Improving Outcomes in Women’s Healthcare

It’s one of the ironies of American healthcare: macro-level policy decisions are often made by men, but when it comes to actual patient decisions, women take charge – not only for themselves but for their parents and their children.

Maternal Care

This conflict between public and personal decision-making may be one of the reasons we sometimes end up with substandard women’s health. Take maternal care, for example. We tend to wax sentimental about the miracle of childbirth and the joy of motherhood, but the sad fact is we don’t take maternal healthcare policy seriously enough. Our childbirth outcomes are the worst among developed nations.

Nearly 10 percent of all US births are preterm, which can cause complications including cerebral palsy, vision and hearing loss, and intellectual disabilities. Being born just a few weeks early increases the risk of respiratory distress, feeding difficulties, temperature instability, jaundice, and delayed brain development. Beyond the emotional impact, prematurity also can have an economic impact on families and employers. Premature birth costs about 10 times more than a healthy, full-term birth, according to 2014 analysis by Truven Health Analytics, commissioned by the March of Dimes. And despite compounding expenses, it is often difficult for a mother or father to return to work with a sick child at home.

Sadly, serious disparities continue to exist between communities and among racial and ethnic groups in the US, with African-American infants about twice as likely to be born preterm as white infants, according to The March of Dimes 2015 Premature Birth Report Card.

Group Prenatal Care

Having a baby is a significant moment in life when people may be more open to behavior change. With social support during pregnancy and beyond, people have been shown to adopt healthier behaviors as they prepare for their new child. Making these changes can improve the trajectory of their health and the health of their baby over the course of their lifetime. 

UnitedHealth Group has been studying the group prenatal care model. In clinical trials, this approach has demonstrated a significant reduction in preterm birth rates. The care model succeeds because women are embraced with more care, more support, and more education. 

Instead of sitting in a waiting room and spending only brief moments with a physician who evaluates basic vital measures, expectant mothers pool their care time together and receive prenatal education from a care provider and social support from other expecting mothers. Women are no longer spending their time alone in the waiting room. Instead, they take their basic vital measures and learn from a physician what each measure means. During group care, women are supported by evidence-based content and conversations with other women due in the same month with knowledgeable care teams guiding these conversations. In this environment, prenatal groups are learning from and supporting each other.

The group prenatal care model has been shown to improve maternal and child health, with lower rates of preterm birth, fewer days in the Neonatal Intensive Care Unit, and a reduction in rapid repeat pregnancies.  

Today, we are working with March of Dimes to scale a new type of group prenatal care called Supportive Pregnancy Care. We also are working with national employers to test a virtual model of group support. Our collective hope is that any expecting woman can have access to these innovative models of group care.

Digital Healthcare (Connected Care)

Another challenge for women’s health is that chronic conditions such as diabetes, asthma, heart disease and obesity have reached epidemic levels. Women focus not only on their own chronic conditions, but also are often supporting care for their loved ones. People with less access to resources struggle the most.

The way we treat and support people with chronic conditions today is based on a century-old model of episodic care that doesn’t reflect patients’ ongoing, daily needs. A hundred years ago, most care was delivered via a doctor’s black bag. There were few technologies available, so caregivers visited homes while relying on their expertise, intuition, and a few simple tools found in their black bag. Fifty years ago, medicine evolved into a black box. We had better, bigger technologies in physicians’ offices, so patients were willing to go to care practices to receive care. When people left the office, they couldn’t access or use the information on a daily basis.

But now, medical technologies are evolving. There are new technologies for patient and care provider alike, and they are small enough to fit in our pockets. We need a new approach to use them effectively. Think of the air traffic control system that manages global aviation.

Today the women who manage increasingly complicated care for themselves and their families are left alone between doctor visits. What they need is the medical equivalent of air traffic control – deploying technologies to enable real-time care and better health.

At UnitedHealth Group, we are advocates of connected care – the real-time, electronic communication between a patient and a care provider, including telehealth, remote patient monitoring, and secure email communication between clinicians and their patients.

One example includes connected technology to treat asthma among children served by our Medicaid programs. This initiative combines timely telephonic nurse intervention with a third-party digital platform to change treatment plans into treatment realities.

We also are collaborating with Children’s Hospitals and Clinics of Minnesota to test a Pediatric Type 1 diabetes program that combines real-time data collection and rigorous outreach to improve young patients’ health and quality of life. The program has been very successful; however, research is not enough. We are now taking what we learned from the pilot and quickly moving forward on a scalable model that can serve even more people with chronic conditions.

These care models teach us a lot about how to use technology and personalized data to improve care outcomes, improve experiences and lower costs for the people we serve. We are connecting patients with their medical providers in real time, when it matters. We are providing data insights in simplified ways so people can better care for themselves and their families. We are leveraging this information into system-wide programs to support people with chronic conditions so they can focus on living healthier lives.