Building a Baseline for Patient Access to Strengthen the Maternal Care Continuum

My husband and I welcomed our first child in late December 2024, baby boy Aaron Henry. Those first few months were a blur of joy and insanity, and when I started to emerge from my sleep deprived haze, I began reflecting on the process of how I received care in the prenatal and postpartum period. I live right outside Boston in Massachusetts, home to some of the best hospitals and providers in the world, and overall, I experienced excellent care throughout my pregnancy. I also have a better-than-average understanding of the medical system, particularly around pregnancy; several years ago, I trained as a doula, I wrote my master’s thesis on the connection between women’s healthcare, specifically pregnancy and childbirth, and value-based care, and I work for a healthcare tech company.

I knew I was better equipped than the average pregnant person to manage my care, yet I was still let down at multiple points by my providers. I often had to do my own research, spend my own money, and navigate my own support systems to access the kind of care I felt was best for me and my family. If this was my experience, with my background and living in Massachusetts, I cannot imagine how the 2.3 million women of reproductive age who live in maternity care deserts manage their pregnancies and the years that follow.

The pervasive challenges of delivering quality maternal care in the US and the results of our failure to do so have been well documented in the last several years. The US lags behind other wealthy nations in most aspects of maternal care; from the aforementioned provider deserts to the extreme racial disparities in birth outcomes to the lack of a national parental leave policy, pregnant patients and new parents are often left to fend for themselves. What the US does have is an incredible body of advanced medical technology—babies can be born at less than 30 weeks and go on to thrive, mothers can go into pregnancy with multiple chronic conditions and give birth to healthy children—and this should be celebrated. But these technologies mean nothing without access, and that access often hinges on a doctor’s office picking up the phone and contacting patients.

Before I went on maternity leave, I started working with our product team on enhancing Azara’s suite of maternal care-related reporting, and I am proud to say we have released several impactful new features to help care teams keep track of their panel of pregnant patients and new mothers. A reporting solution is not going to solve the ongoing maternal care crisis, but it can help fill some of the common cracks in what should be a continuum of care. I can say from firsthand experience that even the most basic of lists that remind care teams when to get in touch with patients can make a world of difference and are an essential step in building a sustainable maternal care program.

Throughout my pregnancy I almost always had a future appointment scheduled, but in early pregnancy, interactions with one’s provider are limited, leaving ample opportunity for patients to be lost to follow-up. As mentioned earlier, I was primed to be following the ACOG recommended prenatal visit schedule on my own, but what if I no-showed or missed a visit? Was someone going to call me to make sure I rescheduled and got the care I needed? That was only going to happen if a staff member in the front office or a provider reviewing their panel noticed and picked up the phone. Timing is important in prenatal and postpartum care, so why not put in a reminder system and make it easy to find patients who are behind on their visits?

A front desk staff member told me once it was “fine for me to miss an appointment” because my provider’s schedule was very complicated that week. Luckily, said provider noticed and insisted that no, it was not acceptable to skip an appointment in the third trimester. These foundational scheduling concerns do not need to be left to chance; as part of the Azara maternal care solution expansion, we now have two new automated text message campaigns, Prenatal Care Appointment Not Scheduled and Prenatal No-Show Appointment. Texting may not be effective for every patient, but it establishes a floor for engagement that can mean the difference between someone who is lost to follow-up and someone who reaches out to re-establish care.

To support more time-intensive and specific outreach, Azara also created a new Maternal Care Management report that allows users to easily filter to a population in need of follow-up; whether a care team member is trying to find patients missing a specific screening, or administrative staff are ensuring a future appointment is always scheduled, there is enormous value in an easily accessible and specific list. This report also allows users to filter to the postpartum period and find patients without appointments. This is the time when most maternal deaths occur and when women are vulnerable to complications, yet it is also a period of significantly less engagement with the patient’s care team.

Many women, myself included, have only one postpartum visit routinely scheduled at six weeks. Compared to the prenatal care schedule of appointments, this is a dramatic reduction in support, and if missed, there is no other prescribed opportunity for women to get care in this highly consequential period. I gave birth in the same hospital where all my prenatal appointments occurred, and I still had to call and schedule my own six-week visit because no one called me. I ended up with postpartum complications which would not have been caught had I not taken this step and my care team should never have left that follow-up to chance.

I wish someone at the office was running a report or taking advantage of the postpartum visit reminders available in Azara Patient Outreach (APO) with the Postpartum Care Appointment Not Scheduled campaign to ensure I was contacted. These steps are crucial for better maternal care, and in a value-based care world, failure to identify these postpartum complications opens the door for more serious, and expensive, conditions later in life.

Every woman I know has had an experience like this, pregnancy-related or otherwise, and many have access to the best care, reliable transportation, and multiple support systems. If someone in the office misses a test result or provider note and never makes a call, it’s understandable given how chaotic healthcare delivery is, but unacceptable. Every person needs reminders for the most basic of tasks, and something as consequential as a postpartum visit should be no different.

Measuring outcomes like maternal mortality are important for broad issue identification, but they only tell us what is wrong, not how to fix it. Data analytics tools are a way to get closer to the root causes of these huge, scary public health crises, and only after understanding the root causes can effective solutions be developed and deployed.

Analytics are of course only one piece of a much larger effort, but solutions like Azara DRVS can help ensure a basic level of engagement with patients. We need to address institutional challenges like healthcare worker shortages and policy failures, but those efforts take years—calling a patient who missed an appointment takes minutes and could make an enormous difference in their care. And when even that one extra call seems like a breaking point for organizational resources, there are automated systems like Azara Patient Outreach that can simultaneously ensure patients are engaged and help relieve staff burdens.

We must keep pushing for system-level change, and in the meantime, Azara is there to help make the smaller, everyday acts easier. Anyone who thinks to themselves that these reports are just another list, another button to click, remember that there is a real person on the other side and that phone call could mean a world of difference to them.

For more information on Azara’s Maternal Health Solutions see our brochure, reach out to support@azarahealthcare.com or contact your Client Success Manager.