0:00

Welcome to First Fridays with Fembridge,

0:02

where we explore crucial topics impacting

0:05

maternal and postpartum health in the United

0:07

States. I'm Maggie Huther,

0:09

your co host, joined by Tracy

0:12

Quillen, my fellow co host. Tracy

0:14

and I are co founders with Fembridge, and

0:17

together we share a passion and

0:19

mission to better support women throughout

0:21

their pregnancy and postpartum journeys. Today,

0:24

our focus is on the significant impact

0:27

of social determinants of health and

0:29

the direct influence. insecurities

0:32

on maternal health. Good

0:34

morning. And we're excited to kick off our

0:36

podcast with you today. We have

0:39

Dr. Shannon Swofford and Max

0:41

to start our discussions. We'd love to just learn

0:43

a little bit about your backgrounds in

0:46

regards to social determinants of health and

0:48

how you play in this world every day.

0:50

So Dr. Swofford, we will start with you. Great.

0:53

Thank you. Thank you for having us on. We feel

0:55

honored to be your guests for

0:57

your inaugural show. I'm Dr. Shannon

1:00

Swafford. My doctorate is

1:02

in healthcare administration with

1:04

a focus on information systems. I'm

1:06

also a long tenured

1:08

credentialed American health information

1:11

management association or a HEMA

1:14

credentialed professional, a certified

1:16

health data analyst, a certified coder

1:18

and a registered health information technician.

1:21

I've been fortunate and

1:23

maybe a little crazy working in

1:25

the healthcare industry. I've worked with health

1:28

plans, physicians, hospitals,

1:31

IT, a quality initiative organization,

1:34

and all of my work has

1:36

been centered around structured

1:38

healthcare data and unstructured healthcare

1:40

data. In our field, I

1:43

have a passion for rural

1:45

health and for social determinants and

1:47

how they impact humans

1:49

in our world. Absolutely.

1:53

Thank you. I appreciate that. Max.

1:56

Thank you, Tracy. My name is excellent,

1:58

and I'm a co founder of V. S. R.

2:01

And I have a. background in a variety

2:03

of industries, but the last two years

2:06

spent a lot of time in the healthcare space,

2:08

working on solutions. My primary

2:11

focus is enterprise

2:13

solutions that, that, that deliver

2:16

a little easier use for

2:18

people and focus on providing

2:21

a lot of benefit for everybody in the process.

2:23

We appreciate being part of your podcast. Awesome.

2:26

Thanks, dr. Swafford, can you shed

2:28

some light on the important considerations

2:30

when it comes to building community based networks

2:33

at the intersection of maternal and social

2:35

care? Yes, we have.

2:37

We have so much work to do. Community

2:39

based organizations have long

2:42

been a pillar for support in our

2:44

communities. They've just been initiating

2:47

their support in, within their community

2:49

and it hasn't necessarily been originating

2:52

in healthcare. But with increasing

2:54

healthcare needs, And

2:57

value based care thinking, we're

2:59

asking these community based organizations

3:02

now to initiate services

3:05

for people where we

3:07

identify those needs in a health care

3:09

space. And in terms

3:11

of having. If

3:13

I'm in a community with a community based organization

3:16

and I can walk into that community based

3:18

organization and they can help me.

3:21

But if I'm a mama going

3:23

to a hospital or potentially

3:25

not, unfortunately going to

3:27

a hospital or to an OB for

3:29

prenatal care, whether that be for

3:32

access or for, prenatal

3:35

visits. If I can

3:37

actually go into my healthcare provider

3:40

and my healthcare provider can ask

3:42

me these questions about what

3:44

is my, what's my social context, right?

3:47

How can I support you at home?

3:49

And if there are needs that

3:51

are social resource driven

3:53

or community based organization driven,

3:56

it would be to be able to efficiently

3:59

connect that mama To

4:01

the needs in her community that are available

4:04

for resources in her community. Being

4:06

able to. As a healthcare

4:08

industry, being able to share that data

4:11

with community based organizations

4:13

and in a language they

4:15

can understand. In healthcare, we have

4:17

data that is structured

4:20

or unstructured data, but every industry

4:22

has their own acronyms and their own

4:24

language. Most community

4:27

based organizations have no idea what

4:29

an ICD 10 code is, but that is how

4:31

we drive the, that's how

4:33

that's data that tells a story on a person

4:36

about a condition or a status. And so

4:38

we need to be able to transact that

4:40

data out to a community based organization

4:43

in a manner that they understand. So

4:46

translate that from our

4:48

healthcare language into language that community

4:50

based organization understands. And

4:53

then you also need to consider HIPAA.

4:55

And what does it mean if

4:58

we send PHI out

5:00

into the world of a community based organization?

5:03

Are we treating that as

5:06

PHI? Does the community based organization

5:09

know how to treat that as what we call PHI

5:11

or protected health information? Or

5:13

does this really fall under, is it no longer

5:15

healthcare data? And it falls

5:18

under the data privacy policies

5:20

that the community based organizations have.

5:23

These are really critical questions,

5:25

and we do, they demand such

5:27

critical, careful consideration

5:30

for how do we effectively

5:32

manage this. One of the questions for our healthcare

5:35

folks that may be listening to this, A

5:38

CBO is not a covered entity under

5:41

what the definitions of HIPAA. They could

5:43

sign a BAA, a business associate

5:45

agreement. They could sign a BAA, but

5:47

do they truly understand what that means?

5:49

And these questions, I'm asking these questions

5:52

just to spark conversation because The,

5:54

from a federal government standpoint, these

5:57

questions haven't been answered yet. Is that

5:59

information still PHI when it

6:01

goes out into the community? So for data,

6:03

there are tons of consideration, but it

6:05

has to be transactional.

6:08

It has to be actionable. It

6:10

has to have integrity and be solid,

6:13

appropriate data. And it has to be

6:15

secure. Awesome.

6:19

Thank you, Shannon. Max, I know that you bring

6:21

a wealth of expertise in data security,

6:24

just based on what Dr. Swafford shared.

6:26

Can you touch on the importance of data privacy

6:29

and security, especially

6:31

when sharing sensitive health care information

6:34

with community based organizations? Absolutely,

6:38

Maggie. The, yeah, it's an interesting

6:40

challenge because the challenge,

6:43

I think Shannon articulated it between

6:46

healthcare and like community based organization

6:48

and what obligations are in there, but

6:51

from a technical standpoint, encrypting

6:54

that data to protect it, that's

6:56

not difficult necessarily. Really what's difficult

6:59

is when you have to encrypt that data and then work

7:01

with it and make it usable for

7:03

people so they can search it

7:05

and even display it, that gets

7:08

to be pretty challenging. But

7:10

we've got to create methods to give

7:13

people access to data that

7:15

they need to help somebody.

7:17

But at the same time, make sure that we aren't

7:20

anybody's data at risk.

7:23

And then at some point you hand

7:25

that off to, to whoever you're like,

7:27

your community based organization, they have an obligation.

7:30

Once you. Give them that data.

7:32

They've got to protect it as well. So at

7:34

some point we transition that over,

7:36

but not a simple isn't as simple

7:39

of a process as you'd hope it would be yeah,

7:41

absolutely. And we all know what an important

7:43

topic health care data security is

7:46

at this point around our world. So it's

7:48

definitely an ongoing conversation for

7:50

sure. So Dr. Swofford,

7:52

why don't we talk a little bit about resource

7:54

coordination into these integrated

7:57

networks? Can you share with us a little bit

7:59

about what it means for mamas

8:01

and babies and how it really

8:03

is important to help coordinate access

8:06

to these resources to really drive

8:08

better patient experience as well as

8:10

patient outcomes? Yeah,

8:13

it's a think about it like

8:16

if you work for a health plan or

8:18

if you're an employed person

8:20

and you have your health

8:23

insurance through your employer and because

8:26

of those contracts, You

8:28

are connected to a provider network.

8:30

Now I'm talking medical providers at this point,

8:32

right? If you think about connecting

8:35

moms to these essential resources,

8:37

think about a mama who goes

8:39

in her first trimester when she

8:41

first realizes that she may be pregnant or

8:43

is pregnant and she goes

8:45

to her OBGYN. But

8:48

because of some risks or

8:50

some additional conditions

8:52

or comorbid statuses that she may have

8:55

they may need to call in a specialist.

8:57

So think about this in that same

8:59

manner. These community based organization

9:02

networks have to be built in a manner

9:05

that They can refer into

9:07

the health care system can refer into

9:10

and not only refer into,

9:12

but be able to ensure that

9:14

their patient once referred into

9:16

that network is getting

9:18

the appropriate resources that they

9:21

need or services that they need.

9:23

to improve the health and being of

9:25

both the mama and the baby. These

9:27

are huge, important impacts,

9:30

whether they receive these services or not.

9:32

Receiving the services can greatly

9:34

improve outcomes. Not receiving

9:37

those services have a detrimental

9:39

impact. And Tracy and Maggie, I know you all

9:41

know so much about maternal

9:43

mortality and postpartum, the

9:45

impact of those things. But consider

9:48

if you have a mom With

9:51

a nutritional need

9:53

and insecurity. If

9:56

you refer them into a

9:58

community based organization where you know,

10:00

not only are they going to be provided

10:02

food, but they're going to be provided

10:04

the right kind of food or they're

10:06

going to get food plus some supplements,

10:09

right? That help. That's huge.

10:11

That can have a huge impact. Or

10:13

what about housing aid? What if a mom,

10:16

a pregnant mama, a pregnant lady is

10:18

homeless or maybe she's

10:20

living on someone's couch and

10:22

when the baby's coming, there's,

10:25

she's still living on someone's couch. You,

10:27

if helping them find transitional

10:29

short term or permanent housing can have

10:31

a huge impact on outcomes

10:34

for mama and baby, not just

10:36

their medical outcomes, but also

10:38

just their bonding time. They need

10:40

a place. where they can bond. And

10:42

if you are addressing these things,

10:45

you can vastly improve maternal

10:47

outcomes, contribute to

10:49

healthier pregnancies and postpartum

10:51

experiences for mom and baby.

10:53

Absolutely. Couldn't agree more.

10:56

And so unique by the community

10:58

that you live in and the community organizations

11:01

that are available. Tracy and I

11:03

just formed a partnership with the

11:05

National WIC Association, and

11:07

as part of our integration for drivers

11:09

of health, we want to connect mothers

11:12

to that program as well. I agree

11:14

with you in identifying insecurities

11:16

and providing those services. Question

11:19

I have regarding operational standpoint.

11:23

What do you expect in terms

11:25

of audits, value based care

11:27

initiatives, infrastructure

11:29

changes, as we integrate

11:31

community based organizations more

11:34

into the maternal health care network?

11:36

Yeah. First, let me say congratulations

11:39

on that partnership with WIC. That's

11:41

amazing. Kudos to you all. That

11:43

will have a huge impact. for your time. And I know

11:45

that's a huge positive profound impact on a lot

11:47

of mamas and babies. So good job. As we,

11:50

yeah, you're so welcome. As

11:52

we think about those networks

11:54

and audits and value based

11:56

care, I think I want to start with the end.

11:59

If the goal is to get, you should always start

12:01

with the end in mind, at least that's how I work

12:03

through things, right? I think here's my problem.

12:06

The goal, the Holy grail is over here.

12:08

Let me start over there and then work backwards. If

12:10

we think about value based care We're

12:13

never ever, as an industry,

12:15

I don't think going to be able to achieve

12:17

true full value based care if

12:20

we can't track where all

12:22

that data is and what

12:24

the impacts have been of the programs

12:26

that we've implemented. Where

12:28

that data is flowing, that data is in my

12:31

opinion, but this is probably because I'm a data

12:33

nerd. In my opinion, data

12:35

is, besides human resources, data

12:37

is the most valuable asset we have in

12:39

health care. And so if you think

12:41

about value based care, let's

12:43

back up and think about how

12:46

do we build an infrastructure? Where

12:48

we're tracing all of that information

12:51

that follows a person because AHIMA,

12:54

my, my alma mater of national

12:56

organizations, human, Health

12:59

information is human information, I

13:01

think is one of their slogans, and it's

13:03

very true. The data tells a story.

13:05

So if you think about the

13:07

dollars and the

13:10

provider networks that you have built, again,

13:12

I'm going to go back to that network. If you

13:14

think about how provider networks are built

13:16

within a health plan, Every

13:19

one of those providers are subject to

13:21

audit because federal dollars

13:23

have to be tracked. The dollars, they

13:25

have a desire to track those. If

13:27

we do the same thing for community based

13:29

organization where we're bringing them in

13:32

as providers, because they do become providers

13:34

of care, it's just social care

13:36

rather than medical care. So

13:38

if you're bringing those in, we

13:41

can anticipate audits. Audits

13:43

always follow the dollars. And

13:45

we can anticipate audit. So building

13:47

that infrastructure where you

13:49

have the ability to send the data

13:51

out. And know

13:53

what's happening to that data when it's there.

13:56

Understanding how a person is being

13:58

treated based on the information

14:00

you sent. In other words, how

14:02

is a person being served? And

14:05

then bringing that information back

14:07

about how needs were met. How

14:09

those needs were fulfilled by a community based

14:11

organization. Then translating

14:13

that again back into healthcare language.

14:16

Putting it in a usable format

14:18

that's structured so that you can tell

14:21

a whole story. That's what is really considered

14:23

a closed loop referral solution.

14:26

That means you've sent it out. Someone

14:28

has responded to it and someone has.

14:31

reported back how they responded.

14:34

Then you take this information

14:36

and you overlay that

14:38

with your medical claims, whether

14:40

you're a provider or a payer, it doesn't

14:43

matter. You lay that information over your claims

14:45

and you determine, okay, for this

14:47

population of mamas, when

14:49

they had a housing insecurity and

14:52

we delivered X support,

14:55

Now we see that their mortality

14:57

rates are better, that they are being adherent

15:00

to their medication, right? Whether

15:02

it's prenatal vitamins or additional iron

15:04

supplements. You're able to track

15:07

that. That is where you learn

15:09

how to employ future

15:12

Programs that actually achieve value

15:14

based tailored care. The

15:16

sad thing currently is we don't know

15:18

what we don't know. So for this

15:20

population of mamas, we just have to

15:22

start somewhere, right? If we, and

15:25

this is the starting place. Get the data,

15:27

share the data, respond to the need.

15:30

Send that information back and

15:32

then start looking at that in association

15:35

with the medical claims and start to help this

15:37

population who I think

15:39

have actually had a decline. Is it

15:41

true that maternal mortality

15:43

is worse now than it

15:46

has been in years? Is that true? Absolutely.

15:49

It is. It is definitely a crisis in

15:52

this country. Obviously one of the reasons

15:54

that Maggie and I created Fembridge is because

15:56

this is such a passion for us and

15:58

being able to address social drivers of

16:00

health for this patient population is

16:03

a critical piece of making sustainable

16:05

change in the horrific statistics

16:07

that we all see in here almost on

16:09

a daily basis. One of the things

16:11

that we talk about all the time is what

16:13

you were just speaking about is collecting

16:15

the data is wonderful. It's data is knowledge

16:17

is power, but we have to figure out a way

16:20

as a health care society to make it actionable.

16:23

Because if we're not doing anything to help

16:25

address the issues once we have the data,

16:28

then it's just data and nothing more. So

16:30

I love The things that you just shared on that topic,

16:32

they're critically important and things that we

16:34

continue to need to evolve for

16:37

this specific patient population. Thank you,

16:39

Dr. Swafford. Max,

16:41

what advancements do you foresee

16:43

in technology to support these

16:45

types of integrated networks in

16:47

the future that, as we've just discussed, is

16:49

so critical for this patient population? Yeah,

16:54

that's a great question, Tracy. The

16:56

the use of AI assisted tools is something

16:58

we've worked a lot on in the past. I

17:00

think that plays a vital role

17:03

in improving what we can do when

17:05

you really think about what we're all doing

17:07

here is we're figuring out a way to have

17:09

people help other people that

17:11

really need help. And we're using

17:13

technology to do

17:15

that in a better way and quicker.

17:18

We're not using AI in a in

17:20

a way that other people are where they're using

17:23

it to make decisions. We're actually using

17:25

AI assisted tools to help us

17:27

do things like get our network

17:29

built out. Help identify things

17:31

that could be red flags or areas of

17:34

that. Somebody needs to take a look at. So

17:36

we're doing it for efficiency reasons.

17:39

So that from a development standpoint,

17:41

and also an operational cost

17:43

standpoint, we can be more efficient.

17:46

I know other people are focused on other weird

17:48

ways of using AI, but we're really not,

17:50

we're not doing it. We're not using it for that.

17:53

So it's fascinating. But I think that's critical

17:55

because at the end of the day, it helps

17:57

us really be able to

17:59

help people that need to help.

18:01

Like you said, it's not just about collecting

18:04

data and having that data. We're actually

18:06

making sure that the people that

18:08

have a need. Get real time

18:10

help as best you can. There's

18:13

limits there, obviously, but that's really what we're doing.

18:15

That's great. Yeah, absolutely That's

18:17

a great point AI is obviously something that

18:19

is a continual discussion in health care

18:21

and the best uses of it reasons We

18:23

should stay away from it, but there's definite

18:26

benefits of it for sure We

18:28

appreciate you guys taking time and discussing

18:30

this topic with us Obviously

18:32

social drivers of health is again a huge

18:35

topic We know that it is a critical piece

18:37

of being able to make sustainable, meaningful

18:40

change with the maternal mortality and

18:42

morbidity rate in this country. So

18:45

we appreciate the time and your expertise

18:47

in this area and we look forward

18:49

to continuing this conversation. Thank

18:51

you all. for having us on. We appreciate

18:54

it. Absolutely.

18:56

Yes. Thank you very much. It's been an

18:58

enjoyable session. We appreciate

19:00

your time and your expertise. Tracy

19:03

and I look forward to next month, Fridays

19:05

with Bembridge. We look forward to exploring

19:08

more critical topics as they relate

19:10

to maternal and postpartum health. Until

19:13

then, take care, stay healthy.