America’s maternal death rate: “This is a national crisis” | Michael Dowling

• Your zip code makes a huge difference in terms of your overall health status. You can have people living 10 years longer in one zip code compared to two miles away, where people live 5 years, 10 years shorter. Why? What's happening there that isn't happening over here?

Well, let's assume you are a physician, and you sit and you talk to the patient, and you analyze what's in front of you, but you do not pay any attention to what happened before. Where does that person live? What's their family circumstance? What's their economic circumstance? It is our job as providers to make sure that we do everything possible to enhance the access to care for everybody in those communities because not everybody has equitable access.

At Northwell, we are, right now, focused on maternal mortality, especially for Black women, because it is three times the mortality rate of white women. This is a national crisis. The question is, of course, is why?

I am Michael Dowling, and I am the president and CEO of Northwell Health. Healthcare, traditionally, has been very transaction-oriented. You come in, deliver a baby, you're in the hospital three or four days, and then we discharge you. You go home, we give you a package, and then we say, "Have a nice day."

Yet, over the last decade and more, and especially at Northwell, we have been moving more and more care out of the hospital into the communities: opening up ambulatory sites, outpatient facilities. Only about 50% of what we do today is hospital-based care.

We have 21 hospitals, but I have 870 outpatient ambulatory locations of care- so as a broad distribution network. And within women's health, maternal mortality, overall, in the United States has a worse statistic than in other countries. This is something that people have been aware of for many years.

There have been some national efforts to deal with it. There have been some statewide efforts to deal with it. It is something the United States should not have a distinction on. So what can we do about it? We, at Northwell, initiated a major pilot program called 'MOMs.'

It's all about navigation. It's about assigning staff to work with a person who has a particular issue and be their mentor, their coach, helping them get the services that they need, following up to make sure that they're complying, setting up the appointments, providing educational services. So, it's a linear process. It's one program with multiple components.

It's what do you do prior to pregnancy, during pregnancy, during birth, and postpartum. As a result, the MOMs program has helped improve outcomes, reduce hospitalization, and enhance care - and it needs to be dramatically expanded. That's the direction that we're moving, and that's progress because the care, the bulk of it, is not in the hospital anymore.

And as time progresses, more of it will be outside the hospital, in other facilities, closer to where you live, and in your home. That's increasing access. You have to be able to work in partnership with people out in the community, who are on the ground where people live.

We look out in those communities and we try to identify who are the trusting partners that people believe in. We recently held a meeting with about 100 pastors from communities that are somewhat disadvantaged, medically and otherwise, and we talked to them about mental health. Without that involvement from the communities themselves, you're not going to get the trusting relationships that you want.

So, it's understanding that background. Nurses, especially those now working on the Black maternal mortality issue, we have had discussions about inherent biases in how it is we act and behave. The key is to acknowledge it, to accept the fact that it does occur, and the fact that we have to actually address it.

I held a meeting on Black maternal mortality a couple of weeks ago, and I had about seven or eight different departments in the room. Because if you are an individual about to give birth, you just don't have a single issue, you might have multiple issues. It can be cardiac, it can be behavioral, it can be medical. You gotta break down those silos.

One of the issues that is a contributor to Black maternal mortality is 'preeclampsia,' high blood pressure, that can happen during pregnancy, which can lead to a fatal result. If you were able to identify things much earlier, the person may never end up in the hospital, and that's also now facilitated by the use of technology.

We have monitoring devices, we have wearable devices, we can monitor you remotely. One of the companies that we developed a relationship with was a company called Aegis. They said, "We wanna come up with AI tools to help improve healthcare outcomes."

And we therefore developed a company called Ascertain. What we're doing with AI here is analyzing all the data of all the pregnancies that we've had, all the deliveries that we've had, of all the patients that had preeclampsia, to figure out: What does all of that data tell us, and how could we potentially predict who might be more likely to suffer from preeclampsia?

So the day we can intervene earlier on. You'll identify upfront the people who might be of high risk, you'll work with them through a navigation program, you work with them during pregnancy for prenatal care, the services you provide, the potential bias issues that might exist, and then you follow up with them afterwards.

So, we are looking at the full continuum of care. And one last point here: these are not short-term projects. It's not gonna be, "We are over it. We'll be finished with it by Christmas." If you're going to deal with an issue of Black maternal mortality, it's long-term. It's having grit, tenacity, and a value of persistence where you don't quit, ever.

I'm an optimist. I believe that you have to be optimistic in any business if you're gonna be successful, and I believe there's lots of successes that we can demonstrate where we are so much better off today than we were 30, 40 years ago.