people have sought preventive care and testing over the past six months due to precautionary social distancing measures against the COVID-19 virus. This includes a nearly 60% drop in vaccinations, as well as declines in more invasive procedures such as mammograms and colonoscopies. Coming out of the first wave of the pandemic, robust population health strategies are needed, not only to mitigate against risk of contracting COVID-19, but to maintain general public health.
As payer and provider organizations look to improve health outcomes around the far-reaching impacts of the pandemic, they must consider the unique needs of some of our most vulnerable populations, such as new and expecting mothers and their infants. Due to COVID-19, many hospitals began discharging mothers quickly, sometimes within 24 hours, to reduce risk of contracting the virus and free up hospital resources. But these early discharges have had unintended consequences. Hospital lactation consultants no longer have the time they desperately need to properly support a breastfeeding mother before she goes home. If a new mom is discharged within 24 or 48 hours, they’re leaving without the benefit of that counseling, which may mean the difference between being able to successfully breastfeed, or not.
Breastfeeding rates are a critical measure of population health
Breastfeeding is a vital population health issue because it has many health benefits for mother and infant. According to the CDC, 84% of children in the U.S. are breastfed for some amount of time, but only 46.9% are exclusively breastfeeding at three months and only 25.6% at six months. This isn’t good enough. Breastfeeding rates impact cost of care as well as maternal and infant mortality, and should be part of health plans’ comprehensive population health strategies. An analysis of data from The United States Breastfeeding Committee shows just a 5% drop in breastfeeding and infant vaccination rates could result in devastating costs to the U.S. healthcare system due to preventable illnesses and deaths, including increased cases of hypertension and diabetes in mothers, and higher rates of obesity, lower respiratory tract infections, and potentially fatal necrotizing enterocolitis in infants.
Ensuring that all new moms who wish to breastfeed are able to do so will help improve outcomes and lower overall costs for health plans. According to a new report, expecting moms covered by Medicaid intend to breastfeed exclusively at around the same level as commercially insured expecting moms (17% and 21%). However, they struggle with putting these plans into practice. New moms covered by Medicaid are less than half as likely (8%) to breastfeed exclusively, compared to new moms covered by private insurance (17%). This indicates that moms covered by Medicaid would exclusively breastfeed at similar rates as moms with commercial insurance, if they only had the support to do so. In fact, due to the pandemic and a need to bolster babies’ immunity, moms covered by Medicaid who are not currently breastfeeding are changing their minds at a slightly higher rate than those with commercial insurance – 16% of non-breastfeeding moms covered by Medicaid are now considering it due to its health benefits, compared to 12% of non-breastfeeding moms with commercial insurance.
Moms covered by Medicaid face unique challenges
Almost three-quarters of new and expecting moms reported concern about in-person medical visits post-delivery, and almost one in five said they would try to postpone scheduled appointments. However, moms covered by Medicaid were 27% more likely to report that they may try to delay some scheduled appointments due to concerns about COVID-19, compared to mothers with commercial insurance. This gap is significant, because postpartum support that’s normally in-person, like lactation support, will continue to be available for higher socio-economic households who can afford private sessions and house visits – luxuries moms covered by Medicaid may not have access to.
In addition, 70% of moms covered by Medicaid reported that they feel COVID-19 will affect their ability to breastfeed, compared to only 43% of moms covered by private insurance – a statistic that could be related to being disproportionately employed in sectors that are less adaptable to telework and the flexibility that comes with it. Moms covered by Medicaid are some of the most vulnerable, and they are at risk of being left behind.
Telehealth can help bridge the resource gap
The good news is that telehealth can be an equalizer. Eighty-one percent of Americans owned a smartphone in 2019, according to Pew Research, a device key to taking advantage of telehealth access. But owning a smart device is only the first step. Unfortunately, just 36% of people making less than $25,000 say they have access to telehealth – a percentage that increases steeply as income rises. This inequity is likely due to several factors, the main one being that before the pandemic, commercial health plans provided and promoted telehealth at higher rates than Medicaid plans.
Maternal and infant telehealth, including virtual lactation support, should be key to any health plan’s population health strategy – it’s critical to give new moms access to the support they need, when they need it. This is especially important for Medicaid plans, as these tools will help bridge the healthcare gap between socioeconomic levels. Safeguarding maternal and infant health is a significant part of bolstering population health during the pandemic – and beyond.
Melanie Silverman, MS, RD, IBCLC, is a registered dietitian and board certified lactation consultant and is currently the Chief Clinical Officer for Pacify, a telehealth mobile application for new parents