As physicians, we rely on data to improve our clinical decision-making in the patient’s room, and as lawmakers, we rely on data to shape public policy. When it comes to maternal and infant health, however, health care providers and lawmakers have been flying blind with many lives at stake.
Maternal deaths in the U.S. fell during the 20th century, but over the last two decades, health organizations warned we reversed course. The Centers for Disease Control and Prevention (CDC) confirmed these warnings, reporting that maternal deaths increased from 7.2 deaths per 100,000 births in 1987 to 17.8 deaths per 100,000 in 2011. The CDC also found that from 2007 to 2016, black women ages 30 and older were four to five times more likely to die from a pregnancy complication than their white counterparts. The Building U.S. Capacity to Review and Prevent Maternal Deaths project team also shed light on this critical problem, estimating that 63 percent of maternal deaths were preventable, ranging from deaths caused by cardiovascular and coronary conditions to hemorrhaging.
States and local communities have begun the hard work of learning where and how our society is failing moms, both those who die from a pregnancy complication but also the 50,000 women who experience severe maternal morbidity each year. Congress and the Trump administration focused on helping states do this by passing the Preventing Maternal Deaths Act last December. This law is currently helping states establish and expand Maternal Mortality Review Committees to better understand the causes of maternal deaths, including disparities in maternal care, health risks and patient outcomes.
Although it takes time for the CDC to receive new information, real-time data from the private sector is helping to fill in the gaps. Premier Inc., a health care improvement company in partnership with over 4,000 hospitals, recently reported that deaths occurring in the hospital have declined by 24 percent over the last decade. In addition, the disparity between white and black mothers’ outcomes has narrowed by 80 percent.
This new information examines a single site of care – the hospital – over a narrow three-day inpatient stay including labor and delivery. This data is insightful as 98 percent of births in the U.S. are in a hospital setting and it identifies where we’ve been successful. The CDC, however, measures maternal deaths more broadly using three periods: occurring at delivery or in the week after, occurring during pregnancy, and occurring 1 week to 1 year postpartum.
Keeping women healthy during the prenatal and postpartum periods is so much bigger than just what happens during labor and delivery. Equipped with comprehensive and real-time data, we can have a clearer understanding of the many forces that influence maternal health and develop a roadmap to eliminate preventable causes of maternal mortality. So how do we ensure our health care system rewards those who keep moms alive and healthy?
Current payment models are largely focused on services provided and do not incentivize care coordination across the many health care providers involved. This can result in fragmented, disjointed care that pinballs women among providers who work in different health systems. For better health outcomes and team-based approach, we encourage the Center for Medicare and Medicaid Innovation to consider payment models that empower patients and their health care providers to work together from conception through one year postpartum.
Armed with the right data, we can begin to make smarter policy recommendations and clinical decisions that will address the gaps in prenatal and postpartum care. In addition, with the right incentives in place, we can improve the delivery of maternal care. Let’s not miss the opportunity to do so.
Rep. Roger Marshall, M.D., represents Kansas’ 1st District. Prior to Congress, Dr. Marshall was a practicing obstetrician and gynecologist in Great Bend, Kan. He received his M.D. at the University of Kansas School of Medicine in 1987. Rep. Ami Bera, M.D., represents California’s 7th District. Prior to Congress, Dr. Bera was a doctor of internal medicine and former chief medical officer of Sacramento County, Calif. He received his M.D. from the University of California, Irvine in 1991.