A new South Country Health Alliance initiative is providing telehealth opportunities for doula services in Minnesota.
South Country partnered with Delfina to extend maternal health services to plan members throughout the eight counties—Brown, Dodge, Goodhue, Kanabec, Sibley, Steele, Wabasha, and Waseca—South Country’s CareConnect Program services in February.
“It is an app-based maternal health program that will provide support and education for our members from the first trimester through 12 months postpartum,” South Country CEO Leota Lind told State of Reform. “One of the access issues we have is that there are not a lot of doulas. And this application and partnership will essentially provide our members access to tele-doulas.”
The initiative is a response to the alarming state of maternal health in the U.S., where more than 50 percent of rural counties have no hospital-based obstetrical (OB) services and one in three women in urban areas live in an OB desert. In Minnesota, American Indian women are eight times—and Black women are one-and-a-half times—more likely to die from pregnancy complications than white women.
Delfina guides who are certified doulas will engage with plan members, and provide ongoing support for them throughout their pregnancy and postpartum, Lind said.
“The app will allow members access to telehealth services for behavioral health or with a registered dietician,” she said. “[It has] lots of educational content and material that will be provided to them. They will have the opportunity to join virtual classes on breastfeeding, baby care, mental health during pregnancy, postpartum nutrition, and lactation. There’s yoga classes that can be offered, and also kind of a peer group—a support group of other members that are pregnant or postpartum—and (it gives them) an opportunity to connect with other individuals experiencing the same thing.”
The counties served by South Country have a shortage of diverse providers, so non-English speaking populations often don’t have access to providers that are culturally congruent with them, Lind said. The app features Spanish translations.
“And there are Spanish-speaking doulas. We are also working to translate the app into Somali and have a Somali-speaking doula. Those are the two predominant non-English speaking populations that are served within our area. From that aspect, it is also helping us meet some health equity goals in providing more culturally-congruent care. Minnesota has a very strong focus on maternal health right now. We see some significant disparities in maternal health within non-English speaking populations.”
— Lind
South Country is also partnering with local public health nurses on the initiative, Lind said. They are introducing the app to members, so it can serve as an adjunct to local maternal child health resources that are provided to members through home-visiting programs and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
South Country piloted the initiative in November 2023, and rolled it out to all its members in February. One of the challenges staff has had has been identifying individuals early in their pregnancy due to the way prenatal billing is done, Lind said.
“It’s done as a bundled prenatal service, and often isn’t billed by the provider until the end of a pregnancy,” she said. “So (we’re) working on ways to try and identify members early in their pregnancy to get this information out to them. As soon as we identify and know a member is pregnant, a mailing goes out that provides a lot of information and resources. We’re doing this in conjunction with our public health nurses. They often (see) individuals through WIC programs. We are in the process of planning some regional community events that will be an in-person educational opportunity for our members, and an opportunity to introduce this resource.”
The U.S. Department of Health & Human Services approved the extension of Medicaid coverage for postpartum individuals to 12 months last year, Lind noted, which should also improve maternal health outcomes in the state.
“Previously, individuals had only been eligible for Medicaid (coverage) for 60 days postpartum,” Lind said. “So that 12-month continuing postpartum enrollment was a great benefit.”
South Country is also working to implement an after-hours care initiative in order to improve access, particularly for behavioral health needs, Lind said.
“In many of our communities, there aren’t extended clinic hours. So the only source of care for after hours, weekends, and holidays is the emergency department. That’s not the best use of healthcare dollars in many situations. We’re going to contract with Included Health to expand access to telehealth services for behavioral health and urgent care. [That will] not only address access issues, but will also help address some health equity issues, being able to provide access to our non-English speaking members—or members of other cultures—to more culturally-congruent care. Our target is September to have that in place.”
— Lind
South Country plans to focus on initiatives addressing health-related social needs in the future, Lind said.
“[We’re] focusing on health equity, and trying to find ways to provide our members with access to culturally-congruent care,” she said. “We are always supportive of any kind of initiatives or funding that would help address health-related social needs. [We’ll] look at how to continue to augment our network to promote access. [And] we’re looking at a number of initiatives regarding food insecurity.”
Lind would also like to see Minnesota continue to build on its loan forgiveness programs, particularly for dental services.
“Dental access is a statewide issue,” she said. “We significantly feel that in rural areas. We’ve got a significant number of dental professionals anticipated over the next (several) years that will be retiring, and (we’re) not getting new dentists in to take over those practices. One way to get more providers in rural areas is to (expand) loan forgiveness programs in rural areas. They tend to receive the loan forgiveness, but then relocate in the metro areas where there’s better reimbursement. I would love to see more expansion of loan forgiveness programs specifically targeted to providers working in rural areas.”
Those interested in learning more about maternal and rural health in Minnesota can register to attend the 2024 Minnesota State of Reform Health Policy Conference, which will be held on Sept. 5 at the Hyatt Regency Bloomington in Minneapolis. Lind will be speaking on the “Exploring Strategies to Improve Rural Healthcare Access” panel at 10:45 a.m.