Imagine this. You're at the Swiss Hotel in
Chicago surrounded by top executives from leading insurance
companies and health systems.
Welcome to Becker's fall pair issues roundtable, November
4th through 6, 2024.
Picture the excitement as you gather business cards
from over 500 executive level attendees,
building invaluable connections.
Feel the energy as you participate in over
26 educational sessions led by 90 elite speakers.
Envision yourself engaging in lively discussions about new
health plans, hospital at home models, behavioral health,
and price transparency.
Now imagine being inspired by keynotes from boxing
legend, Sugar Ray Leonard, and 4 time NBA
All Star, Chris Webber. Their stories will leave
you motivated and ready to innovate.
Don't miss out on this unique opportunity. Get
registered today. Visit beckershospital
hospital review.com
and click on the events page to find
the conference website. That's the beckers hospital review.com
events page. See you in Chicago.
Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast.
Thrilled today to be joined by a special
guest. Doctor Lisa Sall is UnitedHealthcare's
National Medical Director of Maternal Child Health. Doctor
Sall, thanks so much for taking the time
to be with us on the podcast today.
Thanks for having me, Jacob.
Happy to be here.
So, Lisa, the philanthropic arm of UnitedHealth Group,
the UnitedHealth
Foundation,
has just released a report within the last
few weeks called America's Health Rankings 2024
Maternal and Infant Health Data Brief. This is
obviously such an important issue for our country
and within our health care system.
So can you talk to us a little
bit about what this report is showing and
what the need is for such a report?
Well, to start with why there's such a
need for the report is that healthy women
and children are the foundation
of our communities across the country.
And it's really important to understand
the disparities that they face. And so the
America's Health Rankings 2024
Maternal and Infant Health Disparities Data Brief
is really hoping to shed a light on
the breadth,
depth, and persistence of disparities and outcomes
and the drivers of health for
the approximately 61,000,000
women of reproductive age
and 4,000,000 infants in the United States.
So what we typically
have seen in
our America's Health Rankings report is a is
a broader view on maternal and infant health.
And, the way that we're looking at this
new analysis, it builds on last year's America's
Health Rankings of Women and Children
report by looking at 5 years of data
and aggregating that data to offer more detailed
understanding of disparities by race,
ethnicity,
education, and income at both the national and
state levels across 14 measures of of health.
And, ideally,
what we wanna do is align these measurements,
related to public health goals and benchmarks like
healthy people 2030.
So this report, Lisa, it sounds like is
is taking a very wide look at maternal,
and infant health outcomes all over the country
across a wide variety of metrics.
In knowing that, what would you say are
some of the key highlights of the brief
from from this year's report?
There are 4 key highlights
that I would like to call out from
the report. The first is that in 2020,
severe maternal morbidity
was 2 times higher among black women
than white women and
about 1 and a half times higher among
Black than Hispanic
birthing people.
The second
is that infant mortality was 2.9
times higher among infants born to black than
Asian mothers,
2.4
times higher than white, and 2.2
times higher than Hispanic mothers in the 2018
to 2021
time frame.
The next key takeaway
is as as we look at females
that are in the childbearing age defined as
18 to 44,
if we look at the comparison between 2010
and 2014
high school education than college graduates. And then
the 4th item
that I want to note is that the
low birth
weight differed by race and ethnicity with low
birth weight infants born to Black mothers
2 times higher compared to infants born to
white mothers. So these disparities
are are are clear.
They are persistent,
and it's a key reason why a report
like this is is really important to to
highlight some of these differences so that we
can think about how we as communities can
address them.
Absolutely, and some really sobering statistics that you
just shared, especially when it comes to how
these outcomes break down across racial
and uninsured
individuals,
demographics.
Obviously, Lisa, as you know, maternal mortality
rates, it's such a
pervasive issue in this country for,
in for the healthcare system, especially.
Is there anything you want to expand upon
on that issue in terms of what the
brief found
and, what it might be recommending?
Certainly. Well, I've been practicing medicine for the
last 20 years, and the
maternal mortality rate in the United States has
only been steadily increasing
over that period of time.
It is the highest among high income countries.
And as we've highlighted in the 2023
Health of Women and Children report,
in 2017
to 2021
time frame, there were 22.4
deaths per 100,000
live births, which is higher than the Healthy
People 2030 target of 15.7
deaths per 100
live births.
In this time period of
2017 to
2021, 6 states had maternal mortality rates below
the Healthy People 20 20 2030 target rather.
And I happen to live in one of
those states, Minnesota, but the others include California,
Massachusetts,
Pennsylvania,
Utah, and Wisconsin.
And as we break it down
by race
and education,
American Indian and Alaska Native, Black, and Hawaiian
Pacific Islander women had rates of maternal mortality
that were 2 and a half to 4
and a half times higher than other groups.
And by education, the maternal mortality rate was
nearly 3 times higher
among high school graduates than college graduates.
Wow. I mean, just listening to you talk
about some of these numbers and examples, it's
it's,
it's very,
it's such a challenge for our health care
system,
to to
fix clearly.
Can you also discuss, Lisa, about what the
brief is showing related to infant mortality rates
and what your experience has been throughout your
career in terms of,
this this trend and how it's evolved over
over the years?
Well, there is some good news here with
infant mortality rates. Unlike maternal
mortality, the infant mortality rate has improved
over the past decade by about 13%,
decreasing from 6.3 to 5.5 per 1000 live
births,
and it's moving closer
to the Healthy People 2030 target of 5
per 1000 live births.
However,
infant mortality does remain consistently higher in the
United States,
than in any other,
developed
countries.
And as a health health outcome measure in
Healthy People 2030
leading health indicator,
infant mortality is the number of infant deaths
before age 1 per 1,000
live births.
So as we look at our as we
look at the breakdown by racial and ethnic
groups,
there are some positive statistics to report.
As we compare 28
20,008
to 2,011
and 2,018
to 2021,
the rate decreased
by 15%
for infants born to white mothers,
decreased by 12% for infants born to black
mothers,
and decreased by 9% for infants born to
Hispanic mothers.
But despite these improvements, the disparities by race
and ethnicity still do persist.
Infants born to Black American
Indian and Alaska Native and Hawaiian Pacific Islander
mothers
experienced disparities in infant mortality
relative to Asian, Hispanic, multiracial,
and white mothers.
So if we wanna break that down into
more specifics,
for black women,
the mortality rate was 2.9
times higher
than Asian women,
2.4
times higher than White, and 2.2 times higher
than Hispanic mothers.
And it's 2.2 times higher among infants born
to American Indian and Alaska Native than Asian
mothers.
So again, while the news overall is good
that we're seeing an overall trend
towards
decreases
in infant mortality,
we still need to think about how these
disparities,
play a role
and and how we can look at different,
ethnic groups, education levels, and socioeconomic
groups to determine how to close these close
these disparity gaps once and for all.
Understood. So this is clearly a very nuanced
issue in terms of the overall trend is
improving within the country, but there are clearly
racial groups that are not seeing,
the same amount of
increasing health outcomes in this space. It's very
interesting to hear about this.
So then Lisa, what do you recommend that
the clinical community and the public health community
do about these disparities
that you're talking about, both on the maternal
and infant
fronts? The only way that we will tackle
this issue and make any significant strides in
terms of maternal
and infant health regarding morbidity and mortality
is for it to be a collaborative
effort with our clinical community,
our public health community.
And as we as I am representing the
payer community,
these communities do need to come together.
And what this report is intended to do
and what we hope that it accomplishes is
that it encourages stakeholders in these communities
to use this information to spark action
about how they can have an impact on
maternal and infant health disparities.
So we're calling upon our leaders,
providers,
and public health
workers
to engage in this space
to have data driven discussions about solutions
to challenges documented
here in this brief.
We're looking for providers to familiarize themselves with
the findings and the trends and advocate for
their patients.
And also to think about how we can
review the state profiles
provided within the brief
to help public health officials guide actions within
their own communities
based on what they see that specifically
pertains to
the information that is found within their state
to drive significant change.
Absolutely. And to follow-up with you on how
this has to be a collaborative
effort within the healthcare community to address these
challenges.
As one of the country's leading healthcare organizations,
Lisa, what would you say UnitedHealth Group specifically
is doing to address these disparities among,
maternal and and infant
populations?
Well, UnitedHealth Group is doing a really
wonderful job at
engaging
within
communities
as well as engaging
with
members
to think about how we can be part
of the the wheel of of collaborative change
that I described.
And for example, we have programs that are
aimed at improving birth outcomes, including
multiple investments to expand the availability of doulas
throughout our states where we provide
Medicaid
plans. Doulas have been shown to
not only decrease
c section rates, but improve the experience of
birthing people,
improve breastfeeding rates,
both of which are shown to have a
positive impact not only on maternal morbidity
but also,
infant morbidity and infant mortality
as well as, the prolongation of of pregnancy
and gestation.
We are also
working on,
value based relationships with providers
through our UnitedHealthcare network,
and that
in that way, we are aligning incentives for
improved birth outcomes.
We have pharmacy outreach programs in our OptumRx
to support expected people.
We're looking at how we can continue
to grow our member incentive
models
that improve prenatal and postpartum visit rates
and then community engagement models like one that
we have in Kansas City called the UnitedHealthcare
Catalyst Program.
And through that program,
we've seen a 52%
increase in postpartum care engagement
and a 66%
reduction in low birth weight prevalence.
Those are huge impacts and
and really important as we think about,
the continuum of care, the continuum of care
from the maternity time period into the postpartum
time period and how important those engagements
are
in,
the long term health
of birthing people as they go on to
care for their babies.
And then lastly,
I would mention that in New York, to
to address maternal health disparities,
the United Health Foundation and a Brooklyn based
nonprofit named CAMBA
announced a 3 year,
$3,000,000 grant partnership a few years ago
to increase access to prenatal care for underserved
and homeless individuals
in Brooklyn.
So those are just some examples
of how UnitedHealth
Group
is engaging with communities and members and trying
to get
to where care is delivered,
by partnering with both members, agencies,
and and government public health programs
to promote that effort.
Wonderful. Clearly, a lot of impactful work going
on across the UnitedHealth enterprise. So appreciate you
sharing a few of those examples with us,
Lisa.
Before we go, any other final thoughts you'd
like to share while you have the ears
of a lot of health plan leaders from
all over the country?
Well, I think that this is such an
important issue and one that's near and dear
to my heart, as a perinatologist
and one that's practiced for 20 years. My
life's work has been
caring for
pregnant
people
and,
promoting
the best possible
birth outcome both for the birthing person as
well as for their infant or infants. And
I think that
this information that we see in our report
and our in our brief
is just highlighting what we've known
for decades, and we're not seeing things necessarily
improving at the rate that we'd like to.
And I think just to emphasize the fact
that without the collective efforts of all individuals
and all agencies and all health care systems
and providers
that touch birthing people,
we really will not be able to move
the needle in any meaningful way. And so
my plea
is to read the report,
to digest
what what it's saying and where it applies
to you locally,
and to make those efforts and outreach to
collaborate with whomever you can,
to
help us make meaningful change in this space.
Fantastic. Well, doctor Sall, thank you so much
for taking the time to be with us
and for sharing your insights with our listeners.
We truly appreciate it.
Thank you, Jacob. It was a pleasure to
be here.
And if you'd like to listen to more
podcasts from Becker's Health Care, you can visit
beckershospitalreview.com.