By Matt Phillion
There is a maternal health crisis in the U.S.: over 1,200 women die annually from preventable pregnancy related complications. Lack of access to quality prenatal care is an epidemic in its own right, particularly in areas that are rural or disadvantaged. Specific demographics are hit even harder: Black women are three times more likely to die from pregnancy-related causes.
Two organizations have partnered together to offer a new remote patient monitoring and advanced analytics option aimed at improving access and adherence to clinically recommended testing, especially for at risk populations using a portable solution that facilitates earlier identification of complications.
Bloomlife, a maternal health company, and PeriGen, which applies artificial intelligence (AI) to improve safety in childbirth, are partnering on a cost-effective solution that enables patients to receive the monitoring they need without requiring them to travel to testing facilities. The solution also qualifies for reimbursement, making it affordable for health systems and patients. Bloomlife has created a platform that includes a prenatal wearable for at-home fetal monitoring, integrating with PeriGen’s software to leverage statistical tools to analyze patterns and alert physicians in the event of potential issues.
“PeriGen has always been about reducing bad outcomes in childbirth. We do that by applying algorithms to interpret what’s going on with the fetal strip,” explains Matthew Sappern, CEO of Perigen. “The fetal strip is very prone to subjective interpretation depending on level of experience and situational awareness at any given moment, as well as a limited 30-minute view of labor that might be hours-long. We use discriminative AI to separate what’s happening from what’s not happening and use those tools to understand what’s going on throughout the entire course of the labor.”
The opportunity to take this further arose when Sappern met with Eric Dy, CEO of Bloomlife, which worked with the premise of putting the diagnostic element on the patient.
“We’ve got fewer clinicians, fewer places for people to go for care. The number of doctors is shrinking, the number of nurses is shrinking, testing centers and other resources are going away, but the mobile phone is ubiquitous,” says Sappern. “Connectivity is ubiquitous, even in these areas where healthcare deserts exist. You can’t keep requiring the patient to go some place—adherence in that situation is always going to be bad. And in this case, we’re talking about pregnant moms. Between childcare, transportation, time off from work, there are so many hurdles for adherence. We need to put the care on the patient, not require the patient to travel for care.”
And particularly for high-risk mothers, these barriers to adherence can only lead to more and more bad outcomes. That being said, it’s difficult to just put a diagnostic tool on a person because it opens up Pandora’s box of generating so much data there is not the staffing to handle it.
“But if we’re able to combine capturing the data at the mom and then combine it with the right analytics to triage that data, then you turn reams of data into actionable information and doing it a way that’s really comfortable for those moms,” says Sappern.
Affordability at scale
Obstetrics (OB) isn’t known as an area that generates a ton of revenue, Sappern notes, which means for a monitoring option like this to work, it also needs to be made affordable at scale for healthcare systems to make sure it’s sustainable for them.
“I’m convinced many systems don’t like OB because there is so much risk for little money, but if you don’t have OB, you can’t be an enterprise system,” he says. “What we try to do is put the tech on the patient, make this something that makes data visible and accessible.”
It’s also got to be something they can afford to take on.
“It needs to be done in a way that’s economically not punitive to the health system,” he says. “It needs to generate new revenue streams but doesn’t require them to delve deep into their pockets.”
There also needs to be a way to manage all the “headache stuff” like fulfillment, Sappern says.
“You’ve got to address fulfillment, and also make it easy for the moms to use,” he says. “Health systems can’t afford the time and expense of device management. All the doctor does is prescribe the tool and see what comes through to the EHR. If there’s a problem, they’re able to intervene.”
Sappern notes that Bloomlife has experience as a consumer business so they’re used to both fulfillment access and making it simple for mothers to use their devices. And right now is a critical time to find ways to help those mothers, Sappern says.
“Maternal risks are worsening—the rate of high-risk moms is growing,” he says. The need for remote monitoring to help those high-risk patients is greater than ever.
On the provider side, the remote monitoring option has several benefits, Sappern explains.
“For one, when it comes to remote monitoring for high-risk moms for blood pressure and glucose, it’s virtually impossible to rely on consistent, accurate readings—and it’s not reimbursed by CMS when the measurements are all self-reported,” he says.
By comparison, a remote-monitoring tool includes a blood pressure cuff and glucometer that are Wi-Fi enabled, pick up the signal directly, and transfer that data to a cloud-based repository and ultimately to the EHR.
“This makes those readings more dependable, and CMS actually pays for that,” he says. “We’re opening up a revenue stream for physicians and improving adherence for the patient because it’s a lot easier to do. Instead of moms interpreting and self-reporting their readings, these readings are device-driven and not subjective. That’s really important.”
The second component involves the concept of a remote nonstress test, which monitors the fetal heart rate for 20-30 minutes to see if it changes as the fetus moves and during contractions.
“During the third trimester, for high-risk moms particularly, doctors are interested in seeing how the baby’s heart is performing,” says Sappern. “They’re looking for a specific fetal heart rate patterns referred to as variability with periods of acceleration, and absence of decelerations. These are reassuring signs of a healthy fetus. It’s a really important diagnostic tool for treating a high-risk mom.”
Normally, this test requires the mother to go into a testing center or even be admitted for monitoring.
“It’s extremely disruptive and adherence is usually not that great,” says Sappern. “If doctors thought they’d get better adherence they’d prescribe it more.”
By putting the adherence into the mother’s hands, giving the flexibility to conduct the test at night, after work, or even at work during a break, it offers more freedom and takes the stress out of a nonstress test.”
This also enables the physician to configure how they want to handle the testing and provides the physician with information directly to the EHR.
“This can be such a problematic diagnostic test for health systems,” explains Sappern. “It requires very expensive testing centers and staff to maintain those centers, all with a 20%-30% no-show rate.”
The biggest challenge is life
The no-show rates are worth delving more deeply into, because they show a deeply flawed part of the process: it’s not that the expectant mother to be doesn’t care or want to be there for the test.
“The biggest barrier for the mom is life,” says Sappern. “Many come from more socio-economically challenged areas, and if they miss that test, it’s a safe bet they weren’t able to get there: the bus didn’t come, child care fell through, any number of barriers out of their control. Including increasing lack of facilities.”
With remote monitoring, those inherent challenges like transportation, time, or emergencies fall away. And on the health system side, at-home monitoring and testing means a need for fewer of those expensive testing centers.
“If you tell a system it can reduce those capital costs of a physical center and reallocate those funds, all while generating revenue for providers and making the tests more accessible to the mom, that’s truly transforming care” says Sappern.
The push and pull between needing to make money but also wanting to do right by the patient makes improved testing more important. Better monitoring can help reduce costs by cutting down on the number of newborns who need to go to the NICU by intervening early, for example.
“Software alone, technology alone does nothing,” says Sappern. “Tech is a great enabler, but you have got to have great leadership that cares, and you’ve got find a way to elegantly insert it into the workflow.”
The proof is in the results, Sappern notes. His organization has been teaming up with the Department of Obstetrics and Gynecology at Baylor College of Medicine in Houston, the Baylor College of Medicine’s Children’s Foundation in Malawi, and the Malawi University of Science and Technology to help prevent early deaths and stillbirths. The project was recently written up in the British Journal of Gynecology.
“For every 4,000 births in Malawi, there are 43 or 44 early deaths or stillbirths. With this solution in place, that number went down to eight, which is remarkable,” says Sappern. “That changes the lives of 35, 36 families, and its eminently scalable.”
The goal, Sappern says, is to make this kind of technology available globally to impact more lives. A birth is one of the few times you interact with the healthcare system that you expect a joyful outcome, he says, and we should do anything we can to make sure preventable issues are identified and addressed.
“Any solution like this must be really easy on the patient. They have to be able to open the box and put it on,” he says. “It must take this increased amount of data and transform it to digestible, actionable information, and it’s got to be scalable and affordable for the practitioner. If you can hit all of those things, you have real positive change.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at email@example.com.