M Health Fairview to remove race as a factor in pregnancy, maternal health screenings

NINA MOINI: M Health Fairview says it's found a way to help eliminate racial and ethnic bias in pregnancy and delivery care. The health system says it's removing race as a factor for various screenings and tests related to pregnancy. By July, all pregnant patients at M Health Fairview will be universally screened for various maternal and fetal conditions. That includes diseases that are usually prominent in a certain racial group, like sickle cell disease or spina bifida. Here to tell us more about this is Melissa Hasler, the director of nurse midwives at M Health Fairview. Thank you so much for being here, Melissa.

MELISSA HASLER: Hi, Nina. Thanks for having me.

NINA MOINI: You know, Melissa, when I initially heard this, I thought, well, does removing it help, or does it hurt? Can you explain the decision to remove race as a factor in the maternal health screenings and how that actually makes it more equitable in your view?

MELISSA HASLER: Absolutely. This is such an important topic, and I'm really glad we're highlighting it. And it's helpful to start from the point of the fact that we have such a severe crisis nationally. But particularly in our state, we are seeing pregnant people dying at a higher rate than we are seeing people die from pregnancy and pregnancy related issues globally.

So our concerns are around how do we help keep pregnant people healthy during their pregnancy and their postpartum experience and, of course, the birthing experience? So we took a focused look on that at M Health Fairview to figure out what's the issue? How do we drill down to the piece that we can actually impact the care that we're providing pregnant people?

And what we discovered was really the importance of looking at science as the basis of the care that we're providing. So focusing care on evidence based, high quality research and evidence that shows this is how we care for pregnant people in the best way possible. And when looking at that, we discovered one large element that was problematic was using race in many of the different screenings and the biochemical markers for testing that were being utilized at M Health Fairview.

And it sounds a little bit counterintuitive. You're going to remove an opportunity to identify somebody at high risk. But when you really break down the issue, race itself is not a biologic determinant of someone's risk. Race is a social construct. And so when we use that, we under-attribute or over-attribute certain risks to certain people in different socioeconomic and demographic and ethnic categories.

And so it's not enough just to remove the race as a factor. But we need to have robust screening universally, along with interventions that actually can impact that maternal health outcome. We know that a lot of the risks during pregnancy and postpartum come from actually socioeconomic risks that really impact the care that the pregnant person receives. And so how do we actually address that? So robust screening we find is going to be our answer forward and really identifying the right path for individualized care across our entire health care system at M Health Fairview.

NINA MOINI: Yeah, you know what's interesting is in the last segment, we were talking about patients advocating for themselves. But to your point, some patients are not believed. They're not listened to. So what are some of the additional screenings? I listed a couple at the top. But how are you making it more robust so that people don't have to ask for as much and potentially not be believed? It'll just be provided to them. What does it look like?

MELISSA HASLER: Absolutely. Yeah. Great question. So you don't know what you don't know. So if we're not offering educational opportunities to everyone, you're not going to know what you potentially could have or what you're missing.

So the first point is really having robust education for everyone coming in to their pregnancy care, making sure they understand all of the pieces that are critical to quality and how we can help support them in their pregnancy journey. So you did name a couple of screening opportunities that we have changed such as genetic screening and lead screening, for example. That is a new screening that we're going to implement across the board for all pregnant people that really identifies environmental risk factors that could impact not just the pregnant person, but the newborn that comes from that pregnancy.

And then one of the most important aspects that we are building and putting in the system is a social determinant of health screening. And that is a fancy way of saying, what are the pieces of your life that may impact your ability to access care and receive care? So our screening will include things like asking about food security, questioning about transportation barriers, establishing if there's any concerns with housing or safety. Intimate partner violence is a large concern for pregnant people in our state and nationally. And that's something that we want to screen universally for everyone specifically in pregnancy.

And then one other piece that we're adding is an additional substance use screening with a questionnaire that's really focused on identifying folks who are pregnant who may be seeking services or some assistance with substance use in their pregnancy and finding out ways that we can develop really robust resources to help support them in that journey to help elevate their care and help them be healthier at the end of it along with healthier babies in the outcome.

NINA MOINI: The social determinants that you mentioned are really interesting. I was recently at the doctor just for a yearly checkup. And I had a question on my questionnaire about food security as well, which we know is a huge, huge issue right now-- hunger. I'm curious to know what happens if some of these social determinants raise a flag-- housing, economic stability, transportation. What would a provider do with that?

MELISSA HASLER: So that's a really great question. And we don't want to have a screening that asks someone a question but then doesn't do anything with it, right?

NINA MOINI: Right.

MELISSA HASLER: The point of screening is to have some sort of intervention. So part of this robust process in our system is called a care mapping system. And that's a really unique way for us to be able to develop those resources that providers or support staff can access that actually gives that patient or that pregnant person the next step in health supporting them, whatever their needs are. So, for example, there will be something in our electronic health record that allows us to go directly to resources in a website that can schedule appointments for patients who may need assistance with economic security or insurance questions, give recommendations or direct referrals to care coordinators to help figure out what exactly the needs are and how we can individualize that for the person.

So thankfully at M Health Fairview, we have an incredible program and focus on specifically food for health. And we have some wonderful services in our community advancement programs that help connect patients with the particularly culturally congruent food resources that they may need to support their pregnancy and support their families. So we're really being so focused on the community and thinking about maintaining the health of our entire community. Our health care system is really well poised to be able to not just provide health to get you to a healthy state, but also maintain that health with a lot of the wraparound services that we're building in.

NINA MOINI: Sure. And Melissa, I do want to just discuss cost, though, to the patient, because I know when I'm at the doctor every test, I'm thinking, how much does that cost? How much does that cost? So I'm just curious about how you're making all that work.

MELISSA HASLER: So it's been really interesting because this, of course, we want this to be cost neutral for everyone. And we know that we have incredible resources in our system. But we are a large system. And one of the challenges we've had is really coordinating our efforts and actually allocating our resources that we currently have in a way that makes the most sense based on the patient's needs. Right?

And so we have through this care mapping process been able to develop pathways and reallocation of resources that we've had that does not add cost to the patient. It really makes it more efficient for everyone involved, not just the providers and the patients, but the care staff and our partners that work with us in supporting social determinants of health. So this is not a system that's going to actually add any costs to patients that we can identify at this point because it's resources that we have. It's really about coordinating and making them robust and accessible and individualized to that patient's needs.

NINA MOINI: Melissa, thank you so much for coming on and sharing about this. I learned a lot. Thank you.

MELISSA HASLER: You're welcome. Thanks for having me.

NINA MOINI: That was Melissa Hasler, the director of nurse midwives at M Health Fairview.