Challenge:

There is a maternal and child health crisis in America and in California. Black women are more likely to die than any others during pregnancy or delivery, and the cause is largely racism and inequitable access and treatment within the healthcare system. Pregnancy-related mortality rates among Black women are 3X higher than White women. Pregnancy-related mortality rates among American Indian and Alaskan Native women are 2X higher than for White women Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to White women (source: Kaiser Family Foundation).

The evidence and data are clear; real, scalable solutions are not. Even regulations meant to create health equity prohibit payers from providing a greater amount of services to those with the greatest need. And, racism–which nearly 50% of members/clients in one pilot site and 30% in another reported experiencing–is hard to eradicate.

Strategy:

To develop a solution that would be effective, compliant, and scalable, we needed to figure out how to make information and services available to the women who need it most without inadvertently promoting access among those women who can broadly, easily access healthcare and other services and whom were already having good pregnancy and birth outcomes.

We also needed a solution that would be available on demand, online, and in person. Women and expectant parents of color could not solely rely upon healthcare providers to make referrals.

Finally, we needed a solution that could be self-sustaining or low cost enough that Blue Shield could make it broadly available to our lowest income members and community members, no matter their selected health plan (initial focus was on Medi-Cal members).

Solution: Doula Benefits + Prenatal and Postnatal Services

My team and I interviewed and surveyed providers, birth equity advocates, and consumers and members to understand what members might need during and after their pregnancies. We interviewed and surveyed Black members and consumers (those with the greatest mortality risk) to understand their experiences of racism and where they felt their needs were not being met. We used these learnings to design the doula and other prenatal and postnatal services we would provide and the channels through which they would be delivered.

We partnered with community-based organizations in Los Angeles, Sacramento, and San Diego counties who were already serving women and expectant parents of color. We used their trusted networks to inform women and parents.

We partnered with women’s maternal health platform Mahmee to bring as many possible of the healthcare, wellness, and social needs services together and to make those services available anywhere, anytime.

Finally, the team and I developed multiple paths to sustainably funding the services, including Doula Medi-Cal benefits.

In addition to the Medi-Cal benefit, the maternal child health services are live in pilot or beta in several CA markets.

Press Releases

Blue Shield of CA’s New Maternal and Infant Health Initiative Offers Innovative, Comprehensive Program to Improve Health Equity: https://www.prnewswire.com/news-releases/blue-shield-of-californias-new-maternal-and-infant-health-initiative-offers-innovative-comprehensive-program-to-improve-health-equity-301478967.html