Name: Brainstorm Health 2024: The State of Postpartum Care
Uploaded: 2024-05-22
Duration: 16 min 26 s
Description: Dr. Christina Harris, Vice President and Chief Health Equity Officer, Cedars-Sinai Medical Center Leslie Schrock, Author, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Investor; Advisor, Maven Clinic, Alife, Origin, Reverence Dr. Alice Zheng, Principal, RH Capital Moderator: Deena Shakir, Lux Capital

Dr. Christina Harris, Vice President and Chief Health Equity Officer, Cedars-Sinai Medical Center Leslie Schrock, Author, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Investor; Advisor, Maven Clinic, Alife, Origin, Reverence Dr. Alice Zheng, Principal, RH Capital  Moderator: Deena Shakir, Lux Capital

Brainstorm Health 2024: The State of Postpartum Care

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Dr. Christina Harris, Vice President and Chief Health Equity Officer, Cedars-Sinai Medical Center Leslie Schrock, Author, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Investor; Advisor, Maven Clinic, Alife, Origin, Reverence Dr. Alice Zheng, Principal, RH Capital  Moderator:Deena Shakir, Lux Capital

Dr. Christina Harris, Cedars-Sinai Medical Center, Leslie Schrock, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Maven Clinic, Alife, Origin, Reverence, Dr. Alice Zheng, RH Capital, Deena Shakir, Lux Capital

Dr. Christina Harris, Cedars-Sinai Medical Center, Leslie Schrock, Bumpin': The Modern Guide to Pregnancy; Fertility Rules; Maven Clinic, Alife, Origin, Reverence, Dr. Alice Zheng, RH Capital

Hello, everyone. So happy to be here again. You know, last year when we had a discussion on maternal health, it was a special moment for me because I announced my pregnancy on stage and here I am postpartum for the postpartum care panel. So thank you all for joining me today. It's such an important conversation and we have an incredible group of women here uh to address it. So I wanna start with my good friend Leslie, who is known for many things, including two best selling books, one on fertility called Fertility Rules, and one on Pregnancy called Bump In. But we're here today to talk about neither of those things we're here to talk about the thing that comes afterwards, which is postpartum. So talk to me about perhaps what might be your next book? What does Postpartum mean in the context of this conversation? Well, so I'm actually really fortunate I am updating Bump In currently. So it's coming out in its second edition in January and it was published five years ago and I'm really sorry to say that not that much has changed in five years. 80% of maternal mortality is avoidable. And that stat has stood for the five years that I have been writing about this topic. Thinking about this topic. It became very clear to me in revisiting this material that the big gap actually was for most people, what happens in the postpartum period? The unfortunate surprises we all encounter weird hair stuff, you know, sweating incontinence, all of that. But also, um I really, I know you've never talked about this publicly, but I actually revised my book um to reflect an experience that, that Dina had that she's never really spoken about. Um But do you wanna? Sure. Well, I guess the moderator is gonna spend a few minutes talking um, about an experience that happened to me. So I just had my third child. Um, and uh eight days postpartum um was back in the hospital with severe postpartum preeclampsia. Um and almost didn't make it. Um So as someone who, you know, lives and breathes health care, we're here today in the bastion of privilege with access to, you know, many Obgyns on speed dial when I was admitted to the hospital, I was told I was minutes away from having stroked out and having had absolutely no pre existing conditions that would have contributed to that. And if I wasn't someone who lived and breathed health care who recognized those signs, um I wouldn't have made it. Um And so for me, that was just another moment that makes us realize why, what we do is so important. And also, you know, just how many people who don't have those access and don't have those resources are at risk and how much of maternal mortality actually happens postpartum. Um So with that, I, I wanna turn it to you Christina to talk about a topic. Last year, we had a whole panel on the Black maternal health crisis. I don't think enough has improved. It's still a critical topic where black women in America are 3 to 4 times more likely to die in childbirth. And afterwards, uh tell us a bit about some of the work that, that you're doing in the health equity space to address these challenges, particularly in the context of postpartum. Thank you for sharing your story. I think about, you know, situations like this all the time as the only physician in my family and feeling these calls for my friends. And I think how lucky, you know, we are to have me and my family and to be able to answer these questions, but so many women don't. Um And for, you know, one statistic that I think is very important as we think about um the, the challenges that we're facing in the black equity space is the fact that 40% at least 40% of our births in this country are to win in with Medicaid. That's astonishing if you are a black woman, that's 65%. So in our, in my role at J Cedar Sinai. I think a lot about access to care. I think a lot about the innovative things that we'll hear about later and that we're producing to help close this gap. And I think is this gonna be available to the women that need it most? You know, when you really think about these inequities, unfortunately, we are in America, it follows socio economic lines. And if we're not thinking about how we meet the needs of those who don't have access and don't have the means and don't have the education, then we're really gonna miss the mark. Absolutely. Well, you alluded to some innovations in this space and uh we've got a fellow VC here on the panel, Alice who uh invests with a fund that focuses specifically on women's health. And I know, I think a third of those investments are in maternal health. So tell us a little bit, give us some bright spots, some, some things to look forward to. What are some of the innovations that you're seeing in the areas you're excited about investing in and particularly in the, in the postpartum space? Sure. Yeah, you know, we've made over 20 investments and indeed, one third of that is in maternal health and there's different solutions to different parts of the problem. So we have a couple of companies that are in devices um for delivery as well as prenatal monitoring in terms of postpartum care. Four of our companies are delivering some type of care um around that period. Um This includes virtual mental health care, like virtual therapy as well as um do support um attorney Navigators. And actually I'll call out one company in particular called Milly. And we're excited about this company because they have postpartum care that I've actually never seen anywhere else. Um So they actually have a midwife or a model and you get a visit in your home within a few days of discharge from the hospital, another visit two or three weeks later, and this is all before the six week visit, which is all you get in the US and most women, a lot of women actually miss that visit. Um And we know that this matters because over half of paternal deaths actually occur between seven days out up to a year. And another course are actually occur in that period if you add in delivery through the first seven days. So the post random period is really critical to the maternal health experience. And that's why the fund we look at that. Um quite closely. One last comment I'll make in terms of Medicaid is that's a huge part of our investment strategy as well. So all four care delivery companies actually accept Medicaid, one of them actually has an exclusive Medicaid strategy and there are some investors who might ask, how could you make that work, but you can make it work financially and you'd be missing half the market if you don't do that. So, um anyone who's following election knows that women's health has actually made it to the top of the agenda um for, for the US election in many ways and, and related to that, there have been efforts by the current administration to address not only the maternal mortality uh crisis that we have in this country, but also the gap in women's health research, Leslie. I know you've been involved in some of these efforts coming out of the White House. Could you share a little bit about the, the plans coming out of these discussions? Absolutely. I don't think that the core problems are unknown at this point. I don't think anyone uh can say with a straight face that we don't all know that paid leave is a necessary part of the solution and extending the hours, one can access care, which is so critical, especially in the populations. We're talking about, you know, if you can only do it 9 to 5 and you're a shift worker. How are you supposed to access prenatal care? Um So I was actually very fortunate to be part of the maternal mental health task force that HHS and Os and a lot of other various acronyms within government are putting together and we just put out a report to Congress um actually last week and many of the solutions are things that we know. Right. It's, it is paid leave it's better access to a more diverse set of, you know, providers. It's providers that look like the patients themselves. It's increased access to midwives, doulas, all of those. Um But I am actually really excited about the ARPA H as well, the real commitment to research in these areas because the sad truth of it is, you know, as, as we just heard from Dina, we don't even know what causes postpartum preeclampsia. We don't really know what causes prenatal preeclampsia, which by the way, I also had at 38 weeks, I had preeclampsia and help syndrome with my, with my second son. No one really understood why they're either. So I think that, you know, we know that as women go into pregnancy, they're unhealthier than ever. They have more chronic conditions, comorbidities, things that really cause these complications to, you know, be more likely, but we still don't actually know. So, um Arpa, I think it's like $65 million that's been earmarked for women's health research. Uh They tried to make the grant process easier for companies which as we know is a very big barrier for many of these start ups that have very limited resources. Um But to anyone who's building in this space, you know, as someone who's been working in it for a long time, I would really encourage you to take policy seriously. There is only so much that we in the private sector can do without working with government. And there is a real willingness among folks in government right now to work together with the private sector. And if you want to know who those people are, come find me afterwards. I'm happy to connect you. But I would encourage you to have someone on your team who actually is, you know, understands that world because that's the only way anything is really going to change. I just gonna say like, just thank you so much for sharing. It's really an incredible time to be in medicine and thinking about this space for so long. I mean, I'm a physician and in some ways medicine looks very similar than it did a very long time ago. Um But, you know, as I think about health equity, it's truly just patient centered care, like giving people what they need and everybody needs something a little different. Somebody might need a doula, maybe I don't need a doula and we're asking different questions and we're looking at our data differently to understand the differences that are inherent between us and make a difference in our outcomes. Um And then we're taking the opportunity to innovate on that. Um And so I agree, getting involved from a policy standpoint is amazing. Um And so so necessary and, you know, really thinking about how are we designing to solve these very intractable problems? And I'm thinking about health inequities that if it was a simple solution, we would have been done it, it takes everybody in this room to think about something differently and think about how we're designing for everybody um and allowing access um innovations through payer diversity, racial and ethnic diversity and how we're getting it out to the people. Jumping on the policy. I do feel like in this country, it's a tale of two cities. On one hand, you have the White House jumping all in. It's amazing. There's a Arpa Age grant, there's the executive order for women's health. Um Jill Biden is going around to lots of events, speaking about it. And that's incredible. We've never had an administration have this much interest in women's health. On the other hand, women's rights are being rolled back on a number of geographies and, you know, as investors, the way we think about it is no matter what side of the debate you're on. Um in terms of um women's others, reproductive rights, um It's gonna have a huge impact on maternal health. Uh We need to prevent more pregnancies, we need to treat pregnant women better because there will be more of them. Um No matter what going back to, you know, some of the data around maternal mortality, what would you identify as the primary driver in uh in a, in a country where we have so much technology, we have advancements. Certainly there are policy um regresses as well as progresses that have been made. Why is it that maternal mortality has only actually gotten worse. I think we have to think about how we as a country support our women or maybe how we don't support our women. How do we meet the mental health needs? Unfortunately, mental health and substance abuse is one of the largest drivers of mortality. I don't know if anyone has tried to find a therapist or psychiatrist lately. I have a commercial pp, it is not easy. Right. And so for those patients that I care for that have Medicaid, it's virtually impossible. Um And that's a problem because what we know what happens when mental health and substance abuse goes unchecked and then you throw in a newborn baby, I mean, it's literally a recipe for disaster. Um And so, I mean, that's, we have to do things differently. It's I've spoken to thousands of women in the last five years, thousands of pregnant women, postpartum women, women, I, I'm, you know, going through fertility journeys and what's very clear is we not only don't know the basics of our own bodies. We also don't know how to know if something is wrong. You know, you knew that you felt off, you knew you had a headache that wasn't going away and you had the wherewithal to reach out to people and to say, I don't know if this is right for so many women who end up, you know, dying pum because of preeclampsia or something else, they don't even know what to look for, they pass it off as, oh, I'm just tired because the baby's not sleeping and whatever I'm supposed to feel weird because, you know, I'm postpartum and that is simply unacceptable. I had to, one of the decisions I had to make as a writer, everybody wants a pregnancy book. What to expect when you're expecting his soul has been in like the top 100 on Amazon for a million years. And there's a good reason why every pregnant woman wants a book. So when I revisited this content, I had a decision to make. How scary do I wanna be in this book? And I have received notes from readers over the years who have told me actually, like you saying this thing about miscarriage has really like changed my life, you writing about your experience openly. And I have to say like Dina, when you went through what you did, I made a decision. I actually like lovingly referred. It's the Dina page. I had to make a decision and say, well, you know what, even if it's a little bit scary, if I can save a life by putting a page of postpartum warning signs into this book that has been sitting on someone's bedside table for nine months that they trust and they like that is something I'm willing to do even if it does feel a little scary. But women just simply aren't told they're discharged with like a piece of paper and that's all they ever get and then they pass it off because either they feel gas lit, they feel like, oh, it's just not sleeping. They think it's just completely fine and it's not fine. Like if you find your off in this situation, you should always call for help. But again, like I think the asynchronous support telemedicine more flexible formats. It's why innovation is so important. Like Millie, what Millie is doing, I think is so powerful that for this reason, and there's actually a gap between when morbidity, mortality is occurring and when care is delivered. So, you know, once you have the baby, you're home, there's really very little clinical care, whether asynchronous or live. And that's, that's a huge gap in a driver. I wanna we have a few minutes left and I want us to share some of hope here, things that, that we are excited about. Uh we touched on Medicaid. And I think one of the exciting things about Medicaid uh in innovation in general is that when you're looking at a value based care space and you're designing for outcomes, the data drives the innovation. And we've seen much more reimbursement of, of things like doulas, for example, in Medicaid, that was actually are harder to get reimbursements for in a fee for service model. Um would love for each of you to share maybe one or two things that give you hope that you're excited about when it comes to women's health and postpartum care. Um One thing I'm excited about is that in 47 states and more to come, um, there's expanded Medicaid coverage after delivery for 12 months. And that's, that's, I think it's, it's amazing. Absolutely. I will say in the last five years, one thing that has been a positive change is when I used to ask people if they were getting a doula, they would say, what is that? Nobody knew what a doula was. Um And actually there was a lot of misinformation even about midwifery, which I find is really changing. I think like a lot of people understand whether it's because people in Hollywood talk about their doulas or we're just having more conversation. But I think the role of doulas and the tremendously improved outcomes that happen when you have a doula or a midwife as part of your coordinating care team is now something people no longer debate. It is just an accepted fact. And I will say thinking about the mental health task force that just came out in the recommendations. The idea that someone is writing down that six months of paid, you know, maternal care or leave is incredible. The statistic is insane. 25% of working women go back to work within 10 days of having a baby. And then you want me to follow up with my primary care and the postpartum like that's impossible. Um And so, you know, the idea that we will be able to protect our birthing people to be able to spend time on themselves and on their babies. Hopefully, um is incredible and California has made some strides in that standpoint. I know we have a long way to go, but it's so necessary and I will say the fact that we're having this conversation on this stage right now gives me a lot of hope. So, thank you to all three of you and to all of you for your time and attention and I appreciate it. Thank you.