Digital Health: The missing piece of the health equity puzzle
For payers and providers, addressing health equity and Social Determinants of Health (SDoH) to improve maternal outcomes isn’t a new concept. It has been part of the national conversation for years. Despite the attention it has garnered, maternal mortality and morbidity rates have not improved; they have deteriorated.
Not only are these poor outcomes costing lives, data suggest the economic burden of maternal morbidity and mortality amounts to billions of dollars each year. The argument has been made that improving maternal mortality is not only the right thing to do, but also makes financial sense. That much we all agree on.
But exactly how to address SDOH has been debated. Many organizations have created stand-alone programs to improve social determinants and equity, but many of the past efforts have been too siloed. Maybe with the right players working together, the conversation can shift from why we should address social determinants, to how. And effect systemic change.
Enter: digital health. Digital health may be the missing piece to the health equity puzzle. The average person spends approximately 3 hours and 15 minutes a day on their phone and checks for notifications 58 times a day. These statistics are not limited to individuals with private insurance; studies have shown that most Medicaid beneficiaries also have access to technology and an appetite for digital health.
Given that digital platforms are ubiquitous, they provide an ideal space to test innovative programs aimed at addressing SDoH and improving maternal outcomes. Our work and outcomes strongly support this idea.
During pregnancy, the postpartum period, or when individuals are looking to expand their families, their investment in their health is at its peak, as there is more at stake. Our members’ activities reflect this, with most logging in daily. The average user logs in differently based on the stage of their lives but still does so frequently:
- Ovia’s fertility solution: 19/month on average
- Ovia’s pregnancy solution: 34/month on average
- Ovia’s postpartum & parenting solution 92/month on average
Since we have their attention, we’re in a unique position to influence their behavior, educate them and address SDoH.
Every Ovia+ member is required to complete a health assessment upon enrollment, and an impressive 95% of members complete it. This assessment includes a wide range of questions about an individual’s health, financial situation, housing, family circumstances, and medical history. Using this data, we can create a unique risk profile for each member regarding their health and social determinants. Our Care Advocate team can reach out if any risks are detected and help resolve issues, sometimes before they even occur.
This type of solution is succeeding where many other screening programs have failed. Why are people willing to share their information via digital health? Digital enables anonymity. Many in-person programs have not been widely successful in the past, often due to participants feeling uncomfortable answering sensitive questions such as “Do you feel safe at home?” or “Do you have worries about housing in the next two months?” in-person. Online, their identities can feel less exposed, and they may be more comfortable sharing this type of information, especially if they fear that their answers may lead to a visit from Child Protective Services (CPS) in a public setting.
Once risk profiles are created and assessed, our programs can begin to take action. Here are some examples of initiatives we are currently hosting and that you could replicate or join:
1. Addressing food insecurity
Accessing nutritious foods is vital during pregnancy to support infant growth as well as reduce the risk for conditions like gestational diabetes. However, an alarming 54 million people in the United States face food insecurity. While many are eligible for federal support programs like the Supplemental Nutrition Assistance Program (SNAP) or the Women, Infants and Children Nutrition Program (WIC), many do not take advantage due to social stigma, confusion over eligibility, or simply being unaware.
So, we partnered with the researchers from University of California-Davis and University of Wisconsin-Madison to educate people about WIC and improve enrollment to reduce food insecurity.
Our preliminary results, which were presented for the first time at the 2023 CityMatCH conference, suggest that participants in the treatment group were slightly more likely to have enrolled themselves (46.6% versus 42.5%, p=.14) or their child (37.5% versus 34.3%, p=.19) in WIC postpartum, and were significantly more likely to report that they were likely to enroll their child in the future (57.6% compared with 51.3%, p=0.034). You can learn more about that research and findings in this blog.
2. Improving postpartum visit rates for Medicaid or CHIP recipients
Nationally, only about 60 percent of women attend their postpartum visits, with even lower rates among Medicaid or CHIP beneficiaries. But, these visits are vital to catching a number of potential issues, especially PMADs. By increasing the rate of attendance at six-week postpartum visits, we thought we could connect more people to the care they need to prevent adverse events.
So, we created a new program to increase postpartum visit attendance, awarded by the HHS Racial Equity in Postpartum Care Challenge. Starting in the 3rd trimester of pregnancy, we use in-app education and push notifications to encourage members to attend follow-ups. This program also explains what to expect at the appointment and educates members about important questions to ask their provider.
The results are promising: postpartum visit rates were 86% among Black Ovia members enrolled in Medicaid or CHIP and 89% for American Indian and Alaskan Native Ovia members enrolled in Medicaid or CHIP. Compared to the national average of 60%, that’s a 43% increase.
3. Increasing perinatal mood and anxiety disorder (PMAD) screenings
Our solutions also serve as a safety net for those whose providers or circumstances don’t include frequent mental health screenings.
Members receive the universally validated Edinburgh Postnatal Depression Scale (EPDS) while using the Ovia Pregnancy and Ovia Parenting apps. They are prompted to take the EPDS during the first and third trimesters of pregnancy and at least twice within the first six months after birth. Members participating in this program were 67% more likely to complete the screener.
4. Tackling housing insecurity
On any given day, nearly 560,000 people experience homelessness in the United States. In addition, some research shows that pregnancy can increase a woman’s risk of homelessness. Pregnant women face significantly greater health risks when their housing situation is unstable.
To address this issue, if a member expresses concern about housing in the coming months through the Ovia+ health assessment, our Care Advocates proactively reach out to hear their concerns and help connect them to local community resources that can improve their housing security. Similar efforts are made when members express concerns about financial hardships or the ability to pay for or access utilities like water, electricity, or heat. These programs, though relatively new, have already had a positive impact on dozens of families and are expected to grow.
5. Connecting members to racially concordant care
Research has established that when patients have access to racially concordant care, they have better health experiences, appointment attendance and outcomes. Our Care Advocate team understands this and works to connect members with providers who share similar backgrounds, including doulas and midwives in their area. This is crucial because studies indicate doula-assisted mothers were:
- four times less likely to have a low-birth-weight baby
- two times less likely to experience a birth complication involving themselves or their baby
- significantly more likely to initiate breastfeeding.
All members who identify as Black or African American will receive this message from their Ovia Health Coach/Expert: “Sometimes it feels most comfortable to have healthcare conversations with providers you identify with who can really understand your personal experiences. If you have health questions you’d like to discuss with a Care Team member who identifies as Black or African-American, we’re here and ready to support you! Just send us a message.”
This work complements our Black Maternal Health program, which is designed to empower and support Black members while predicting their unique risks based on experiences and conditions they are more likely to face. We partnered with Reproductive Health Impact (formerly the National Birth Equity Collaborative) on this program and their Respectful Maternity Care Framework.
6. Removing obstacles to care
Accessing proper healthcare can be challenging for many individuals due to transportation or childcare limitations. However, many people are unaware that local and federal programs are available to help them overcome these obstacles. If our screening detects that someone is hindered by either of these issues, our Care Advocate Team proactively reaches out to connect members with the available resources. Although these programs are relatively new, they have already assisted more than 60 families in accessing the care they need.
Leveraging digital health to improve health equity and SDoH programs
These are just a few of the programs we’ve built to support members and address social determinants. We’ve also piloted programs to help members who are experiencing domestic violence and need access to childcare.
While we have achieved success thus far, we recognize that there is still much work to be done to achieve health equity. To make lasting change, we must also address systemic racism in our systems and connect more people with available community resources and health programs. If your organization aims to address social determinants and improve health equity, it’s time to consider partnerships with organizations like Ovia. Our unparalleled access and engagement open new opportunities for improvement that traditional providers and payers do not possess.
I urge you to take action to ensure that the next generation does not face the same health equity challenges we are addressing today.