Telehealth and Maternity Care

Strategies and Resources for State Policymakers and Payers to Improve Access to Telematernity

Transforming maternity care in the U.S. in a way that reduces maternal morbidity and mortality and eliminates health disparities will require supporting maternity-specific telehealth. U.S. maternal mortality rates are much higher than other industrialized countries – nearly 10 times higher than in Italy and about three times higher than in Australia. Additionally, there are considerable racial and ethnic disparities in pregnancy-related deaths in the U.S.

State policymakers can help improve maternal health outcomes by implementing policies that increase access to telehealth for maternity care, especially prenatal care. This new resource supported by the Commonwealth Fund provides actionable insights for state policymakers and payers to improve access to maternity care via telehealth, including the key takeaway for states, which is that equity must be part of the policy design.

A list of contents and description of available downloads appears below.

• Policy Overview
  • Telehealth and Maternity Care: A COVID-19 Policy Crossroad: In this issue brief, we review current federal and state policy approaches to telehealth that are likely to impact the provision of telematernity. The brief discusses what policymakers need to do next to ensure state telehealth policies are instruments for improving, not worsening, maternal health outcomes, including information on unifying telehealth and maternal health policy proposals – what’s needed now.

• Telematernity Policy: A View from State Medicaid Programs
  • Arizona: An interview with Dr. Sara Salek, Chief Medical Officer of the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency

• • North Carolina: An interview with North Carolina Medicaid M. Kathryn Menard, MD, MPH, Upjohn Distinguished Professor of Maternal-Fetal Medicine, University of North Carolina School of Medicine; Velma Taormina, MD, MSE, FACOG, Senior Policy Consultant Women’s Health, North Carolina Medicaid, Division of Health Benefits, North Carolina Department of Health and Human Services; Beth Daniel, MSN, RN, Associate Director Medical and Behavioral Health, North Carolina Medicaid Clinical Policy, Division of Health Benefits, North Carolina Department of Health and Human Services; Ginger Webster, RN, Nurse Consultant, North Carolina Medicaid Clinical Policy, Division of Health Benefits, North Carolina Department of Health and Human Services; Shannon Dowler, MD, Chief Medical Officer, North Carolina Medicaid, Division of Health Benefits, North Carolina Department of Health and Human Services

• • Wyoming: An interview with Dr. James Bush, Medicaid Medical Officer, Wyoming Department of Health

• Telematernity Policy: A View from Medicaid Managed Care
  • AmeriHealth Caritas: An interview with Karen M. Dale, R.N., M.S.N., Market President, AmeriHealth Caritas District of Columbia, a mission-based Medicaid Managed Care Organization in Washington, D.C., and the Chief Diversity, Equity, and Inclusion Officer for the AmeriHealth Caritas Family of Companies

• Redesigning Prenatal Care: The Role of Telehealth
  • An interview with Dr. Alex Peahl and Dr. Michelle Moniz, University of Michigan: The prenatal schedule of visits recommended in the U.S. hasn’t changed since the 1930s. Dr. Alex Peahl from the University of Michigan is leading a team to consider how the typical prenatal visit schedule and content of those visits should change, including incorporating telehealth visits. We chatted over Zoom with Dr. Peahl and her colleague, Dr. Michelle Moniz, about how this work arose and what they think needs to happen next for the broader system to change in a way that improves disparate maternal outcomes in the U.S.

• Telematernity Policy Toolkit for State Policymakers and Payers, including:
  • Important features of equitable telematernity policy
  • Checklist: Specific Features of Equitable Maternity Policy
  • Advice from other states who are moving forward with telematernity
  • Why coverage of audio-only service is essential for equitable telematernity care
  • On the horizon (What are we not thinking about?)
  • Contextual considerations for telematernity
  • State policies to improve maternal health outcomes
  • Resource list

Acknowledgements: A special thanks to all of the experts who were willing to contribute and be interviewed for this project, as named throughout the project materials.

This project was supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.