At Ascension, maternal morbidity rates are 20% below the national average for all patients and 32% below the national average for Black patients, according to Stacy Garrett-Ray, MD, chief community impact officer at the St. Louis-based health system.
“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,” she told Becker’s.
Improving access to high-quality maternal care and mitigating long-standing disparities in maternal health outcomes is a focus that extends throughout the organization, from each facility up to the board level, Dr. Garrett-Ray said. One of Ascension’s systemwide clinical goals is to reduce severe obstetrical complications, both across its overall population and in communities identified as medium to high risk on the Social Vulnerability Index. Each market is accountable for progress, with results reported to the board.
“That enhances our accountability as an organization and puts mission into action,” she said.
Rather than treating maternal health as a standalone initiative, Ascension has embedded the work into its broader quality and safety infrastructure. Dedicated committees track maternal outcomes, monitor disparities and oversee interventions aimed at reducing preventable complications.
Leaders have also been deliberate about avoiding a siloed approach, placing equal focus on improving quality and outcomes in both inpatient obstetric care and ambulatory settings from early pregnancy through postpartum.
On the ambulatory side, much of the strategy centers on keeping patients connected to preventive care and addressing social needs that can create barriers long before a health complication arises. Dr. Garrett-Ray said Ascension combines data from social determinants of health screenings and community health needs assessments with community input to pinpoint gaps in access and tailor interventions accordingly.
One cornerstone of that work is the system’s maternal health navigation program. The team, composed of community health workers embedded in local markets, connects patients to resources for transportation, food access and other social needs, while also serving as a trusted source of education around prenatal and postpartum care.
Patients are referred to the program in several ways. A missed prenatal appointment triggers outreach, as do referrals from clinicians. The system also identifies patients living in areas with higher social vulnerability.
“If a mother does not come to her appointment, that’s a red flag for us,” Dr. Garrett-Ray said, adding that teams do not assume what the reason is and instead follow up directly with patients.
Among patients who are not enrolled in Medicaid and not uninsured but who live in communities identified as medium to high risk on the Social Vulnerability Index, those participating in the navigation program are nearly twice as likely to receive adequate prenatal care compared to similar patients not enrolled, according to Ascension data. That improvement is reflected in significantly higher completion rates of eight or more prenatal visits. Postpartum visit completion is also about 1.6 times higher for patients engaged with a navigator, she said.
Ascension is also expanding a digital initiative designed to keep new mothers connected to care in the first 30 days after discharge, a period when postpartum complications can emerge and follow-up often lapses.
Originally launched in the system’s Pensacola, Fla., market, the opt-in program sends patients 12 text messages over a 30-day period following discharge. The 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.
In Pensacola, postpartum follow-up visits rose 3.5% for all patients and 10.4% for Black patients after implementation of the program, according to Ascension data.
“That is a program that is now expanding into all of our markets,” Dr. Garett-Ray said. “It has shown significant improvements with access.”.
Scaling amid disruption
The health system’s focus on prevention has also contributed to broader improvements in utilization patterns, including declines in preventive emergency department use.
The emphasis on prevention is gaining urgency across healthcare as systems prepare for looming cuts to Medicaid funding and grapple with fallout from the expiration of enhanced ACA subsidies — changes that could increase the number of uninsured patients and disrupt access to prenatal and postpartum care.
“The legislative changes that we’re seeing with Medicaid and more people potentially losing coverage are truly a disruptor right now within healthcare,” Dr. Garrett-Ray said. “But within this disruption, it gives us a nice opportunity to step back and think about where we can do better to ensure that we are taking care of patients in the way that they deserve.”
Ascension has launched a broader transformation initiative focused on Medicaid beneficiaries and uninsured populations, which centers on population health management and deeper collaboration with federally qualified health centers and community organizations.
“We cannot do this alone,” Dr. Garrett-Ray said. “The community is the center, and we all have to wrap our resources around it to ensure that patients have access to care.”
