Article

Spotlight on maternal health

As maternity care deserts grow and mortality rises, providers and suppliers across the healthcare ecosystem are working to ensure better outcomes for mothers and their babies.
Quality & Clinical Operations
November 8, 2023
Erin Cristales, Vizient
Randena Hulstrand, Vizient

The headlines are hard to miss.

"Rural Hospitals are Shuttering Their Maternity Units," The New York Times reported in February. Just two weeks before, the paper published a piece titled "Childbirth Is Deadlier for Black Families Even When They're Rich."

A month earlier, Axios declared "Hospital Obstetrics on Chopping Block as Facilities Pare Costs." A month after, Beckers Hospital Review found "As Birth Rates Increase, OB-GYN Shortage Worsens."

The statistics are even more alarming.

The headlines are hard to miss.

"Rural Hospitals are Shuttering Their Maternity Units," The New York Times reported in February. Just two weeks before, the paper published a piece titled "Childbirth Is Deadlier for Black Families Even When They're Rich."

A month earlier, Axios declared "Hospital Obstetrics on Chopping Block as Facilities Pare Costs." A month after, Beckers Hospital Review found "As Birth Rates Increase, OB-GYN Shortage Worsens."

The statistics are even more alarming.

Maternal health in the U.S. continues to worsen despite spending more per capita on care than any other nation in the world. In 2021, 1,205 women died of maternal causes in the U.S. compared with 861 in 2020 and 754 in 2019.

More than 50% of rural counties in the U.S. have no hospital-based obstetrical services, according to research by The Commonwealth Fund, and one in three women in metropolitan or urban areas lives in an OB desert.

But what's often left uncaptured amid the facts and figures is the work that's happening to turn the tide. More than 80% of maternal deaths in the U.S. are preventable — and dedicated healthcare providers, suppliers and nonprofits across the nation have rolled up their sleeves to put that number on the decline. From cutting-edge research and reimagined models of care to multidisciplinary partnerships and health equity deep dives, many industry stakeholders are moving the needle on the maternal care crisis to provide the positive outcomes that mothers and babies deserve.

"As a preeminent convener in healthcare, Vizient is uniquely positioned to motivate the industry during these challenging times for maternal health," said Monica Davy, Vizient chief culture, diversity & impact officer. "We know what great work looks like because we work with the providers and suppliers who are innovating in this incredibly important space. We're excited to share best practices across the healthcare ecosystem to reduce disparities and enable quality care."

Read the stories below of organizations that are making a difference by tackling various aspects of maternal health.

Nurses Gina Horne and Camielle Fishel have spent their nearly collective 75-year careers on a mission to make maternal and infant healthcare safer — and more equitable — for women.

They've tackled a myriad of the leading known causes of preventable severe maternal morbidity and mortality — from improving cardiac conditions in obstetric care to helping reduce first-time cesarean births. Most recently, they took aim at severe hypertension in pregnant and postpartum women.

Their organization, Baptist Memorial Hospital for Women in Memphis, is nestled between Mississippi and Arkansas. The two states are respectively ranked No. 5 and No. 6 in the nation for obesity, a leading cause of high blood pressure, while Tennessee ranks No. 6 for maternal heart disease. As part of the Tennessee Initiative for Perinatal Quality Care hypertension in pregnancy maternal improvement project, Baptist Women's Hospital joined as one of five state pilot hospitals in 2019.

Hypertensive disorders in pregnant women, especially Black women, are one of the leading causes of maternal and perinatal mortality worldwide. Since 1987, hypertensive disorders have increased by 25% and are the leading drivers nationally of maternal morbidity such as seizures, stroke, heart attack and death. Fetal risks — including decreased blood flow to the placenta and decreased oxygen to the fetus — lead to placental insufficiency that can result in low birth weight or premature birth.

The only cure for preeclampsia is to give birth and even after delivery, a woman's symptoms can last six weeks or more.

Horne, director of nursing, and Fishel, director of perinatal services, created the Severe Hypertension in Pregnancy & Postpartum Journey (SHIPP) program, a standardized set of protocols that provides education for clinicians and guidance for patients on how to best manage their hypertension after discharge from the hospital. As part of their sustainment plan, they conduct drills each quarter to ensure pregnant and postpartum women with acute onset severe hypertension are assessed and treated within one hour of being seen.

They also use the patent-pending Vizient Vulnerability Index™ to illustrate the relationships between their neighborhood vulnerabilities, obstacles to care and maternal outcomes.

"Implementing a protocol of treatment within 60 minutes is absolutely vital for patients when they come in with severe range blood pressures," Horne said. "But we're also focused on reaching our community's vulnerable populations and gauging long-term success with lowering readmission rates as a result of educating patients about the importance of self-monitoring at home and taking their medication to prevent disease progression."

Before discharge, patients receive blood pressure cuffs and training from nurses, and staff ensure a follow-up appointment is scheduled seven to 10 days post-delivery — the window when most readmissions occur for blood pressure issues. To further assist these efforts, Baptist Women's Hospital has applied for a Department of Health and Human Services grant to provide for individual case workers to follow up with patients.

Horne and Fishel emphasize the importance of continued care and identifying obstacles that make it difficult for some women to receive treatment after discharge. For example, many new mothers don't have transportation for follow-up visits and may not be filling or taking their prescriptions consistently.

With an increase of severe hypertension in younger patients, education and support is key.

"Studies show that living with chronic stress for periods of time — like drug use, abuse in the home, homelessness, not getting enough to eat, etc. — has affected women's multigenerational health across populations. Over two or three generations, the stress is actually changing their DNA," Fishel said. "We're passionate and persistent about helping these women get the care they need."

For more information about Baptist Women's Hospital Severe Hypertension in Pregnancy & Postpartum Journey (SHIPP) program, email gina.horne@bmhcc.org or camielle.fishel@bmhcc.org.

In 2013, Cessilye Smith attended a maternal health conference in her hometown of Fort Worth. It was there that she first heard Jennie Joseph — a renowned women's health advocate, midwife, and founder and president of Commonsense Childbirth — vocalize what seemed like unbelievable statistics.

Black women are three to four times more likely than white women to die from pregnancy-related causes, even when the causes are preventable. Black infants have two to three times the rates of infant mortality than their white counterparts.

As a new mother and recently trained doula, Smith knew those numbers needed to spark more than just outrage.

They needed to spark action.

"The seeds were planted that day," Smith said, "and then they sprouted into something huge."

What took root was Abide Women's Health Services, founded in 2017 in South Dallas to improve birth outcomes in communities with the lowest quality of care. According to the 2021 American Community Survey 5-Year Estimates, 21.4% of Dallas County residents are uninsured and nearly 15% live in poverty. Simultaneously, Dallas has a scarcity of primary care physicians practicing in neighborhoods with large minority populations.

Abide is an accredited Easy Access™ Clinic that offers services including culturally informed pre- and postnatal care, childbirth education, nondiagnostic ultrasounds and breastfeeding support. At Abide, clients are made to feel safe, and the financial barrier to exceptional care is removed because no client is ever turned away.

Still, poverty alone doesn't explain the statistics, Smith said. In fact, studies show that Black college-educated women are at an equal, and sometimes higher, risk of death.

"There are a lot of biases in healthcare that are the main catalyst behind the vast majority of these deaths — the way Black women are perceived and the lack of belief that they know what's going on with their bodies," she said.

That's why the organization's mission is fivefold, with one particularly crucial focus being to increase the number of Black midwives and birth workers of color. Through its services, Abide also strives to reduce infant and maternal mortality rates and pre-term birth rates and increase babies' birth weight and breastfeeding rates.

Organizations across the healthcare ecosystem are supporting Abide's cutting-edge work. Vizient, for instance, partners with Abide through its Vizient Cares corporate grants that support organizations committed to addressing social determinants of health.

Moving forward, Abide aims for its capital campaign to help support a new birth center in South Dallas, which will include birth suites, a conference room, space for prenatal yoga, massage therapy and more (this fall, the clinic received $300,000 in federal funding to open the center). The organization recently purchased a 12-passenger van, which will allow it to expand mobile services to nearby high-needs areas like Fort Worth while also providing ease of access for regularly scheduled appointments.

"There's a quote by Michelle Obama: 'Communities, countries and ultimately the world are only as strong as the health of their women,'" Smith said. "Now it's just a matter of recognizing these disparities are preventable — and doing something about it."

Interested in delving deeper into Abide or supporting its mission? Find more information on its website.

Read more recent coverage featuring Abide:

What if the 84% of U.S. maternal deaths deemed preventable never happened — signs of trouble weren't overlooked, patient concerns weren't brushed aside, preconceived notions weren't allowed to influence the caliber of care?

Imagination only takes you so far. True change requires a change of thinking.

That's precisely the reason the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), with support from Huggies® Healthcare™, last year rolled out its Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline and corresponding Respectful Maternity Care Implementation Toolkit. The first-of-their-kind resources provide evidence-based approaches that help reduce disparities in maternal morbidity and mortality outcomes and support birthing women and their families as they safely prepare for birth, postpartum recovery, and begin breastfeeding and parenting.

Respectful Maternity Care (RMC) emphasizes equitable access to healthcare that is free from implicit and explicit bias that can cause harm during patient interactions. A Centers for Disease Control analysis of a 2023 PN View Moms survey found that one in five women reported mistreatment while receiving maternity care, with mistreatment most often experienced by Black (40%), Hispanic (37%) and multiracial moms (39%), and those with public insurance (26%) or no insurance (28%).

According to research published in the American Journal of Public Health, the maternal mortality rate for Black women is 3.55 times that for white women, and late maternal deaths — those occurring between six weeks and one year postpartum — are 3.5 times more likely among Black women than white women.

"It's no secret that the U.S. has had a maternal mortality crisis for some time, and in particular, a Black maternal mortality crisis," said Jonathan Webb, CEO of AWHONN. "There's been a lot of activity around teaching what bias looks like, but one of the things we hear when we engage with members of the healthcare community is, 'Now that I know, how do I do better? How do I operationalize this?' These guidelines are meant to connect the dots."

In November 2022, AWHONN also launched a Respectful Maternity Care Research-Based Study, which includes 12 healthcare organizations that represent geographic and demographic diversity in patients and staff in maternity care settings. Goals include defining what respectful maternity care looks like; increasing awareness of the need for respectful maternity care; promoting accountability; encouraging reflection for personal and organizational improvement; and improving the birth experience.

Huggies Healthcare, which has sponsored many of AWHONN's education and advocacy initiatives for more than a decade, is likewise supporting the three-year research study as part of the company's commitment to bettering outcomes for every mother and baby. It's a mission that has only intensified through conversations that convey the lived experiences of pregnant and postpartum women.

For instance, in late 2019 Amy Cunningham, consumer healthcare sales leader at Huggies' owner Kimberly-Clark Corporation, met Jenné Johns, founder of Once Upon a Preemie, Inc. Johns shared her experience of feeling ignored and unsupported in the NICU after birthing her micro-preemie son and her subsequent commitment to health and racial equity training for healthcare professionals across the globe.

"It was a reminder that there's this whole other space out there that we need to lean into," Cunningham said. "Not long after, we were on our monthly call with AWHONN, and they mentioned that they were putting together respectful care guidelines and needed funding support. We were like — 'Choose us.' This idea of respectful, neutral and compassionate care from the moment a mother enters the health system to the moment they leave aligns with everything we want to be as Huggies Healthcare."

In fact, the solidarity between AWHONN and Huggies' missions is exactly how the two organizations are paving the way to a future that's tough to imagine, but essential to work toward.

"Our goal is that someday we won't want to have to talk about preventable maternal deaths at all," Webb said, "because these practices will be consistently implemented — and lives will be saved."

To reach out to AWHONN and learn more about its Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline, contact sales@AWHONN.org.

Nearly one in five women experience mood or anxiety problems during pregnancy and after delivery, which not only affects their own mental and physical health, but also that of their newborn babies.

And 75% of women who experience these symptoms go untreated.

But the Healthy Expectations Perinatal Mental Health Program — run jointly by Children's Hospital Colorado and the University of Colorado's Center for Women's Behavioral Health and Wellness — has helped families for nearly 15 years by offering innovative care for mothers, their babies and their families.

A leader in perinatal mood disorder treatment for pregnant and postpartum parents and caregivers, the program offers options ranging from a free support group to evidence-based mother-infant group psychotherapy, drawing on experts from various medical and mental health disciplines including psychiatry, psychology, pediatrics, nursing and social work.

"Our focus is not only on the mom, but on supporting the attachment relationship between the mother and baby," said Dr. Celeste St. John-Larkin, a child psychiatrist and director of the program. "There is evidence that these early relationships have long-term effects on child development so we're intervening early to hopefully prevent some of the behavior problems that we see later in our offices, as well as to promote the wellbeing and safety for the mom and baby. With mental health and substance use as the two leading causes of maternal death in the first year postpartum — it's extremely important take a preventive approach to care."

To help address the disparities in infant and maternal mortality for Black mothers and babies, the program added the Black Mamas Circle in 2021, a free weekly peer-to-peer mental health support group for pregnant and postpartum African American and Black-identifying women.

"Guided by community peer mentors and a racially concordant perinatal psychiatrist, the group is uniquely inclusive to Black women and their babies," Dr. St. John-Larkin said.

During the COVID-19 pandemic, the Healthy Expectations team quickly adopted a telehealth model to make care more accessible in an increasingly stressful and isolating time for new mothers (the groups remain available remotely). While the program bills for the clinical time with the mother registered as the patient, the team relies on securing financial support through the Children's Hospital Colorado Foundation and grants and donors to fund future growth.

For example, looking ahead Dr. St. John-Larkin and partners recently received a Health Resources & Services Administration grant to fund a perinatal psychiatry mental health consultation and access program to support healthcare providers in obstetric, midwifery and other primary care settings to address the mental health and substance use disorder needs of pregnant and postpartum individuals in their care. The funding will support the planning and development of free, statewide e-consults and real-time telephone consultations with perinatal psychiatrists, and educational programs that will incorporate addressing maternal health disparities.

"We'll be able to connect people to existing services via telehealth and focus on rural areas in Colorado, including Native American communities, which are especially underserved and at even higher risk of adverse perinatal outcomes," she said.

Focused on the entire family, Dr. St. John-Larkin says Healthy Expectations has zeroed in on specialized work by also including dads, parenting partners or grandparents in the psychotherapeutic group program to provide much needed support and connection. The program hopes to provide additional programming specific to fathers in the future.

"We know that 1 in 10 dads also can suffer from postpartum depression or anxiety," she said, adding they recently included a male medical student who is a dad as part of the rotation. "Several dads attended each of the pregnancy and the postpartum groups — it was really powerful."

The Healthy Expectations program, intentionally named to counter the "artificial expectations" that society places on mothers with their newborns, is centered on supporting pregnant mothers and their families and the real postpartum issues they face.

"There's often this Hallmark-movie, picture-perfect image of pregnancy and the beautiful, immediate attachment a mother has at delivery. But often that doesn't happen for a variety of reasons, whether the mom experienced a traumatic delivery or has delayed feelings from anxiety and depression," Dr. St. John-Larkin said. "Our goal is to help mothers understand that even if they do not form immediate bonds with their babies, they can develop a healthy relationship through treatment. Nothing is more rewarding than hearing a mom say, 'I've been able to fall in love with my baby.'"

To learn more about the Healthy Expectations Perinatal Mental Health Program, email healthyexpectations@childrenscolorado.org.

Though it's early in the morning, and she's sitting amid the hustle and bustle of Logan Airport, Lee Sullivan is more than happy to jump on a call to talk about the many ways Boston Scientific collaborates with clinicians and patients to better women's health.

In fact, Sullivan, senior global market development director for the urology business at Boston Scientific, is waiting to board a flight to Austin, Texas, for an American Urological Association sectional meeting. In her 30 years at Boston Scientific, she's been committed to amplifying the needs of women clinicians and patients — a passion shared by her employer, which has long focused on technologies and advocacy that can improve the lives of female patients around the globe, including those with pelvic floor disorders that can result from a variety of factors, including childbirth.

A major tenet for Boston Scientific is listening. Whether it's attending AUA meetings to support new and established female urologists or facilitating programs to help them understand the safe and effective use of its medical devices, the company listens to the voices of its customers.

"According to the AUA Annual Census (2022), only 11.6% of board-certified urologists are women," Sullivan said. "After childbirth, women may wish to seek out clinicians who have experienced childbirth. Increasing the number of female urologists may impact access to care for these women."

And that access is hugely important. Pelvic-perineal dysfunctions are highly prevalent in women following pregnancy — according to the National Institutes of Health, roughly one-third of new mothers experience urinary incontinence after childbirth, with some women experiencing it months or even years later. A separate study found that 38% of women feel self-conscious speaking about the problem with a healthcare professional.

That's part of why Boston Scientific has worked with societies like AUA and the Society of Women in Urology to bolster membership among women. Through these collaborations, Boston Scientific hopes it is contributing to the recently increasing number of female urology residents. As of the latest AUA census of residents and fellows in the U.S. (2020-2021), 33% of urology residents are women, a number significantly higher than the percent of currently practicing female urologists.

"At the meetings, we talk through the different issues women face, like inequitable pay and how to navigate being a working mother," Sullivan said.

While Boston Scientific is well-known for its medical devices to address female pelvic floor disorders, the company is focused on fixing more than just physical ailments.

For instance, Boston Scientific is looking to decrease stigma around urinary incontinence and pelvic organ prolapse, a challenge it is addressing through its patient education and therapy awareness resources on ChooseYou.com. On the website, several female patients share their experiences with stress urinary incontinence, and visitors can take a quiz and discover educational resources about common pelvic floor disorders.

But really, Sullivan reiterated, great maternal care — and great care in general — relies on a collective approach.

"Boston Scientific is committed to making a difference and impacting the demographics of urology," she said. "Our best chance at accomplishing this is through talking with and listening to patient and physician challenges and needs. Our initiatives aim to help women and underrepresented patients access care. Listening and collaboration can help us address complicated health care challenges together."

To learn more about the work Boston Scientific does in urology, reach out to your local Boston Scientific sales representative.

  • Learn more about Choose You.
  • Learn about Close the Gap, an initiative run by Boston Scientific for more than two decades that identifies gaps in cardiovascular care and provides data aimed at empowering providers to reduce health inequities that women and people of color often experience.

A pregnant mother at 26 weeks learns during a routine sonogram that her placenta has grown through her uterus and attached to her bladder. She's told to "get her affairs in order" before undergoing an emergency cesarean hysterectomy delivery where she hemorrhages her body's volume of blood three times over.

It might seem like an unusually horrific scenario, but placenta accreta spectrum disorder (PAS) — when the placenta grows too deeply into the muscles of the uterus — is far from uncommon. A significant contributor to maternal mortality and morbidity, the prevalence of PAS is rising worldwide, and in the U.S., the disorder is estimated to affect 1 in every 272 pregnancies. A history of previous caesarean deliveries is the most common risk factor, and maternal and neonatal outcomes are greatly improved when diagnosis is made before delivery.

Dr. Mehmet Genc, a maternal and fetal medicine specialist at the University of Florida Health Women's Center, professor at the University of Florida College of Medicine in Gainesville and expert on the condition, describes these incidences of PAS as unpredictable land mines — just waiting to detonate.

"There may not be an explosion every day in a hospital, but just one PAS case — not well planned for — can cause a blood bath for the woman and leave deep scars for her family. The ripple effects to practitioners' stress and hospital resources can be devastating from a workforce perspective," Dr. Genc said.

Historically, obstetricians managed PAS patients on a case-by-case basis without a standardized protocol or well-defined clinical pathway. Consultations with other services were inconsistent, as were decisions about diagnostic imaging, delivery timing, cystoscopy, surgical techniques, and other aspects of maternal care during and after surgery.

To help mitigate this potentially deadly disorder in pregnant mothers, in 2018 Dr. Genc — with support from his hospital leadership — created a program to address inconsistencies in PAS patient management. He formed a multidisciplinary team of more than 30 staff from several clinical departments, including obstetrics and gynecology, interventional and pediatric radiology, obstetric anesthesia, transfusion medicine, pathology, neonatology, urology and nursing.

Together, they focused on timely identification of at-risk patients; defined clinical pathways based on risk stratification; and created protocols for diagnostic imaging, antepartum care, and intraoperative and postoperative management based on best practices. They also hired Amy Mosely as perinatal nurse navigator to shepherd the efforts and serve as a conduit for patients and the community.

"A key component of our program is formal preprocedural planning meetings combined with data collection and analysis," Mosely said. "This process has allowed us to create standardized approaches and identify key areas to target improvements. We also improved communication within the team and with other colleagues at our institution and those in the community who refer these high-risk patients to us."

The impact of the program has been tremendous. Since the implementation of the protocols, 70% of patients treated had less composite maternal morbidity and lower blood loss, patients were 68% less likely to require transfusion of blood products, and the rate of PAS undiagnosed before delivery decreased by 42%.

"This organized approach is serving as a mine detector," said Dr. Genc, who presented the program's outcomes at the 2022 Vizient Connections Summit. "It maps out the incidences of PAS and creates a pathway for preparation so that we can achieve more security for our patients and improved wellbeing of our staff and physicians."

For more information about the University of Florida College of Medicine PAS program, email mosela@shands.ufl.edu.

Pregnancy is quite the journey for women who live in the rural villages dispersed between Nome and Anchorage, Alaska — and not just in the figurative sense.

To attend their prenatal care checkups, expectant mothers have to board a boat, plane or snowmobile to visit major hospitals, trips that for many add up to weeks away from family and friends.

But Philips Healthcare, which for decades has pioneered innovations in obstetrics care, landed on a simpler solution. Field clinical instructors trained local teams in nine villages across the state on the use of Philips’ Avalon FM20 fetal monitors, and expectant moms can even take and send pictures of the fetal monitoring recording paper to their obstetrician, which allows for early identification of any potential issues.

"As we all continue to work together to address OB-GYN shortages and access to care, one of the biggest ways we can solve for these problems is to shift to virtual health," said Jenn Quattrone Brown, director of marketing access/women's health ultrasound at Philips North America, who noted Philips is also exploring remote fetal monitoring as part of the shift to virtual models. "It's not only more convenient for moms, but less expensive for health systems."

In fact, Philips has launched several devices and apps that enable care close to — and in many cases, right at — home. For instance, their Lumify handheld ultrasound is being used in conjunction with Emory University's nursing program to help monitor the health of migrant workers and their families. With funding from the Bill & Melinda Gates Foundation, the company also is developing a set of new AI-driven algorithms on the Lumify handheld ultrasound that can identify six critical parameters in prenatal ultrasound exams to provide expectant mothers with a health check of their unborn baby.

Thanks to digitalization, informatics, and AI, interpretation of the images is no longer required by the operator, which reduces the training needed to perform the exam, hugely expanding the pool of frontline health workers who can learn to use the technology and integrate it into routine care. Where concerns may be raised for expectant mothers, a second opinion can be obtained through an existing antenatal referral process to health centers, where comprehensive obstetric ultrasound expertise exists. The new phase of funding will support the deployment of the AI-assisted tool to underserved communities globally.

And this year, the Michigan Department of Health and Human Services provided access to Philips' Pregnancy+ app — which offers parents personalized content and expert information, as well as an interactive 3D model to track fetal development — to every Medicaid-eligible patient in the state. MDHHS partnered with Philips to further tailor the app so that participants can view and access state programs that improve maternal and health outcomes through resources for breastfeeding, mental health and RSV, among others.

It's that kind of collaboration that drives innovation, Brown said, and with nearly 800 maternal deaths occurring globally each day, those partnerships are absolutely vital. In addition to its work with the Bill and Melinda Gates Foundation and health systems, Philips also supports organizations and initiatives including March of Dimes, the Black Maternal Health Momnibus Act and the Biden-Harris Maternal Health Blueprint.

"The U.S. maternal health system is in a state of crisis, and deploying solutions for virtual care, supporting safety-net clinics and Medicaid and Medicare for moms, and making sure women have access to care are all so important," Brown said. "This is not a problem we're going to solve with just our organization or any one organization that we partner with — it's going to take public-private partnerships to address this crisis.

"We're actively working to do our part," she said, "to help address maternal health challenges."

To connect with Philips about their work in bettering maternal health, visit their healthcare equality landing page.

Dr. Renée Allen is a former OB-GYN hospitalist and physician advisor and Rebecca Kojak is a former hospital service-line leader responsible for the care of women and children. But in their roles at Vizient, you could simply call them "agents of change" — experts who use their clinical backgrounds to guide providers and patients through uncertain times. They recently launched Vizient's Maternal and Infant Care Solutions Advisory Services, which helps hospitals identify key drivers of these challenges and implement innovative changes for optimal outcomes.

As mothers, the work Dr. Allen and Kojak are tackling — to reduce maternal and infant morbidity and mortality by ensuring that obstetric facilities are prepared to provide risk-appropriate care — is near and dear to their hearts.

"Our boutique perinatal and neonatal advisory solutions are addressing really important issues for obstetrics (OB) and the neonatal intensive care unit (NICU) — together a mini hospital within the hospital that can have their own unique set of length-of-stay, practice standards and accreditation challenges," Dr. Allen said. "We're targeting the root causes of these pressing problems with cost containment strategies, revenue generation and solving for quality care issues from prenatal care through labor, delivery and postpartum."

Additionally, through their assessment of a hospital's current state with data analysis, on-site observation and interviews with key stakeholders, Dr. Allen and Kojak offer workforce models that include OB hospitalists, physician advisors, midwives, doulas or a combination thereof — tailored to fit their needs — and help identify social determinates of health to improve access to care.

"OBs are not entering healthcare at a rate that is sustainable so midwifery, depending on the level of care allowed by each state, can play an important role in maternity desserts and be especially significant for prenatal care and in-between pregnancies," Kojak said. "Optimizing adequate prenatal care for women before they get to the hospital to deliver has tenfold benefits — for example controlling hypertension during pregnancy keeps the patient from delivering in crises."

Dr. Allen also says hospitalists, who work 24-hour shifts in the hospital as backups to primary OBs, can serve as "safety nets" for more high-risk patients whose medical emergencies cannot wait for their OB private practice physician to arrive. And physician advisors, who take deep dives into making sure OB and NICU departments meet regulatory and documentation requirements, are valuable for hospitals from quality, utilization management and revenue generation perspectives.

"Physician advisors can help with length of stay by implementing multidisciplinary rounding and also educate OBs on the importance of documenting the quality of care the patients receive," she said. "Complications outside of the maternal global bundle of care — for example, severe preeclampsia that requires a patient's extended stay for treatment — must be documented differently in order for payers to process claims correctly."

Whatever obstetric setting a hospital has, pairing their expertise and customized solutions drive Dr. Allen and Kojak's dedication with a singular goal.

"A healthy mom and a healthy baby going home to a happy family," Kojak said. "That's the epitome of success because if we can help providers get it right from the very start, we'll have a healthier population moving forward."

For more information about Vizient's Maternal and Infant Care Solutions, email maternalandinfantcaresolutions@vizientinc.com.

Authors
Erin Cristales, Vizient
Randena Hulstrand, Vizient