Subscribe to Lemonada Premium for Bonus Content

Too often than not pregnant patients in the U.S. leave their provider feeling like concerns weren’t carefully listened to or things weren’t properly explained. As two moms and experts, Wildflower Health CEO Leah Sparks and obstetrician and gynecologist Dr. Fatima Naqvi know this experience far too well. That’s why they’ve dedicated their time to providing value-based care by meeting mothers where they’re at. Leah and Fatima tell our host Gloria what it looks like to move from reactionary care to preventative care and transform maternal health across the country.

This episode is presented by Accountable for Health. To learn more visit https://accountableforhealth.org.

Transcript

SPEAKERS

Gloria Riviera, Dr. Naqvi, Leah

Gloria Riviera  00:25

Hello and welcome to Good things, I’m your host, Gloria Riviera, maternal mortality rates. The phrase alone doesn’t even seem like it should be in the same sentence with the United States, but it is in fact, the US stands out among high income nations for its alarming rates of maternal deaths despite substantial health care spending. This is clearest when we look at comparing patients from different racial and ethnic groups, unfortunately, maternal health is only a fraction of how the US health care system as a whole is failing. The Commonwealth Fund reports the US spends nearly 18% of its GDP on health care, yet Americans die younger and are less healthy than citizens in other high income countries. It is not good. But what if there was a payment model for Americans that also impacted how healthcare works here in the US in every sense? What if healthcare workers were supported fully? What if patients came to expect having a good experience? What if preventing illness was far from inconceivable, but instead a very reasonable hope or optimal health outcomes were the norm? Value based care is designed to do all of that. It focuses on quality and provider performance to improve health outcomes and services at a reasonable cost. In this episode, I talk to Leah sparks, the CEO and founder at wildflower health, and Dr. Fatima Naqvi, an OBGYN with Atlantic Medical Group. Dr Naqvi knows firsthand the downfalls of working within a healthcare system where clinicians struggle with staffing shortages and unreasonable demands on their time. Wildflower health has played a critical role in helping the healthcare system advance in virtual and value based care. Its founder Leah is hoping that this model can further help medical professionals like Dr. Naqvi nationwide. Thank you both so much for making the time to be with us today.

 

Dr. Naqvi  03:28

Thank you Gloria for having us today to discuss value based care.

 

Leah  03:32

Thank you for having us.

 

Gloria Riviera  03:33

I want to get started because I really love hearing about what brings people to their passions and their line of work. You are both mothers as am I, and this issue hits home for every parent, because every one, every child, has a different birth story. I had two children in the United Kingdom, in London and my third in California. I mean, what radically different experiences. Both the prenatal care all the way through the birth and then the postnatal care, not only for me as a mother, but also adjacent to that, the way in which my career was supported after I had children. I like to think that having a baby is akin to walking into a game show titled How vulnerable are you willing to be? Because, guess what, you have no choice. You have to be totally vulnerable. So I would love to start with you, Fatima, can you tell me about the moment you knew you wanted to make a difference for other women in this field?

 

Dr. Naqvi  04:38

So it actually began during my sabbatical that I took right in March of 2020, I still remember coming down with covid, being extremely ill, and I knew accessing health care at that point, going into the emergency room, not knowing what it was all about, not you know what. Once you went into the ER, the narrative was you may not be coming out because we just didn’t know what covid was at that time. After that point, I took a break actually trying to reassess what I wanted to do in my life, and I came to the realization that I really I love delivering babies. That is my heart and soul of why I went into obstetrics and gynecology, but at that point, I really needed to go from academics, teaching residents to actually going back into the community. And that really was that just resonated with me, and I wanted to be back really in the trenches with my colleagues and but at a community level. So I became and I basically defined my own job description. I worked with a close friend of mine, and I said, You know what? This is, what I want to do. Do you have a spot for me? Can you create something? And she did it for me, and I joined Atlantic health, created, I’m completely ambulatory, living the life meeting, you know, I got, I earned my great stripes, delivered lots of babies. Thank goodness. All healthy, doing well. But you know, at this time, I’m like, I really want to engage what makes our patients who they are, where they live, how are they interacting with the environment and really improve the care, you know, figure out and just it’s kind of happened in parallel. Honestly, I started diving into healthcare policy, healthcare reform, just on my own, and I wanted to just make a difference. And I started applying, and where I was working, obviously, Atlantic health, I came across Leah, and that honestly, was another little bit of, you know, like a spark that went off, and the chemistry has been phenomenal, I will say. So she’s a great partner for me. But it, you know, it’s just that whole concept of value based care really resonated with me. So that’s where the spark came from, 2020 and it’s been ongoing ever since then.

 

Gloria Riviera  07:05

2020 that’s not a long time ago. I have to say, I love hearing about this spark. You mentioned that you felt when your professional life crossed paths with Leah. It’s so critical how what’s so critical is the people that we surround ourselves with, right? And it enables us, it empowers us as it should. Leah, I would love for you to now break down the state of maternal health in this country, and I’d love to know what you can tell us. I’m sure you have many, many stories, but what you can tell us about the way our system in the United States treats expecting mothers.

 

Leah  07:46

Yeah. Thank you absolutely. So we’ve been on this journey for 10 years at wildflower with this ambition to transform the trajectory of outcomes and quality and in safety and everything else in maternal health care in the United States. And you know, candidly, right now, we are sort of losing that battle at a macro level. In many places, the outcomes are going the wrong direction. The safety profile of care, especially for mothers of color, is horrible, and in some cases, getting worse. And you know, we believe, and of course, people like Dr. Naqvi really shared allies in this. You know, we believe the one of the fundamental differences between maybe what you experienced in the UK, Gloria and what we see here in the United States is our system of medicine. This is true not just in maternal health, but globally. In the United States, our system of medicine is built on a model of reactive care, as opposed to preventive care, and in part, that is due to the way it’s structured economically, where the compensation and the reimbursement is focused on procedures and interventions and high acuity complications, and there isn’t funding for community based prevention or non clinical prevention. And so we are. The state of maternal healthcare in the United States is subpar. We spend the most for the worst outcomes, quality and inequities, and it is really driven by systemic challenges having to do with the way our system is structured and paid for. And that to us, I think, for people like Dr Naqvi and I, that is the promise of value based care, not just to change the dollar flows, but to change the systemic underpinnings of how the mindset, of how care is delivered, so that we can really nationally address this, this crisis that we’re facing.

 

Gloria Riviera  09:34

Would you say that the care was structured with a reactive mindset already in place? Was the entire system designed from a reactive mindset?

 

Leah  09:44

Well, I mean, I look, I think, if you look at the US healthcare system, the way it’s put together, with government payers, commercial payers, employers paying for healthcare, the doctors reimbursed the way that they are, and health systems reimbursed the way they are, you would never design it this way If. You are looking at it globally, right? And, you know, in the United States, the way it has been developed in part because the way it’s paid for, we have these silos, right? So, you know, Dr. Naqvi, I’d love for you to chime in here, because we’re talking a lot in our health system about that big gap between what she is dealing with in terms of clinical health for pregnant women and that behavioral health component. And part of the challenges is, you know, we were on a call yesterday. We don’t have any the payers in her state all paying for the same level of behavioral health care. So how can she integrate it the way that you did? So there are lots of problems that have to do with not just the economics, but access to certain types of clinical specialties, and just the fragmentation you have when you have three or four payers carving up the state of pregnancies, none of them can have just one global strategy, if that makes sense.

 

Gloria Riviera  10:49

Right, no, I think it does. And I think I can bring it back to Dr nakavi, because, you know, as a gynecologist who provides care to women on a daily basis, let’s take it from how it was structured, right? Sort of a meta angle to a micro angle. What issues are women most commonly facing when it comes to maternal health care? What does it look like in front of you, and what are their biggest needs?

 

Dr. Naqvi  11:14

I think we do have to realize how I’m going to go back to Leah’s point just for a second that most of our spending right, national health spending, is, when you divide it up, it’s, it’s like, I think $4 trillion right on the latest statistics that came out, 30% of us is driven to hospital care. So it’s that acute care, that sick care. So we actually have to go step back and change the narrative, right? So when we think of value based care, most people automatically think of alternative payment reform, right? But actually, what it is, actually, in my mind, is it always comes back to the patient. You have to keep the patient in focus so that you improve their outcome. So how do we do that, right? So right now in my patient population, I am seeing patients have difficulty accessing care to good providers, right, the providers that they want. So why? Why are we still stuck in brick and mortar buildings? Right care now can be delivered leveraging technology. It can provide equitable care. It can be where the patient is. So going from like, really point of care to point of need, right? You’re really harnessing the power of technology and providing connecting doctors providers to patients using a digital platform.

 

Gloria Riviera  12:42

I love that you said that part of your work is focused on restructuring the point of care to the point of need. And I can tell you, as an educated white woman with a healthy income, it took me a moment to use my app from Johns Hopkins Hospital right to use MyChart, which might resonate with some people, and I can’t tell you how fast the response time was, how pretty straightforward. And to be totally honest, I was dealing with a lack of sleep, and you could call it delayed postpartum or early menopause, it was probably both, but very quickly, it was dealt with in what I felt was a competent way. So I feel like I’m sure there are people smarter than I am looking at the branding of drawing people in and convincing them that this will make their health care easier. I want to go to Leah because wildflower health is a value based care company, and I think we just need to define that for our listeners, because we’ll be using that term value based care and accountable care interchangeably throughout this conversation, Leah tell us what it is and how it works.

 

Leah  14:00

Yes, I’m gonna, I’m gonna try to break this down pretty simply. So I think value based care is really two components. It is a change in the way we pay for healthcare directly to providers, as well as alignment with care models that enhance and improve medical costs, medical safety and quality. And I think one thing that’s really important for people to understand about the way healthcare is paid today, and I’ll go back to a conversation I had in 2020 with a clinician in private practice who said healthcare is like running a restaurant. If people don’t come in, you don’t get paid. It is you have, you know, going to the doctor’s office, having a surgery, having a lab test, all of those things today are how you stack up the income of clinicians in high health systems, and what value based care aspires to do is really turn that on its head not have you get paid by having to see people, which can be inconvenient for the patient or a necessary lab test, but have it be paid by based on a healthy, safe delivery of a baby, and get paid in accordance with quality measures, fewer C sections, perhaps, or fewer preterm deliveries, fewer NICUs. And it just, it’s a different way of thinking about, quote, reimbursement for healthcare, and it enables clinicians like Dr notfi to rethink, okay, what do I really need? Maybe you don’t have to, if you’re a healthy routine pregnancy, you don’t have to come in 12 times. You can do some virtually. We can knit together non clinical work and remote monitoring and behavioral health, because we know it will improve that outcome, and we can help get that funded so it just changes that whole mindset.

 

Gloria Riviera  15:41

We’re going to take a quick break, but we will be right back with more on Good Things.

 

16:00

So let me just be sure that I understand accountable care, value based care. That’s the goal of that is to change how we pay for things, and also it sounds like you’re saying holding providers accountable for the care that they give the patient.

 

Leah  18:02

Yes, absolutely accountable, and also in so in many respects, ironically and Dr. Naqvi, I’d love to hear your thoughts on this. I think of it as for high quality clinicians putting them more in the driver’s seat of having levers to say, okay, yeah, this patient can monitor her blood pressure at home. Call, you know, and have me be alerted if I need to. This one needs to come in and, you know, and we need social determinants intervention, because this patient can’t get to her appointments because of transportation. It’s a whole fabric of of care interventions that are not reimbursed in that restaurant model, but are really needed to move the needle on outcomes that providers have the liberty to help direct, is that fair, Doctor?

 

Dr. Naqvi  18:43

Yeah, absolutely. I think this is why I re engaged with the medical community. Because, yes, I was teaching, but what was I teaching? What was my framework, right? Like, you’re going to get out there, I’m training for young residents, not just in surgical, obstetrical, but really, you know, the the little bit that I, you know, I was in private practice before academic medicine too. So I was in that fee for service, right? This is that restaurant type of model that we’re talking about. You had to see volume. You had to see patients, 10 minutes, five minutes, you know, like, that’s not, that’s not even a high. Hello. How are you? And you’re done with your visit. So you know, how do you engage? How do you know what that woman is going through? So coming to this model really gives me, honestly, power, autonomy I can with the patient, drive their care, right? The patient engagement becomes so important, and then they realize it gives me the opportunity to educate them. Preventive Care is given to them, and you just engage at a very different level. So definitely, health outcomes is what’s driving my need today to remain in medicine. I want to make a change with my patient in their lives and. That’s where I am at. So yes, it definitely I agree with Ilia. It gives me a little bit more flexibility. It frees me up from like saying I have to see 100 patient or my patient panel is XYZ, but I actually remember who my patients are, why they’re coming in, what happened to them last year. It creates that bond.

 

Gloria Riviera  20:19

Yeah, and what I’m hearing you say is that this is centering the patient in the patient’s own care, right?

 

Dr. Naqvi  20:25

Absolutely.

 

Gloria Riviera  20:26

Because you’re describing a relationship with the patient and a knowledge base that can go back years. So I really love that. I think about one of my dear friends in Washington, DC, who was a nurse, and her focus was delivering babies, and she would tell me these stories about women coming into the hospital, never having seen a doctor before it was time to deliver. I mean, it’s like you ask one question and you’re down a rabbit hole, and I tip my hat to both of you for devoting your professional life to trying to change and solve what is not working. So back to you, Dr. Naqvi, what you’re doing now seems very different from what you were doing before, right, which had its own value, to be sure, why did that model fall short for you? Every time that that you mentioned very quickly, how many patients am I seeing? How many? I mean, really, it’s like, how many babies am I delivering? Was your mindset like that was tied to your worth in that particular role, your professional worth?

 

Dr. Naqvi  21:33

It was a different environment, right? I mean, right now in our country, we’re still in a fee for service model, right? We’re still in there. But the tide is changing. We are experimenting across the nation, right, in different states, with these different platforms that we have different value based but at that time, though, that was it. I only had one career path, honestly, that’s what was taught to me, right? I’m going to graduate, I’m going to finish my residency, I’m going to join a private practice, I’m going to see patients and retire, or maybe I’ll become a part owner of it right, become a partner in that. I’m lucky that now I’m part of a movement where you can change it like I beginning of our conversation, I said I created my own job description. Someone had to buy my vision and understand where I was going with it. So you need that one ally, one person who’s on your corner to see the vision that you’re trying to do. So now I can definitely in the position that I’m in. I’m really actively pursuing changing how we look at physicians. We have people who want to only work outpatient. We have people who are driven to work inpatient. We have people who just want to do GYN, and that’s okay, and that’s completely okay, guess what? I thrive in the ambulatory environment. I’m going to bring the best outcome, right, right? Why should I wear five different hats? I can wear one hat and make it great, you know? Yeah, and that gives me a better work life balance. So let’s talk about physician shortages, right? So one part is we’ve got this infrastructure, like the payment reform, the business model of it, but also OB gyns as a field, we are graying. I’m part of that graying population of it. And medical schools, you know? Yes, they’re, they’re putting out physicians, but you’ll see the residency spots and Obgyns haven’t increased, so you’re not going to get more doctors out of it, right? So what are the care models? Are we going to look at this pop my generation is going to retire, then who’s coming after me? Well, we’ve got a whole set of different generation with different values, how they engage and they themselves are health consumers. So, yeah, it completely the conversation is changing for me. When I was growing up in, you know, coming up the ranks very different my the people that I looked up to are the people, you know, they were already had their own private practices. Now, private practice, you say that nobody wants to buy into that everybody’s part of some sort of a health care organization, whether it’s a big conglomerate or a health care system, you know, private practice and a health center system.

 

Gloria Riviera  24:15

Yeah, and I can feel your energy in this conversation, that you are enthusiastic and engaged in the work that you’re doing now. And I love this angle on okay, what are you as a doctor able to provide? What environment do you need to thrive? Right? It’s it’s like a DOM. It’s a positive domino effect for both patient and caregiver. I want to switch lanes briefly and ask Leah about how all of this helps us move. In the beginning, we talked about preventative care, so how does your work and where we are now help us move from providing reactionary care to really looking at providing good preventative care?

 

Leah  25:00

Yeah, and happy to address that. And I think I would just bring home what we’ve been talking about, about this, what value based care can promise, the way that you hear Dr Naqvi describe her current environment, if I may say, so, is in large part due to the system where she has Atlantic health system is way out on the forefront of value based care as a system. I mean, you talk to little senior leaders at Atlantic, and they are committed to value based care. They are committed to taking risk and being accountable, and they also think it’s good for their sustainability. I’ve talked to some of your senior leaders, and this is good for our balance sheet, right? It’s better for our clinician. So it’s a really unique spot. So I just want to acknowledge that I think that’s part of the reason, and it sort of answers your question too. When you create that kind of environment, you get the energy and the vision of clinicians like Dr. Naqvi. And what we do at wildflower is really, when we say we’re a value based enabler company, we are enabling that vision to take hold by providing a technology and services layer so that Dr. Naqvi can have at her practices disposal, a digital extension branded for her practice, seamless to her patient as just part of Atlantic that follows them into the home, enables them to have ongoing access via messages to non clinical support staff that we provide on their behalf, access to remote monitoring for blood pressure, glucose, ongoing mental health screening and anxiety and emotional support coaching for life stressors, coordination of social determinants, helping to navigate. You know, even in a system that is doing this right, you have that fragmentation that Dr. Naqvi described. I’ve had providers tell me their worst nightmare is having someone be flagged for having a risk of depression because they don’t know how to refer to behavioral health, because every health plan has their own network of partners and providers, right? So we help with all of that to help reduce those obstacles, but none of it happens without that alignment between a provider who’s committed to these new payment models and the health plans and the employers surrounding it, so that is what we’re doing.

 

Gloria Riviera  27:08

Okay, sit tight everyone. We’re going to take one more quick break and we’ll be right back with more Good Things.

 

27:36

Leah, I want to ask you if you can just indulge me for a moment. And Dr. Naqvi, please chime in as well. It really resonated with me when you’re saying that every state has its own structure, right? Every state you know, last summer, I was diagnosed with sciatica, and I was told I needed an MRI. And, you know, sciatica is very painful. It’s in the lower back. It’s excruciating. I wouldn’t wish it on my worst enemy. But I was told the next MRI scan that was available was in seven weeks. So I was being told, you know, first of all, I was. Are offered, you know, all these drugs, right? All these drugs here, I could listen, there are many, many, many, many drugs, and you’re just going to have to wait. So how would this change that? I mean, just to take a very, you know, real life example, in an in, and I’ll ask a question that you know, may not be able to be answered tomorrow, but in an ideal world, what would the process be for someone like that who was in pretty acute pain and needed an MRI to really figure out what was happening in there?

 

Leah  30:34

I mean, look, and Dr. Naqvi, I’d love your clinical expertise, but I would say, in a in an environment where the incentives are aligned to get you well as fast as possible in the most cost effective way possible, prescribing you a bunch of medication is probably not that path. Delaying an MRI is probably not that path. Things like physical therapy are probably underutilized because they’re not really lucrative for the system. I hate to say it, and so, I mean, I can’t, you know, talk about the clinical protocols for treating sciatica, but I think just the notion of, when you have aligned incentives, you can make different decisions and make, you know, access to certain procedures more seamless, because, you know, I am incented to get this person well and healthy as quickly as possible and prevent some other complication, right? Like, if you when you take a whole health approach, you think, well, this person can’t live her lifestyle and do exercise or be healthy. That’s actually gonna have ramifications for other things, right? So we don’t have that whole health approach of thinking about you not as just one acute issue, but as a whole person. And that is, we see that in pregnancy, but you see it everywhere.

 

Dr. Naqvi  31:42

So I will add that I think what also helps is when you standardize care, right? So instead of one doctor doing one thing a different approach, or going for a third opinion, and some other doctor will do something, when you standardize protocols, when you control like you’ve looked at the best practices, and then you implement them in a standardized way, so everybody knows what to order if someone’s coming in for back pain. And I’m not an expert on back pain, but you know, you’re kind of like doing that triage. You do the triage you implement, okay, this is when x rays needed, maybe not an MRI you’re going for trying to decrease cost, but at the same time providing that patient experience, right, getting that patient that outcome that they need. So when you standardize it, I think that’s where we need to be, standardization across all metrics, right, whatever healthcare field that you’re looking at, but you want to look at those as well as document patient and provider experiences too. So I think that’s what’s also key here, when we talk about access and care.

 

Gloria Riviera  32:49

And Dr. Naqvit, what I love about what you mentioned before, is that connection between patient and provider, right? Let’s work through this together and level set the education on the patient side. I do want to touch on mental health, because this is an episode on the maternal health crisis in this country, and that’s such a significant component. But Dr. Naqvi, can you tell me why, whether you agree or disagree with this statement? I would like to know that too. I feel like patients are not mentally taken care of under our current system. Do you agree with that? Are there for trimesters of pregnancy? Absolutely okay. Let’s talk about that. What does it look like to you and what do you see?

 

Dr. Naqvi  33:31

So I will tell you, like where we’ve gotten because the spotlight is on maternal care. These past few years, we’ve really gotten good at providing hospital care. What we’re missing is into pregnancy care and postnatal care.

 

Gloria Riviera  33:44

What is interpregnancy care is while you’re pregnant.

 

Dr. Naqvi  33:48

Yeah, pre pregnancy, so in between pregnancies that you are trying to optimize that woman’s health before they embark on their next pregnancy journey, right?

 

Gloria Riviera  33:58

Oh, our Inter pregnancy, between […]

 

Dr. Naqvi  34:02

Like me, I had my last baby at 40 right.

 

Gloria Riviera  34:06

Three for three on this.

 

Dr. Naqvi  34:07

By the way, in other parts of the world we are normal,

 

Gloria Riviera  34:10

Yes, very important.

 

Dr. Naqvi  34:12

Completely normal pregnancy.

 

Gloria Riviera  34:13

My sister had twins at 46 I think so that’s the back end, and that was after a lot of IVF, a lot of prayers, a lot of hope. But […]

 

Dr. Naqvi  34:24

aAgain, patient demographics changing. Who’s getting pregnant nowadays? Right in this country? Who’s getting pregnant? The people who are getting pregnant, or people who’ve delayed childbearing or focused on her career. And different cultural annotations come into this play too, which I recently learned from a friend of mine, they’re like, Yeah, in the in the black women experience. Their focus is on career. They have to stand up on their own before embarking on fertility. So guess what? That pushes that conversation off to 35 And over, right? Yes, different people who are getting pregnant are people who are older. We are older, we’re going to access yes, our needs are going to go up. Yes, we’re going to have complex high risk pregnancies, because we may be overweight, we may have high blood pressure, we may have diabetes, we may have XYZ, we may have cancer, right? Cancer rates are going up in our patient population, too, and this demographic, so it’s just a different, completely different pregnancy model, but fascinating, okay, the postnatal care, right? So when a patient comes to me, this is all like real examples. This is what I do in my office at 28 weeks, I start the conversation. I talk to them about, like, digital apps, resources at the beginning, but really they’re not listening. They’re just so happy being pregnant. So you kind of focus on nutrition, you focus on enjoying the pregnancy, making it really a normal experience for them. But at 28 my conversation starts to change and like, I’m like, okay, let’s talk about what is like, I start talking about designing their postpartum team. Okay, I’m like, in this country, you don’t have that. So in other parts of the world, it’s embedded in the health systems there. So I start talking about doula care. I taught. Start talking about like, having, like, we’re lucky, we’re in New Jersey, so we actually do get a nurse, you know, they’ve deployed like a nurse to come out to your house within 10 days to check up on you and your baby. It’s going to be fully implemented, I think, in the next three years, but it is accessible in certain counties right now. Expansion of Medicaid right for 12 months postpartum, right? That’s key, but in other like Leah and you were talking about in other states, you don’t have that, so you really have to educate the patient about why a doula is important. A doula is important. They’re non medical, but they’re great for your emotional, physical support, whether it’s during labor, whether it’s after labor, you have doulas taking care of you after miscarriages, so I highlight all of that for them. And then I go into, immediately into mental health. So I talk about the 988, the, you know, the 911 for mental health, suicide phone number. And then I talk about, like, 1833, TLC mama, right? That’s a national maternal mental health hotline to resource for them, for my specific patients. And what I mean by that is, first, I ask my patients how they identify themselves, you know. So if they say, Oh, I identify as a black, you know, woman, then I actually refer them to specific, culturally congruent care and community based organization, because I’m hoping that they can leverage that, and it’s culturally appropriate. You know, you don’t have somebody coming out talking about, oh, yeah, this, but maybe binding their abdomen is important to them eating high fat meal, because it helps with breastfeeding that’s important to them. Culturally, maybe they can’t have cold water to drink.

 

Gloria Riviera  38:08

There’s so much good information in what you just shared with us. I want to take it back to Leah, because part of what you’re talking about is the individuality of each patient, right, and who you will refer them to, and what community based organizations may be best suited to meet that patient’s need. So Leah with wildflower health, talk to me about how you approach each patient. You know, do you get their zip code? How do you learn about who they are and where they’re coming from and what that person’s needs might be?

 

Leah  38:38

Yeah, absolutely. And I think thematically, I want to go back as you both were speaking just now, Dr nokva, you said earlier something I completely agree with. We need to standardize evidence based care at a clinical level, but we also need a layer where you’re going Gloria, to individualize to the community and to the person and the demographic. And I think that is what we aspire to do at Wildflower. This sort of I use the term non clinical, but it’s not the interventions. It’s the rest of the patient’s life, right? And one of the things that we do to personalize our experience of both digital, non digital outreach, digital outreach and our human component, is we build a whole health profile of the patient. So when we onboard patients, we know from their provider. We’re inviting them when they enter prenatal care on behalf of the provider. We certainly know age, but we also typically have race, ethnicity, preferred language, and then when a patient on boards, we try to find out anything about, am I LGBTQ having a baby? Am I have certain social needs, things that may not be coming up in a typical clinical intake, but impact the way that I’m going to approach, approach healthcare, zip code, level of education, all of that goes into our health profile and individualizes everything for. From, obviously, the language in our applications that our advocates use, to the, some cases, the literacy level of how we, you know, explain things in the content, and certainly, to just, you know, the journey that that patient is on, really individualizing to their needs. And so it’s really a whole health approach, and a whole patient approach, which, you know, Dr naughty is one of those rare clinicians who you’re doing that at 28 weeks, but we have to standardize that and make it scalable, so that it can be accessible to all in any patients, regardless who their clinical providers.

 

Dr. Naqvi  40:29

And that’s what I like about using that digital platform, right? So I know that my patient, if they’re onboarded on wildflower, they’re going to get that at 28 or 32 weeks, right from the health advocates, they’re going to get that education. So in case I miss it, or in case my partners are not, you know what? I mean, well, educated they are. But just for the conversation that there’s, there’s this other platform that they’re going to be able to on their phone, right? It’s always with them, right? It’s not somewhere else. It’s where the patient is at that’s where they’re going to get that, you know? And the other thing is, I will tell you, as a provider, what this does is it decreases the office burden. It allows me to have more resources available so my one nurse doesn’t have to do teaching, but actually can spend the time saying, Actually, let me check what’s going on with you. Are you having transportation issues? What’s going on? Why didn’t you come to the you know, office? Even wildflower does that? You know, they’re like, wait, you’ve been missing appointments. How can we help you? You know? But it allows me to have my nurse focus on care coordination, on case management of my patient with me, so that way all this other stuff, not that I’m saying it’s less priority, but it’s something that can be outsourced. Like, why waste my like, right? So you want to decrease the waste in the health system too at the same time. And this is sort of like, okay, Leah, hand off to you to try to figure out what’s going on. Can you help my patient set up the Bluetooth? Can you help them set up the blood pressure cuff for me? I need my nurse to actually call this patient because I’m trying to set up something, because she’s got a fetal heart anomaly, and I gotta do kiss coordination between MFM and chop and whatever else I have to do. I’ll use my nurse in better capacity.

 

Gloria Riviera  42:20

Right, you’ll make more out of the nurses time in your office, right? Just a quick question, because we’re going to run out of time very soon. I want to get to maternal morbidity before I do, I’d like to ask you both, Leah, in the 10 years since you started wildflower health, to what extent is the coordination between providers and an organization like wildflower health, is that coordinated? Is there a spreadsheet that you’re looking at? How do you know what’s going on between the right hand and the left hand for patients? How does that work?

 

Leah  42:54

We integrate into the provider’s workflow, and we integrate in a way that they don’t have to do a lot of extra stuff or create burdens so we’re current. We’re collecting data from their electronic health records. We are customizing our protocols for how we reach out to them when they are needed in a way that’s very bespoke to a practice. And I think of it is really force multiplying this very unique asset in healthcare, right that OB your midwife is going to deliver your babies, your babies, your center of trust, but they only have so much time. And if you look at the four trimesters of pregnancy, it’s 364 days you’re in the healthcare system, 16 of those, maybe, right? So you are not always in front of Dr nokvi. So how do you create a layer that works for them, makes their lives, makes them more impactful when they are in front of you, but can deal with you all those other 364, days, not deal in a bad way, but like be there as a resource, Screening for Mental Health, supporting social determinants, and you have to do it in a way that fits into the workflow of these busy practices. So we integrate the the Atlantic application for wildflower is Atlantic, my baby and me, it looks like their brand. It is connected to Epic. They get the, you know, data from our interventions back into epic. That’s their electronic health record. So it feels very seamless for both parties. It’s crucial.

 

Gloria Riviera  44:12

Okay, that sounds amazing and okay. I am done having babies. I have a nine year old daughter, but for her babysitters, or my friends who are 20 somethings or 30 somethings, I would want to have my baby with a provider who had wildflower health integrated into their system. If I knew that, I would seek out a provider who was working with wildflower health. How do I find out who that provider is?

 

Leah  44:38

I want to take it back to value based care. Wildflower is not funded in the fee for service restaurant model. We are funded in a value based care model. So we basically go into models like we’re doing with Atlantic and New Jersey, and we are also on the risk for improving your outcomes and your savings. And I share this as an answer to your question, because this type of intervention is only. Going to take hold and scale to national level where many people can access it, whether it’s wildflower or other companies, right? I’m not assuming we’re going to be it’s there’s other but we’re taking, don’t worry. Model of care is only going to happen if we, as as patients, as you know, US citizens like really advocate for ongoing reform at the national level for our payment model, and so much of this has been driven by the federal government. So the Centers for Medicare and Medicaid have put in place changes to payment model. Medicare at scale. That’s where this really started. Now it’s happening in Medicaid in New Jersey with Dr. Naqvi system, we are applying for a federal grant to take this to the entire state, and then hopefully it becomes a model of care that other states can replicate. But I you know, at this point, it is still limited. You know, there aren’t that many providers and models of care like this. It is nascent, but we are we’re determined to make it as big as it possibly can. Again, whether it’s where, the where the inspiration other models markets can follow.

 

Gloria Riviera  46:07

Well, I think it’s the first thing that I’ve heard of happening in the area that I’m most interested in, which is maternal health, that it echoes of anything similar to what I experienced in the UK, right? Because, you know, I cover abortion, I cover all sorts of issues that leave me very frustrated as a journalist. So I can only imagine how frustrated you both became in order to launch what you’re both doing now, before we run out of time, let’s talk about maternal morbidity rates in this country, which are shockingly high compared to other places in the world, and if you’re a woman of color, the chances are even worse. How do we address this issue in marginalized communities? And is that where we’re going to make the most progress if we focus in on those areas?

 

Dr. Naqvi  46:56

I think, you know, I’ve been thinking a lot about this, right? So what, why we’re throwing money at the problem? Why isn’t it getting fixed, right? Going back to how much money we spend in hospital, why isn’t it working? Patients fine. We improve access, right? We’ve increased access. Patients are coming in, getting cared for during their pregnancy. But why are our rates still going up, right? And the reason is because we haven’t actually looked at the patient as a whole. Going back to what Leah and Vivek Murthy wrote in his, you know, health report, public health report as well in 2022 you got to look at the whole person. And that’s the public health you cannot address it without looking at all the external factors. So what we’re embarking on in New Jersey, if we get the heroes grant, I say that if we you know is that if we get that, honestly, it’s a game changer, because what we’re leveraging is community health workers, which is not even on the scene here. We’ve talked about midwife we’ve talked about doula care, but we really are trying to get into, break into the communities where the patients are to see what’s going on. Why aren’t the rates improving here? You know, whether it’s preterm birth, whether it’s, you know, preeclampsia. So what we’re doing is we’re really strategizing and figuring out what communities need, what services so it’s not one size fits all. It’s going to change. It has to change, and that’s where I think we’re going to be able to make a difference, which is why value based care, I think will make more of an impact in maternity care versus how many calves I’m doing, how many bones. I’m fixing an ortho right? It’s just a different model. You cannot apply the same.

 

Gloria Riviera  48:46

And I would also think that the focus on preventative care will influence those [..]

 

Dr. Naqvi  48:51

Well, just even talk about interpregnancy care, right? We just talked about that woman gives birth, she’s found to be anemic. Anemia has been linked to depression, anemia has been linked to multiple other diseases. But what are we doing about it? Is a patient educated about it that she’s walking out of the hospital with a hemoglobin of nine probably not. Does she have follow up at her primary care doctor? Probably not, because she’s like, I’m normal. I just gave birth. I’m just going to go back, because I gotta go to work. I gotta go to work in six weeks. I gotta go I gotta make money. Gotta support this family so.

 

Gloria Riviera  49:22

Leah, you’ve mentioned how important it is to understand how we fund healthcare, and I know that you partner with different healthcare partners who share your same vision. I wish I understood more, but I can just imagine there is incredible innovation from the tech industry going on, and just gleaning a little bit of what you said about how you integrate into larger healthcare providers. Tell us how you find the right people to invest your time and money in.

 

Leah  49:52

Oh.

 

Gloria Riviera  49:53

Do we need another hour to answer that question?

 

Leah  49:56

No, you don’t.

 

Gloria Riviera  49:57

Oh, good.

 

Leah  49:57

Since the shared commitment and the passion. So we have, we have launched these models in New Jersey and Nevada so far, and we have more states, you know, on our horizon. In both cases, it was really spearheaded by people at the local level saying, we’re going to change things for our community. And that’s when, you know, and it’s, and it’s both on the provider side and the health plan side, or the employer side or Medicaid side, wherever it is, or if you can get that alignment and that shared vision of we’re going to change it, we’re going to make history. It was literally a quote this week in New Jersey on one of our calls, and that is when you know these are the right people to be working with for this early promise of transforming maternal health.

 

Gloria Riviera  50:39

I love that we’re at time now I just want to get one question to you both. I would love to know how, and we’ll start Dr. Naqvi with you. How do you think having VBC based care available to you would have changed the way you experienced pregnancy and delivery?

 

Dr. Naqvi  50:57

If I had it?

 

Gloria Riviera  50:59

Yeah.

 

Dr. Naqvi  50:59

Personally.

 

Gloria Riviera  51:00

Yes.

 

Dr. Naqvi  51:00

Oh my god.

 

Gloria Riviera  51:02

Well, I think we have our answer. She has a big smile. She’s just going, well, it would have, I mean, been a totally experienced.

 

Dr. Naqvi  51:10

I think. I mean, I had a very good experience. You know, I picked my provider, right? It was a friend of mine. But thinking about, why do I pick my providers the way I do, right? Right? So I picked because I knew who to go to and who not to go to. But most people don’t have that luxury. They don’t see that inner working, right? So I picked them because I know that they took time with me, right? So yes, I did. I had great experiences with all three of my babies. The only thing I would say is, honestly, if you know, I was in the driving seat of my own care just because of what I do for a living. So my friends, you know, they were kind of like, yeah, are you doing what you’re supposed to be? You know, it was more that. But where I missed the chance was, honestly, in post partum care, I wish I could go back and harness what I know now, how I could rewrite that history. I wish I had taken time off. I wish I had a doula. I wish I had breastfeeding support. Even I’ve read textbooks, but I’m telling you, postpartum depression, mental health, the mood changes. That’s why I’m so passionate about it, because I lived through it three times. And it’s not pretty. You think you learned your lesson. You think you’re hard, like you were finding new resources, but they weren’t there for me. They really weren’t in this country, my oldest is 20, right? So, like, wasn’t there.

 

Gloria Riviera  52:38

But they might be for the next generation, you know that’s that’s the work that you’re doing. And Leah, the same question to you, how do you think it might have changed your experience with pregnancy and after delivery?

 

Leah  52:51

Yeah, actually, very similar. I had a good prenatal experience. I hired a doula out of pocket. If we had value based care, it might be reimbursed, because it was very impactful to my outcomes. But postpartum, I instantly felt like I went from all this attention to healthcare to none and completely left alone. And it was a real shock. So I think that having that under if you look at maternal mortality and morbidity, most of the problems happen after you go home from the hospital, and that lack of support, yeah, for me, it was, you know, just difficult from a sort of maybe preventive health perspective, but it really does impact lives and safety, and so figuring out how to have the alignment to have that full support postpartum is crucial.

 

Gloria Riviera  53:37

Well, I just want to say thank you to you both. I feel like this conversation has been so informative. I also feel like it’s breaking news, in a sense that this is something that you both are invested in changing. For all of those out there who are pregnant now about to give birth, really changing that experience. I feel like this conversation has shown me that you’re both dedicating your professional lives, to improving the narrative for women out there everywhere, to improving that experience. I mean, I remember coming home with my baby and not knowing what to do with my baby or with myself, right? And it’s that feeling of being alone and so much attention, right when you’re pregnant and then, and then it’s just you, and that’s a very that can be a very scary place. So I commend you both for seeing it and seeing women out there, and I’m so grateful that you’re both doing what you’re doing. It is so important and needed in this country, specifically. So thank you.

 

Leah  54:39

Thank you for having me.

 

Dr. Naqvi  54:42

Thank you, Gloria.

 

CREDITS 54:52

This episode is supported by Accountable For Health. This series is produced by associate producer Dani Matias. Our supervising producer is Jamila Zarha Williams, mixing and sound designed by Noah Smith. Steve Nelson is our SVP of weekly content. Executive Producers are Stephanie Wittels Wachs, and Jessica Cordova Kramer. Help others find our show by leaving us a rating and writing a review. Thanks so much for listening, see you next week. Follow Good Things wherever you get your podcasts and listen ad free on Amazon music with your Prime membership.