As an ER doctor, Olan Soremekun noticed something he hadn’t expected: pregnant patients needing what sometimes amounted to routine care. Some wanted reassurance that their pregnancies were on track. Some had been unable to make regular OB appointments. The more women* he spoke with, the more he learned many lacked access to transportation or stable housing. Some needed support navigating maternal health care beyond the ER. Soremekun knew the ER was not the best place for routine visits. But he wondered how women could receive the full spectrum of care they needed.
Blue Cross and Blue Shield companies are taking meaningful action in every ZIP code, forging partnerships to make a lasting impact.
The answer was Cayaba Care, a Philadelphia-based company he co-founded. The core of Cayaba Care’s work is its maternity navigators, who visit pregnant and new moms at home, between OB visits. The company has partnered with Independence Blue Cross (Independence) to extend its reach.
Moms are coming home from the hospital. No one is dying. That is the story we want to hear. – Dr. Seun Ross, executive director of health equity at Independence Blue Cross
Meeting patients where they are, between OB visits
“We support patients beyond what is traditionally seen as ‘clinical.’ We address social determinants of health, behavioral health and much more” says Soremekun. “And that support has to happen in between OB visits because the community is where most time is spent and where you actually have the ability to improve outcomes.”
Meet maternity navigator, Victoria Brown.
The maternity navigators come from the communities Cayaba Care serves. They’re former medical assistants, doulas, community health workers or have other valuable experiences. “We provide additional training, so they know how to support women who are either prenatal or postpartum,” says Soremekun. “And because they have this knowledge, and because they're able to go into homes and build trust, patients feel heard and comfortable sharing their needs.”
Before a postpartum visit, maternity navigator, Victoria Brown, packs her caregiver bag at Cayaba Care’s clinic in North Philidephia.
Supporting patients in the community complements care in the exam room
Navigators don't replace a patient's primary OB provider. They are part of a patient’s multidisciplinary care team, including OBGYNs, social workers and psychiatrists, all of whom want the same thing: a healthy mom and baby. Navigators may be closer to a patient, seeing her every week, building trust. They may identify needs a doctor doesn’t typically address, such as groceries, transportation to appointments or even making a connecmtion to a diaper bank. Soremekun says Cayaba Care meets patients where they are.
Brown travels to her patients weekly, eliminating barriers to care like transportation and childcare.
But Soremekun says navigators provide more than emotional and social support. “They provide patients the education that they need to go into the health care system and ask the right questions or be ready for that experience.” He says sometimes patients fear they won’t be listened to, or that a symptom doesn’t matter. A navigator can pick up on that and help a patient report what could be a dangerous condition. “If a patient says, ‘I feel short of breath,’ or if our maternity navigator notices a mother’s legs are swelling, which could be a sign of a serious condition called eclampsia, they can let the patient know she should not ignore those feelings. The navigator can call a physician and possibly even save a mom’s life.”
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Reinventing maternal health care to eliminate racial disparities
Dr. Seun Ross, left, executive director of health equity at Independence Blue Cross, collaborates with Cayaba Care co-founder and CEO Dr. Olan Soremekun.
Cayaba Care set out to invent a new model of maternal care. They were taking on new patients, looking for ways to plug into Philadelphia’s larger maternal health care ecosystem and seeking partners in the community to sustain its growth. Meanwhile, Independence Blue Cross, the region’s largest health plan, was looking for a new way to help their pregnant and new moms who have barriers to care or at risk of complications. The partnership made perfect sense.
"As we looked at our maternal data, we recognized that we had challenges, as did everyone," says Dr. Seun Ross, executive director of health equity at Independence. Ross’ job is to bake health equity into everything the health insurer does, including how members get care. She says a deeper look into claims data showed greater rates of high blood pressure among some groups of women. Black women, compared to other races and ethnicities, have higher rates of high blood pressure, a leading risk factor for childbirth complications.
Faced with that clear disparity, Ross says Independence decided that was where to focus efforts to help pregnant members at risk. One route to achieving that goal was to meet the full range of their needs, in settings where they felt comfortable. “And so that is why we decided to partner with Cayaba Care,” says Ross.
Now, Independence reaches out to members who might benefit, doctors make referrals or patients can enroll themselves in Cayaba Care's program.
Community health workers promote whole health, from food security to healthy blood pressure
“Research shows that community health workers reduce disparities,” says Ross. “They’re the gold standard.” Maternity navigators can advocate for the patient. And they can combat the interpersonal and institutional racism that has caused these disparities.” Ross says that social and health needs are intertwined: take away the risk of food insecurity, and a pregnant woman has more access to healthy, affordable food. Healthy food leads to lower blood pressure. And a weekly visit from a maternity navigator, who can take a blood pressure reading and talk with a mom and her doctor about how to manage that risk, means a healthier pregnancy.
Research shows that community health workers reduce disparities. They’re the gold standard. – Seun Ross, DNP, executive director of health equity at Independence Blue Cross
“And most of all,” says Ross, “moms are coming home from the hospital. No one is dying. That is the story we want to hear.”
Independence Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.
*We recognize that not all birthing people identify as women.