When compared to ten other developed nations, the United States has the highest maternal death rate. Yet, according to a recent maternal mortality review committee report by the Centers for Disease Control and Prevention, 84% of pregnancy-related deaths are preventable. This maternal health crisis has been shaped, in part, by socioeconomic inequities and inconsistent insurance coverage policies, which limit healthcare access by underserved populations. So what tools are available now to help reduce preventable harm among childbearing women? Clinical evidence suggests that telehealth could be one solution.
Third-party payers are in a unique position to improve maternal health outcomes by supporting telemedicine integration into care programs. In recent years, many payers have partnered with technology platforms to support their members' remote healthcare needs. Government agencies and medical societies are also calling on the healthcare community to use telemedicine to improve maternal health outcomes and address health disparities. However, much room for improvement remains. No federal requirements currently exist for third-party payers to cover telemedicine; state regulations vary widely, and a survey of private payer policies on telehealth reveals inconsistent coverage conditions. Pandemic-era expansions for telemedicine authorization and coverage by Medicare are set to expire with the end of the Public Health Emergency on May 11, 2023, and while telehealth expansions for behavioral health are being made permanent, policies on telehealth maternity services will not carry over, endangering care for pregnant women who currently rely on telemedicine.
ECRI's Clinical Evidence Assessment service routinely assesses clinical data on telehealth's effectiveness for treating a wide array of conditions. Based on our recent assessments, here are four maternal health conditions that may be effectively treated through telemedicine, even leading to care cost and time savings in some cases.
Gestational Diabetes Mellitus
Lifestyle interventions (diet, exercise, and glucose monitoring) are critical for preventing complications associated with gestational diabetes mellitus (GDM), and lagging information and insufficient communication between doctors and patients are a major barrier to delivering these interventions. Telemedicine through remote communication technologies may facilitate educating, monitoring, and treating pregnant women with GDM and reaching underserved populations. ECRI's Clinical Evidence Assessment, Telehealth Monitoring of Pregnant Women with Gestational Diabetes Mellitus, found:
- Telehealth interventions used to monitor GDM during pregnancy are as effective as or better than in-person care for improving glycemic control and lowering maternal and fetal complication risks.
- Clinicians reported a 27% reduction in clinician time and an 88% reduction in face-to-face visits per patient after introducing a web-based telemonitoring intervention.
- Healthcare providers reported 16% cost-savings when pregnant patients received remote telemonitoring compared with standard in-clinic care.
Managing patients with or at risk of developing hypertensive disorder during pregnancy involves frequent blood pressure (BP) monitoring; however, frequent clinic visits for BP measurement may not be possible for patients with low income or living in rural settings. Using telemedicine to monitor these patients involves having them measure BP at home, sharing the results with their healthcare provider, and educating them about what they can do to manage the condition themselves. ECRI's Clinical Evidence Assessment, Telehealth Monitoring of Pregnant Women with or at High Risk of a Hypertensive Disorder, found:
- Home BP monitoring during pregnancy appears to be safe and effective for reducing antenatal visits, prenatal hospital admissions, preeclampsia diagnosis, and labor induction compared with conventional care.
- Studies reported high rates of adherence and patient satisfaction with home BP monitoring.
- Three cost studies found home BP monitoring to be cost saving.
Excess Weight and Obesity
As with GDM, lifestyle modifications are the first-line approach to prevent excessive gestational weight gain and reduce pregnancy complication risks associated with excess weight and obesity. In this patient population, telehealth approaches are intended to improve outcomes by providing education and coaching in dietary control, physical activity, and weight management. ECRI's Clinical Evidence Assessment, Telehealth Coaching of Pregnant Women Who Are Overweight or Obese, found:
- Telehealth interventions used alone or as part of a bundled approach to coach/monitor women who are overweight or obese during pregnancy are more effective than standard care for reducing gestational weight gain.
- Telehealth interventions (alone or as part of a bundled approach) appear to be as effective as standard care for reducing GDM incidence and perinatal or neonatal complications.
Postpartum depression (PPD) risk factors include personal or familial history of depression, unintended pregnancy, diabetes, age >35 years, multiple birth, maternal or neonatal medical complications, stressful life events, lack of support, substance use, low income, and African- or Latin-American ethnicity. Healthcare professionals may use telehealth technologies to remotely deliver psychosocial therapies with proven effectiveness and to reduce PPD risk through education, screening, assessment, and support. ECRI's Clinical Evidence Assessment, Telehealth for Treating Postpartum Depression, found:
- Web-based psychoeducation offered as an adjunct to standard prenatal or postpartum care appeared to reduce PPD symptoms up to three-months postpartum.
- Web-based psychoeducation was as effective as home-based psychoeducation at reducing depression symptoms at up to six-months postpartum.
- Women with prenatal depressive and anxiety symptoms who received prenatal internet-based mindfulness training benefit with fewer PPD symptoms up to one-year postpartum.
- Four weekly postpartum phone calls and text messages by trained volunteers reduced PPD risk.
Learn more about how payers and providers can rely on ECRI Clinical Evidence Assessments to make unbiased coverage and utilization decisions that improve patient outcomes.