The Reaching Impact of Health Disparities: Why Closing the Gap Begins Before Birth

Managed care organizations must ensure that all of their members—including their youngest—receive the most equitable start in life. Here’s how to get started.

Despite great advances in the U.S. medical community, lack of health equity denies too many Americans the opportunity to have as healthy a lifestyle as possible. Before a baby’s very first breath, socioeconomic factors way beyond their control will play an irrevocable role in their long-term health and well-being.

The statistics reveal startling truths: racial and socioeconomic factors play a major role in a baby’s health even prior to birth. The preterm birth rate has been on a steady rise for the past five years, and hit 10.23% in 2019, the highest it has been in a decade. Critically, the rate of extreme preterm birth is four times higher for black infants than white newborns. Black, American Indian, and Hispanic women are more likely than their white counterparts to receive late or no prenatal care. Their babies have a much higher risk of low birthweight, are less likely to be breastfed, and tragically, are more likely to die within their first year.

This is simply unacceptable. When one looks at the data, the sad and indisputable truth is that there is so much work to be done to improve the quality of maternal and newborn health for our most vulnerable populations. The data demands that we find higher ground. Now is the time for health plans, providers, and partners to join forces and engage women in their journey before, during, and after pregnancy to plan and solve for care gaps. To make a tangible impact, health plans can begin by ensuring maternal and newborn standards of care are applied equally to all mother-newborn dyads.

It’s never too early to focus on SDoH

Identifying potential gaps early is critically important. Ensuring SDoH resource information is readily available to case managers and providers, equips them with the right set of tools and questions to initiate conversations and build trust. Proactively assessing and solving for SDoH needs leads to better health outcomes for moms and newborns—and makes a big impact on long-term population health.

We have been working with neonatal intensive care units for over 17 years. In our experience, it is best to foster an open, understanding dialogue with families by building non-judgmental SDoH screenings into the care management workflow. This is often a great way to build trust and strong relationships with your members and their families, many of whom have likely previously encountered healthcare discrimination. By keeping the door open, encouraging open conversations, and promoting regular screenings, you or your support partners can monitor for new gaps in care as needs arise.

Finally, in order to meet these needs, work to develop partnerships with local community organizations that can help provide necessary items, financial resources, grants, and more, and empower your members and their families to transition confidently and securely into motherhood.

Collaborate with providers on appropriate care during the hospital stay

While each delivery and NICU admission case is unique, it is important to ensure that appropriate levels of care for mom and newborn are determined equitably. Dedicated collaboration with hospital providers on best practices can help ensure that every baby receives the same exacting standard of high quality, evidence-based care, regardless of socioeconomic background, insurance type, or race.

This begins by establishing regular communication across a NICU-centric team of experts—including the neonatologist, utilization manager-nurse, case manager-nurse, and social worker. Having the full team round on every case and closely monitor every aspect of the baby’s progress helps generate the best outcomes for all of your members.

Provide resources and fill in gaps in real-time after delivery

The 12 months post-delivery are of the utmost importance, both for the mother-child bond and for the newborn’s critical early development. Case managers should use this window to nurture relationships with new mothers and maintain an open line of communication post-discharge.

At ProgenyHealth, we make sure that mom and baby are ready to take their first steps together once they leave the hospital. First, we ensure that every mom has a car seat so she can safely take her baby home. Additionally, during their first three years, the American Academy of Pediatrics recommends that children should have 12-13 well child visits. More than half of these visits should occur during a child’s first year. That’s why we schedule the first pediatric appointment before discharge, and make sure that mothers have safe modes of transport for both legs of the journey.

Case managers are best positioned to provide real-time care and fill gaps at critical moments. We find it best to make connections with necessary resources while we are on the phone with the mother, tackling issues together. We have helped new moms obtain grants to pay for rent, purchase needed baby care supplies, and cover monthly utilities to keep the home environment safe and warm. We have helped others apply for food stamps, apply to work-study programs, obtain financial assistance for childcare to support working mothers, and more. While each new family’s needs are different, our approach is always the same—we work to maintain a continuum of care and help provide access to resources and care that will improve lives.

An Urgent Need

The need to improve equitable standards of quality care for every mother and newborn is not new. And yet, the need is more urgent than ever. The pandemic has spurred an exponential rise in Medicaid enrollees across the nation: a staggering 11.3% growth in MCO enrollment from March 2020 through September 2020. Additionally, emerging evidence suggests that women pregnant during the pandemic are experiencing elevated levels of emotional distress, which is often associated with adverse impacts on maternal health, perinatal outcomes, and child development.

Facing greater disruption to daily life and care than ever before, now is the time for health plans, providers, and partners to take the necessary steps to provide greater standards of care. Start by proactively engaging women in their journey towards motherhood, from pre-delivery through 12 months post-discharge and beyond. Partner with hospital providers to ensure a coordinated approach from delivery and through the stressful NICU experience. Finally, ensure new mothers receive education, resources, and support after delivery to ease their transition and cover any gaps in their financial, food, and healthcare needs. By supporting hospital providers with a thoughtful, team-based approach, health plans can ensure that all of their newest members receive the most equitable start in life.

Author Ellie Stang, MD, is founder and CEO of ProgenyHealth, which focuses on improving the health outcomes of premature and medically complex newborns through provider collaboration and parental engagement.