July 6, 2023

This paid piece is sponsored by Avera.

It’s heartbreaking, but it’s reality in rural America: A pregnant mom at risk for complications makes the difficult decision to go to work to put food on the table for the children she already has, rather than drive for hours to a prenatal appointment to help ensure the health and safety of a baby she’s expecting.

Avera will play a major role in addressing realities like this thanks to the federal RMOMS grant. In October 2022, Avera was one of four nationwide sites to receive Rural Maternity and Obstetrics Management Strategies Program funding awarded by the federal Health Resources and Services Administration.

“We as a medical community need to do better in understanding why women sometimes forgo prenatal care and connect with each one in order to help women experience a healthier pregnancy,” said Dr. Kimberlee McKay, clinical vice president of Avera’s OB-GYN service line and medical director for the Avera Research Institute.

OB hub with rural spokes

The grant provides $1 million per year over four years to help increase access to obstetrics services and improve outcomes such as pre-term labor, low birthweight, infant mortality and more in South Dakota.

During the first several months of the grant, the Avera team partnered with South Dakota Medicaid, the Department of Health, Urban Indian Health and Rural Health Inc. to design care pathways to help close the gaps.

Next, as pilot projects begin this fall, Avera will create an OB hub that reaches out to rural spokes with three components:

• Care coordination – Care coordinators will work with doctors to ensure patients have the wraparound services they need, whether that’s food and nutrition assistance, home visits, resources to quit smoking, addiction services, specialty care or transportation to appointments.
• Remote monitoring – This component harnesses the latest telehealth technology so moms can benefit from remote monitoring of their condition, whether this is gestational diabetes, high blood pressure or a heart condition.
• Intrapartum surveillance and virtual nursing – This involves a software surveillance system, like mission control, that gives a designated OB nurse a line of sight via telemedicine for every hospitalized laboring mom in the health system. This provides a 24-hour additional layer of support for on-site nursing staff in hospital OB units, watching for signs of complications or downward trends.

“Instead of only seeing their doctor once a month, there will be many touch points through the pregnancy with various services. What we want to do is prevent complications in the pregnancy itself, at the hospital during delivery, as well as prevent a possible NICU admission,” McKay said.

Meeting patients where they are

In addition to a complete medical screening, expecting moms will be screened for factors that could impact their pregnancy like anxiety, depression and basic needs. There are five core domains of social determinants of health, including food security, transportation, utilities, housing and interpersonal safety.

“Do they have access to healthy foods? Reliable transportation? Decent housing? If not, patients will be connected to services they need,” said Lacey McCormack, a research scientist with Avera Research Institute.

“It’s about providing services in a way that meets patients where they’re at financially, emotionally and culturally,” McKay added.

Avera McKennan Hospital & University Health Center is the grant recipient and is collaborating with numerous partners, including regional Avera hospitals in Aberdeen, Mitchell, Pierre and Yankton; Avera@Home; Access Health; South Dakota Urban Indian Health; the South Dakota Department of Health and Department of Social Services; and Premier Inc. Additionally, project activities will support two rural critical access hospitals: Milbank Area Hospital Avera in Milbank and Avera St. Benedict Hospital in Parkston.

Avera will work through pilots with the intention of rolling out the entire program to all participating sites over the next three years.

Transforming pregnancy care

“Simply put, we want to see that moms and babies are healthy – throughout pregnancy, delivery and beyond,” McKay said. “For that to happen, moms need access to high-quality prenatal care and careful management of conditions such as high blood pressure and gestational diabetes, regardless of their ZIP code or income level.”

An important component of the study is data sharing to provide care in ways that are smarter and more effective. “We’re looking to answer important questions and hopefully move the needle as payers consider what’s important to cover for expectant moms,” said Christine Hockett, director of community research for the Avera Research Institute.

The study will look into not only improved outcomes but also what costs were saved or avoided.

“We’re hopeful this will set us up for 20 years of transformative, community-based support that takes good care of pregnancy and honors the journey that it is,” McKay said.