OSF OnCall plugs pregnancy and postpartum care gaps for Medicaid patients

Pregnant woman connecting for virtual visit

Samantha, a 25-year-old woman who recently had her second baby, enrolled in a new program through OSF OnCall Connect that provides support to pregnant women with Medicaid insurance.

The program likely saved her life. Eight days after she delivered a healthy baby girl, Samantha messaged her care team through an application that can be accessed on a tablet or smartphone that serves as a key connection and education tool.

It’s available through the OSF OnCall Connect pregnancy-postpartum program and connects patients instantly to a nurse. Samantha explained she was suffering from a terrible migraine headache and chest pains. The OSF OnCall nurse immediately recognized the significance of her symptoms and notified the advance practice provider who recommended Samantha go directly to the Emergency Department. She had a serious condition called postpartum pre-eclampsia, which can lead to brain damage, stroke and death if left untreated. Samantha was to make a full recovery. She’s also is a Black woman, and in the United States, pregnant Black women are three times more likely than white women to die as a result of pregnancy.

A report from the Centers for Disease Control and Prevention (CDC) found 80% of maternal deaths between 2017 and 2019 were due to preventable causes, and many of the deaths occurred within the first year after giving birth. The statistics are behind the new OSF program that was launched under the umbrella of a state-funded program called the Medicaid Innovation Collaborative.

Kate Johnson, clinical supervisor for Digital Care at OSF, says 970 women with Medicaid insurance have signed up for the pregnancy and postpartum program since it was launched in August. Currently, nearly 500 women are actively enrolled. Johnson says pregnant women, especially those who have a lack of resources, are eager to have the 24/7 connection offered through an app they can download on their smart phone or tablet

“It provides check-in questions, routine questions, like ‘Are they having any signs of infection, UTI symptoms? Are they struggling with breastfeeding; having any depression symptoms?’ And if they answer in any kind of an alarming way, that lets our nurses know right away … sends them an alert, and we're able to contact those patients via telephone and triage if we need to.”

Women on Medicaid can self-enroll in the free program starting eight weeks into their pregnancy by going online to register. After they enroll, women will be sent a blood pressure cuff to take regular readings and the program can connect them to other equipment they might need such as a breast pump.

Women can also enroll in the postpartum program without having participated in the pregnancy support. Johnson says women will receive new education messages each week throughout their pregnancy and postpartum.

“I think the education that we provide those moms during their pregnancy is awesome because it's getting them ready to deliver their baby. So, helping them think about things like how they want to feed their baby, birth plan, pain management for their delivery, things of that nature.”

Connecting women to mental health support

The CDC study found mental health issues were among the preventable, pregnancy-related conditions that lead to higher mortality rates. Johnson says that’s why the program offers depression screening upon enrollment in the pregnancy program, and when they deliver, they have the option to enroll in the postpartum portion. For postpartum support, they can indicate the type of support they need, such as selecting whether they delivered vaginally or via C-section or if they require information on infant care.

Even though women are screened for depression in the hospital after they give birth, it’s often six weeks before they have a follow-up appointment. Johnson says that’s sometimes too late, and women too often suffer in silence.

“So, we will be screening her right upon enrollment into the postpartum loop. And then we'll do a two-or three-week check-in to make sure emotions are doing okay. There is such a huge change in emotions postpartum with the changes in your hormones and bringing a baby home plus the sleep deprivation. So, we want to be there to support them in that initial six weeks before they see their provider.”

A patient named Jane enrolled and indicated she suffered from untreated postpartum depression after her first child, which is a risk factor she could experience that with another pregnancy. Jane had messaged regularly after delivering her second child, and by her third week, made contact and told the OSF OnCall nurse she had worsening depression to the point she had suicidal and homicidal thoughts. The woman was taken to a local hospital to get help, and remained calm while waiting for the ambulance because of the connection and trust she felt with a nurse she had had regular contact with through the program.

The OSF OnCall Connect pregnancy and postpartum initiative also screens for social determinants of health – all those factors outside of a medical office, such as food insecurity, financial struggles, housing and transportation challenges, to fill the gaps that could contribute to the woman’s health and the health of their baby. Johnson shares there are common struggles.

“I think what we're seeing mostly is patients who are struggling with transportation to get to their actual OB provider appointments, so we are able to align transportation for them in most cases. Just this past weekend, we had a patient that had no car but needed a prescription. So, we aligned her with a pharmacy that delivered those medications directly to her door.”

Women with Medicaid insurance enrolled in the program have the option of being connected with a digitally-enabled community health worker who can help them navigate ongoing support from community-based organizations. Translation services are part of the support provided to make sure women get the medical care and outside resources that can help meet their social service needs met.