Three questions with Megan Carr: Current federal efforts to address maternal health care equity

I sat down with the 3M Health Information Systems Vice President of Regulatory and Payer Solutions Megan Carr to explore maternal health disparities and current U.S. approaches to addressing and supporting successful outcomes for mothers and newborns.

With the U.S. having one of the highest maternal mortality rates among high income countries, what is what is currently being done to support maternal health care on a federal level?

The maternal mortality rate in the U.S. is a critical public health concern. While the maternal mortality ratio (MMR) globally went down between 2000 and 2020, here in the U.S., it continues to rise. What makes this even more upsetting is the fact that 80 percent of pregnancy-related deaths are preventable, according to the Centers for Disease Control and Prevention (CDC). In addition, non-Hispanic Black women are disproportionally impacted, with maternal mortality rates more than 2.5 times the rate for non-Hispanic whites.

The problem is recognized– and the need to act – at both the national and state levels. Nationally, key policies have been advanced, and others are still being discussed. For example, Congress included a provision in the American Rescue Plan Act of 2021 to permit states to extend Medicaid coverage from 60 days postpartum to a full 12 months. In December 2023, the Center for Medicare and Medicaid Services (CMS) announced the Transforming Maternal Health (TMaH) Model to help states develop a whole-person approach, from pregnancy to birth and postpartum; and covers physical, mental and social needs throughout.

The fact, however, is that maternal health protocols and policies are mostly set at the state level since Medicaid is the largest single payer for maternity care in the U.S., covering more than 40 percent of all births. States have been very active – with 44 state Medicaids having implemented 12-month postpartum coverage and another three planning to implement. States have set up maternal mortality review committees to review trends and patterns contributing to maternal deaths and assist in the development of strategies to reduce any future deaths. States have invested in doula coverage, midwifery services, remote patient monitoring, nutrition counseling and more.
 

What are some of the unique challenges or barriers to addressing maternal health care?

Getting this right is a huge challenge that will require many approaches. And it is important that we don’t just focus on the mortality aspect but also maternal morbidity – and how we improve maternal health overall. I won’t name all of the challenges and barriers, but in part, it has been access to coverage – which as we noted, states have really stepped up on. There are maternity care deserts in parts of the U.S., with more than half of rural hospitals not offering maternity care. It is making sure at-risk mothers are identified and receive focused care management support and culturally and linguistically appropriate services. It is ensuring follow-up care happens in a timely fashion. It is a multitude of additional things, and of course, it includes understanding the racial and socioeconomic inequalities that plague the health care system and impact maternal health and care.
 

What has been 3M Health Information Systems’ approach to addressing maternal health? How does it relate to CMS’ initiative?

There are many of us at 3M that are highly engaged and interested in making a difference when it comes to maternal health. I see many ways 3M can help, but let me share thoughts on two areas – data documentation and quality oversight.

On getting the data right, our colleague Dr. Melissa Clarke recently wrote an article for Kevin.MD.com that I encourage everyone to read. As Dr. Clarke outlines, making sure that we correctly and fully capture and document data allows us to analyze and surface patient needs and take action. Specifically, better data documentation can proactively flag potential patient health issues, identify disparities in care and outcomes, monitor progress and enhance accountability.

Related to having this data is using it to learn and build evidence-based solutions. As I mentioned, many of the state maternal mortality review committees are focused on what we can learn from maternal deaths, but not all of them also track and assess maternal morbidity. Additional information can be yielded by studying maternal morbidity data, such as postpartum readmissions. Studies show that postpartum readmissions have risen over the past 8-10 years. It would be helpful to understand more about these readmissions, which ones are potentially avoidable, and what best practices providers are successfully using to manage maternal health and avoid readmissions or ED visits.

While maternal mortality and morbidity are large challenges, the spirit and energy to act are equally significant. Ensuring data is part of the solution – collecting and using it – is key, and 3M is eager to contribute to those important initiatives.

Megan Carr is the head of the regulatory and payer solutions team at Solventum.

Courtney Howell-McAnelly is a marketing communications specialist at Solventum.