Tears in my eyes

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Post by Lewis G. Sandy, MD, FACP

I had tears in my eyes, and I was not alone.

The whole room was silent as Charles Johnson told the story of his wife Kira. Kira was healthy, fit, full of life, and gave birth to her second son, Langston, via C-section. Twelve hours later, she was dead. 

Minute after minute, hour after hour, frantic calls for assistance went ignored, and Kira slowly bled to death from an undetected hemorrhage, from care delays, and perhaps because she and her husband were not the same color as other moms in the unit. In the 12 hours between when Kira brought life into the world and lost her own, her husband pleaded with medical staff to tend to his wife’s worsening condition, only to be told that she “was not a priority right now.” She died in one of the nation’s leading hospitals, surrounded by technology and people that could have saved her.

Charles told us (the leadership of UnitedHealthcare) that Black mothers die at 3-4x the rate of white mothers. He told us about the rising maternal mortality rates in the U.S., and he challenged us to fix it.  He said, “If you can fix it for moms like Kira, you can fix if for the nation.” 

We took Charles’ challenge as a call to action. We got to work.

Focusing on three states, UnitedHealthcare identified gaps in care among our Medicaid enrollees for postpartum care, and designed culturally and regionally tailored interventions to reduce disparities. We focused on promoting early and comprehensive postpartum care. We supported community health workers to evaluate and assist members with their unique needs in Michigan, Ohio, and Hawaii. These activities included home visits, local primary care and obstetric nurse partnerships, and care coordination. As a result, between 2018 and 2019, UnitedHealthcare reduced disparities in timely postpartum care for Black women by 42.4% in Michigan (from 15.1% to 8.7%), 83.2% in Ohio (from 19.6% to 3.3%), and 40.3% for rural women in Hawaii (from 12.9% to 7.7%).

While I am proud of this work (led by Mike Currie, our head of Health Equity Services, and Janice Huckaby, our CMO of Maternal-Child Health), and it received a 2020 CMS Health Equity Award, I am still troubled. 

How do we just make things work without the need for a “special program?” What do we need to today so there are no other Kira’s? 

Can I look Charles in the eye and say, “We’ve fixed it?”

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The Johnsons’ story is in the public record, re-told here with Mr. Johnson’s permission. The views expressed in this post are my personal opinions and are not those of UnitedHealth Group or its affiliates.

Lewis G. Sandy, MD, FACP, is Executive Vice President, Clinical Advancement, at UnitedHealth Group where he focuses on clinical innovation, payment/delivery reform practice and policy, and physician/health professional collaboration.