The United States continues to grapple with concerning rates of maternal morbidity and mortality, particularly among Black women. Though, a growing number of healthcare systems are prioritizing comprehensive strategies to improve outcomes, and Ascension, one of the nation’s largest non-profit health systems, is demonstrating notable progress. By embedding maternal health into its core quality and safety infrastructure, and focusing on both clinical care and addressing social determinants of health, Ascension is achieving maternal morbidity rates significantly below the national average. This proactive approach offers valuable lessons for other healthcare organizations striving to address this critical public health challenge.
Ascension’s commitment extends beyond simply treating complications as they arise. The organization recognizes that systemic issues and inequities contribute significantly to adverse maternal outcomes. A key component of their success lies in a holistic strategy that encompasses preventative care, robust data tracking, and community engagement. This dedication is particularly crucial given the potential disruptions to access to care stemming from evolving Medicaid policies and the expiration of Affordable Care Act (ACA) subsidies, which could leave more individuals uninsured and vulnerable.
Addressing Disparities in Maternal Health Outcomes
According to Stacy Garrett-Ray, MD, chief community impact officer at Ascension, maternal morbidity rates at the health system are 20% below the national average for all patients. More significantly, rates are 32% below the national average for Black patients. “Our outcomes have been better than what we see nationally because of our sustained improvement as an organization and making [maternal care] a primary focus,” Dr. Garrett-Ray stated in an interview with Becker’s Hospital Review. This improvement isn’t accidental; it’s the result of a deliberate, organization-wide effort that permeates all levels, from individual facilities to the board of directors.
Ascension has established a systemwide clinical goal to reduce severe obstetrical complications across its entire patient population, with a specific focus on communities identified as medium to high risk based on the Social Vulnerability Index (SVI). The SVI, developed by the Centers for Disease Control and Prevention (CDC), measures a community’s vulnerability based on factors like poverty, lack of transportation, and limited access to healthcare. The CDC provides detailed information about the SVI and its methodology. Each Ascension market is held accountable for progress toward this goal, with results regularly reported to the board, fostering a culture of transparency and continuous improvement.
A Multi-Faceted Approach to Prevention and Care
Rather than treating maternal health as a separate initiative, Ascension has integrated it into its existing quality and safety framework. Dedicated committees meticulously track maternal outcomes, monitor disparities, and oversee interventions designed to prevent complications. This integrated approach avoids the pitfalls of siloed programs and ensures that maternal health is consistently prioritized. The focus isn’t limited to inpatient obstetric care; Ascension also emphasizes quality and outcomes in ambulatory settings, from early pregnancy through the postpartum period.
A cornerstone of Ascension’s ambulatory strategy is proactively addressing social needs that can create barriers to care. The organization combines data from social determinants of health screenings and community health needs assessments with direct input from the communities they serve to identify gaps in access and tailor interventions accordingly. This community-centered approach ensures that resources are directed where they are most needed and that interventions are culturally sensitive and effective.
Maternal Health Navigation Programs
Ascension’s maternal health navigation program is a prime example of this commitment to addressing social determinants of health. Composed of community health workers embedded within local markets, the program connects pregnant and postpartum individuals to vital resources, including transportation assistance, food security programs, and other essential social services. These navigators also serve as trusted educators, providing information about prenatal and postpartum care.
Referrals to the program are initiated in several ways. A missed prenatal appointment automatically triggers outreach from the navigation team. Clinicians also directly refer patients who they believe would benefit from the program. Importantly, the system proactively identifies patients residing in areas with higher social vulnerability, ensuring that those most at risk receive targeted support. As Dr. Garrett-Ray emphasized, “If a mother does not come to her appointment, that’s a red flag for us,” and the team prioritizes direct follow-up to understand the reasons for the missed appointment rather than making assumptions.
Data from Ascension demonstrates the effectiveness of the navigation program. Among patients who are not enrolled in Medicaid and are not uninsured, but live in communities identified as medium to high risk on the SVI, those participating in the navigation program are nearly twice as likely to receive adequate prenatal care compared to similar patients not enrolled. This translates to significantly higher completion rates of eight or more prenatal visits. Postpartum visit completion rates are also approximately 1.6 times higher for patients engaged with a navigator.
Leveraging Digital Tools for Enhanced Postpartum Care
Recognizing the critical importance of the postpartum period – a time when complications can emerge and follow-up care often lapses – Ascension is expanding a digital initiative designed to keep latest mothers connected to care in the first 30 days after discharge. Originally launched in Pensacola, Florida, the opt-in program sends patients 12 text messages over a 30-day period. These messages prompt mothers to reflect on their physical and emotional well-being, highlight warning signs of potential complications, and encourage timely follow-up with their care team.
The impact of this program in Pensacola has been significant. Postpartum follow-up visits increased by 3.5% for all patients and by 10.4% for Black patients after the program’s implementation. Ascension is now expanding this successful initiative to all of its markets, recognizing its potential to improve access to care and reduce postpartum complications.
Scaling Prevention Amidst a Changing Healthcare Landscape
Ascension’s focus on prevention has yielded broader benefits, including declines in preventable emergency department (ED) visits. Becker’s Hospital Review reported on Ascension’s 5% drop in preventable ED visits, highlighting the positive impact of their proactive approach. This emphasis on prevention is becoming increasingly urgent as healthcare systems prepare for potential cuts to Medicaid funding and grapple with the expiration of enhanced ACA subsidies, changes that could lead to an increase in the number of uninsured patients and disrupt access to essential prenatal and postpartum care.
Dr. Garrett-Ray acknowledged the challenges posed by these legislative changes, stating, “The legislative changes that we’re seeing with Medicaid and more people potentially losing coverage are truly a disruptor right now within healthcare.” However, she also emphasized the opportunity to reassess and improve care delivery to ensure that all patients receive the care they deserve. To that conclude, Ascension has launched a broader transformation initiative focused on Medicaid beneficiaries and uninsured populations, centering on population health management and strengthened collaboration with federally qualified health centers and community organizations.
“We cannot do this alone,” Dr. Garrett-Ray stressed. “The community is the center, and we all have to wrap our resources around it to ensure that patients have access to care.” This collaborative approach underscores the importance of partnerships in addressing the complex challenges of maternal health and ensuring equitable access to care for all.
Key Takeaways
- Integrated Approach: Ascension’s success stems from embedding maternal health into its broader quality and safety infrastructure.
- Social Determinants of Health: Addressing social needs, such as transportation and food security, is crucial for improving maternal outcomes.
- Community Engagement: Collaboration with community organizations and direct input from patients are essential for tailoring interventions effectively.
- Digital Innovation: Utilizing digital tools, like text message programs, can enhance postpartum care and improve follow-up rates.
As the healthcare landscape continues to evolve, Ascension’s commitment to improving maternal health serves as a model for other organizations. The system’s proactive strategies, coupled with a dedication to addressing systemic inequities, are paving the way for better outcomes for mothers and families. Ascension is actively monitoring the impact of changing Medicaid policies and will continue to adapt its strategies to ensure continued access to care for vulnerable populations. The next steps will involve further expansion of the digital postpartum care program and continued refinement of the maternal health navigation program based on ongoing data analysis. We encourage readers to share their thoughts and experiences regarding maternal healthcare access in the comments below.