![]() ![]() Traditional prenatal care models recommend upwards of 14 in-person visits 2 throughout pregnancy. ![]() ![]() Prenatal Care: Reducing the Need to Travel These data do not include uninsured patients or patients with public insurance, and also may not capture services delivered using bundled payment plans for pregnancy care. Examples of the claims delivered via telemedicine included visits for lactation complications, postpartum mood disturbances, postpartum follow up and routine prenatal care. The majority of telehealth encounters took place over the phone, while a minority took place online. 1 Of all de-duplicated claims analyzed within pregnancy-related care, just 0.1% were delivered via telemedicine. Using a sample of outpatient medical claims of reproductive age women enrolled in large employer plans, KFF analyzed telemedicine utilization within the following domains of pregnancy-related care: supervision of normal and high-risk pregnancies, mental health disorders associated with pregnancy and lactation services. Utilization for pregnancy-related care is very low. high-risk obstetricians, lactation consultants, mental healthcare providers) ( Figure 1).įigure 1: Many healthcare services can be delivered via telemedicine during and after pregnancy Telemedicine has been used for innovative approaches to prenatal/postpartum care, at-home monitoring for conditions like diabetes and hypertension, and for phone/video consultation with specialists (i.e. Telemedicine in Obstetrical CareĪ broad range of pregnancy-related services can be offered via telemedicine. ACOG writes that telehealth opportunities “enhance, not replace, the current standard of care.” This brief outlines how telemedicine is currently used in obstetrical care, how these services are financed and regulated, and reviews federal efforts to expand the use of telemedicine, particularly to address maternal health disparities. In fact, the American College of Obstetricians and Gynecologists ( ACOG) has endorsed telemedicine to improve maternal morbidity and mortality, encourages OBGYNs to adopt these technologies. Telemedicine, or telehealth, is one proposed method to address these disparities, defined broadly as the provision of health care services by health care professionals, using technology to exchange information in the diagnosis, treatment and prevention of disease. A recent study found that rural residents have a 9% greater likelihood of severe maternal morbidity/mortality than their urban counterparts because of factors including workforce shortages, transportation barriers, the opioid epidemic and limited access to specialty care. live in rural counties where obstetricians are scarce and pregnant people often must travel significant distances to access care due to hospital closures. Poorer obstetrical outcomes are particularly pronounced among Black women and American Indian/Alaska Native women, as well as women living in rural areas. has lagged behind other high-income countries, often attributed to poor access to prenatal care, high rates of chronic disease, and the highest rate of skipping necessary health care due to cost barriers. stands out as one of the only countries where maternal morbidity and mortality have actually worsened over the last few decades. While global trends show maternal morbidity and mortality improving, the U.S. Growth in the field will likely depend on developing models for how to finance use of telemedicine in pregnancy, investments in broadband, research demonstrating improved maternal and infant outcomes, and payor willingness to reimburse providers for services provided to patients through a telemedicine platform.Only 19 state Medicaid programs reimburse for telemedicine services delivered to the patient in their home, which limits the opportunities to expand telemedicine approaches to provide care to pregnant patients on Medicaid. are financed by Medicaid, expanded access to these technologies in pregnancy will also largely depend on state and federal decisions regarding telemedicine coverage. ![]() Limiting factors include high startup costs, limited internet access in rural areas and inconsistent reimbursement requirements across different state Medicaid programs and commercial insurance plans. Although there are a number of uses for telemedicine in obstetrics, implementation of such technologies has been is minimal.Throughout pregnancy and postpartum, telemedicine can connect patients to mental health care. In the postpartum period, telemedicine has been used to enable earlier postpartum follow up visits and access to lactation consultants. In the prenatal period, these include using videoconference to replace in-person visits, implementing at-home monitoring, and enabling consultation with remote specialists, including maternal fetal medicine doctors. A range of obstetrical services have been implemented using telemedicine by a handful of medical centers. ![]()
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