Strategies for Improving American Maternal Health Decline

In the United States, more than 40,000 babies die after birth or are stillborn each year, a tragic statistic attributed to a lack of access to adequate pregnancy, birth, and infant care. This alarming number highlights the urgent need for reform in the country's healthcare system, particularly in the Medicaid programme.

Currently, Medicaid pays a total of $1,000 for nine months of pregnancy and postpartum care, a stark contrast to the $1,600 it reimburses for a one-hour joint replacement. The programme's reimbursement for modern technologies in obstetrics, such as remote monitoring, telehealth, and other innovative solutions, is low compared to other conditions and varies by state.

This underfunding creates a financial strain for the 80 percent of providers whose patient caseload is primarily covered by Medicaid. Disproportionately low reimbursement rates for obstetrics are a significant issue, as they discourage hospitals from providing care and push them into bankruptcy.

A proposed solution to this issue is replacing Medicaid's maternal and child health coverage with a nationwide managed care program for pregnancy, birth, and infant care called "Medi-Mom." This programme would operate similarly to Medicare Advantage plans that provide coverage to seniors through private insurance.

Medi-Mom would be jointly funded by Medicare and Medicaid, reducing state program costs and expanding low-income patients' eligibility to include at-risk mothers and infants. This expanded coverage would enable access to all, whether through public funding or private pay.

Research shows that when new moms on Medicaid get help to access medical, social, public health, education, and other services, this reduces infant deaths. The organisation "Medi-Cal" in the United States has introduced programs in recent years aimed at supporting maternal and child health, similar to Medi-Mom; such programmes have improved prenatal care access and reduced infant mortality rates by providing healthcare coverage and supportive services to low-income mothers and children.

One of the key advantages of Medi-Mom is its focus on accountability. The programme would hold providers accountable for outcomes, promoting modern technology to lower costs and improve quality. By prioritising necessary data to understand problems, Medi-Mom aims to ensure the adoption of life-saving technologies and the delivery of coordinated medical services.

Using remote monitoring and telehealth technology for postpartum care can help avoid costly rehospitalizations. For instance, 10 percent of breastfeeding mothers develop mastitis infections and visit the emergency room, but the condition can be easily diagnosed through a telehealth appointment and treated with antibiotics at home.

During the COVID-19 pandemic, the Program for All-Inclusive Care of the Elderly (PACE) demonstrated the potential benefits of such a system. PACE providers moved quickly to educate patients, adopt telehealth, and coordinate with services such as meal and medication delivery, resulting in a lower infection rate among PACE participants compared to comparable nursing home populations.

While infant mortality is rising at a rate not seen in two decades in the U.S., nearly every other industrialized nation continues to improve. The implementation of a programme like Medi-Mom could help reverse this trend and ensure that every baby has the best possible start in life.