Leveraging virtual tools to mitigate maternity care deserts

UNDERSTANDING THE MHC PROGRAM

The MHC program offers pre-pregnancy, prenatal and postpartum maternal health services through a team of maternal-fetal medicine providers, obstetrical providers, registered nurses and doulas, Richards said.

The care teams lease space in community healthcare facilities to set up MHC clinics. For instance, in Evanston, the MHC team has leased space at a medical group clinic, while in Montana, they have leased space at the two critical access hospitals.

Patients are typically referred to MHC through local providers, community organizations, public health services or self-referral. Richards explained that once the clinic receives the request, an MHC registered nurse reaches out to the patient, describes the program and offers an enrollment visit. Following that, the nurse reaches out to the patient's OB and lets them know that the patient wants to participate in the MHC program.

The first patient visit takes place in person at the MHC clinic, after which visits are conducted virtually or in the patient's home, Richards said. The RNs meet with the patients every two weeks through pregnancy and up to two months postpartum. Then, they meet with the patient monthly until one year postpartum.

Using telehealth technology, the RN facilitates prenatal visits with the patient's OB provider, mitigating the need for travel for what is usually a short 15-minute appointment, Richards said. Further, the care team tracks patient vitals using RPM devices, such as blood pressure cuffs, thermometers and pulse oximeters.

"[The RPM kit] allows their care team to track blood pressure, O₂, weight, temperature and heart rate on a regular basis," she explained. "This allows us to see trends that may need to be followed more closely. And then, having the kit at home also means the care team is able to get reliable vitals information when a patient is wanting to do a virtual visit at home or if they call in with a concern. We can go, 'You know what? Go ahead and check your blood pressure. Let's see what that's at.'"

Continuous monitoring combined with virtual and in-person care not only enhances maternal outcomes but also expands the care options available to people in maternity care deserts. 

For instance, it provides more convenient access to specialty tests, like fetal stress tests, which sometimes need to be done weekly or twice a week, Richards noted. Each MHC RN also has a mobile handheld ultrasound device that allows them to perform biophysical profiles, check positioning and more without making the patient leave their community.

"Patients deserve choice in their care, and being able to offer a range of options means we're able to get care to the patient in a way that fits their preferences," Richards said. "When a patient's four days postpartum and struggling with lactation, our RNs can come to their home and help them. When it's snowing and the roads are dangerous, we can still do many of those visits virtually without the risk of them getting in the car."

USING FEDERAL FUNDS TO INCREASE MATERNAL CARE ACCESS

Data from a 2024 March of Dimes report reveals that 35% of U.S. counties are considered maternity care deserts, leaving 5.5 million women with little or no access to maternity care services.

Healthcare systems are working to improve access in various ways, including through government grants. The Maternal Health Connection program is the result of one such grant. In an interview, Krystal Richards, grants project director and business analyst for Maternal Health Connection at Intermountain Health, described the program's origins.

"Intermountain Health is part of the Healthy Granite County Network in Granite County, Montana," she explained. "And together with that network, we applied for a Health Resources and Services Administration RMOMS grant -- RMOMS stands for Rural Maternity and Obstetrics Management Strategies, which is why we really love the acronym -- [and] we were awarded the grant at the end of Q3 2022 with the goal of increasing access to and continuity of maternal and obstetrical care in rural Montana, specifically Granite and Powell County."

Patients deserve choice in their care, and being able to offer a range of options means we're able to get care to the patient in a way that fits their preferences. When a patient's four days postpartum and struggling with lactation, our RNs can come to their home and help them. When it's snowing and the roads are dangerous, we can still do many of those visits virtually without the risk of them getting in the car.

Richards noted that these areas are maternity care deserts, which means pregnant people in these counties end up having to travel long distances for care. As a result, they are less likely to access the prenatal, childbirth and postpartum care they need.

"In fact, when we went live with the program in Montana, the last individual that had delivered -- on their birth certificate was a mile marker because they were just trying to get to a facility for help," she added.

To counter the risks of living in a maternity care desert, which include a higher likelihood of preterm births and maternal deaths, the Intermountain leaders used the grant funding to launch the Maternal Health Connection [MHC] program, which offers access to virtual visits with Intermountain OB-GYNs, remote patient monitoring and in-person care at an MHC clinic.

"We wanted to improve maternal and neonatal outcomes and ultimately develop a financially sustainable program to increase access of prenatal, pregnancy and postpartum services that could be replicated throughout the rural areas in the Intermountain West," said Richards.

Though the RMOMS grant funding was meant explicitly for the Montana counties, MHC program leaders decided to expand the program to Evanston, Wyoming, after Evanston Regional Hospital discontinued labor and delivery and other obstetrical services at the end of 2024. This made the Evanston area a maternity care desert.

"We found Evanston Regional had already started discussions with our Park City Hospital to help ensure patients were given information on the nearest care available," Richards said. "So, through these discussions, we garnered the support from Evanston Regional, Intermountain's administrative leadership, OB providers, hospital leadership and clinical leadership to move forward with expanding the MHC to Evanston."

After getting the final approval from HRSA, Intermountain added the Evanston area to the grant's scope and used carryover funding to expand the program.

INTEGRATING AND EXPANDING THE PROGRAM

Bringing the MHC program to rural counties requires program leaders to integrate with the community. In Evanston, Wyoming, Richards noted that MHC leaders attended community forums and baby showers to meet community members and introduce themselves and the program.

Further, they created a baseline services map to better understand currently available resources and services and identify potential gaps. In that process, they contacted those local entities, which helped raise awareness of the program.

However, successfully integrating the program into maternal care deserts goes beyond raising awareness. MHC leaders are also tasked with ensuring the program's sustainability, which is difficult amid narrowing reimbursement and a lack of access to impactful care like doula services.

MHC is addressing these challenges by leveraging the Centers for Medicare & Medicaid Services' Community Health Integration (CHI) Services reimbursement pathway and advocating for legislative support of doula services.

"Our team has helped really educate on the benefits of doula services, which include decreased C-sections, increased breastfeeding, decreased preterm birth rates and fewer adverse maternal outcomes," Richards said.

MHC leaders plan to expand the program beyond the areas in which it currently operates. Richards shared that they have applied for additional RMOMS grants to extend the program to other parts of Wyoming and Nevada.

As they look to expand the program, program leaders aim to stay laser-focused on MHC's main goal: enhancing maternal outcomes by widening care access.

"Really, the thing that we're looking for is: are we bringing access to these services to the communities?" Richards emphasized. "Are they utilizing that access, and is it improving maternal and neonatal outcomes? Are we able to catch those preeclampsia cases before they're an emergency? Are we able to improve the amount of preterm births so we're not seeing them as much, right? Are we decreasing that rate? So, I think the things that we are looking at, there's lots of different elements, but ultimately, are we improving that continuity of care?"

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.