Ep 34: Pomelo Care CEO Marta Bralic Kerns on Improving Maternity Care & How to Sell to Payers
Nov 14, 2023
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Marta Bralic Kerns, Founder and CEO of Pomelo Care, discusses payer contracting, career advice for startups, and the pressing issue of maternity care in the US. They also talk about the challenges faced by OB practices, different types of practitioners in maternity care, and the importance of building an EHR as part of a business strategy.
Access to care in maternal and newborn health is significantly worse in the US due to lack of OBGYN capacity and closure of OB practices and rural hospitals.
High rates of comorbid conditions in the US directly impact pregnancy outcomes, indicating insufficient primary care and health insurance coverage for vulnerable populations.
Pomelo Care provides virtual team-based care for pregnant individuals, addressing access to care and high-risk comorbid conditions, and working in coordination with OB practices for comprehensive care throughout the entire journey.
Deep dives
Access to care is a major issue in maternal and newborn health outcomes
Access to care before pregnancy, during pregnancy, and in the postpartum period is significantly worse in the US compared to other developed countries. Over a third of US counties lack sufficient OBGYN capacity, leading to long travel distances for care. The closure of OB practices and rural hospitals exacerbates this issue. The lack of access to care contributes to the rising rates of maternal morbidity and mortality, particularly in the postpartum period where more than half of the pregnancy-related deaths occur.
High rates of comorbid conditions affect pregnancy outcomes
The US has higher rates of comorbid conditions such as diabetes, high blood pressure, obesity, and behavioral health issues compared to other countries. These conditions directly impact pregnancy outcomes, increasing the risk of preterm birth and NICU stays. The rates of these conditions are growing, indicating the insufficient primary care and health insurance coverage for vulnerable populations. The complex health profile of pregnant individuals in the US contributes to poorer outcomes compared to other developed countries.
Pamela Care's approach to improving maternal and newborn health outcomes
Pamela Care is a virtual medical practice focused on addressing the access to care and high-risk comorbid conditions in maternal and newborn health. They employ their own providers and offer team-based care, providing personalized care plans for patients during pregnancy and one year postpartum. Utilizing data, they identify individuals at risk for conditions like preeclampsia and engage them in evidence-based care plans. Pamela Care works in coordination with OB practices, ensuring a smooth handoff and comprehensive care for patients throughout the entire care journey.
Accountability gaps in OB-GYN and neonatal care
There is a lack of accountability and resources in the field of OB-GYN and neonatal care, leading to gaps in patient care. OB-GYNs often don't take responsibility for neonatal intensive care unit (NICU) costs as they focus on prenatal care. Neonatologists, on the other hand, can't take risks for babies in the NICU due to predetermined decisions made during pregnancy. This accountability gap is further compounded by the shortage of resources and data. Additionally, the lack of data and metrics in OB practices makes it difficult to track and improve patient outcomes.
The challenges and advantages of focusing on Medicaid
Focusing on Medicaid as a business model poses different challenges and advantages compared to employer and commercial populations. Medicaid plans operate under higher standards in terms of quality and outcomes. Engaging Medicaid populations is also more challenging compared to engaging employees. However, targeting Medicaid presents an opportunity to address high-risk births, access gaps, comorbidities, racial disparities, and maternal morbidity and mortality. State-by-state variations and regulatory hurdles exist, but early entry into Medicaid allows for flexibility and a natural fit in regions with high Medicaid enrollment and healthcare disparities.
Jacob and Nikhil sit down with Marta Bralic Kerns, Founder and CEO of Pomelo Care, a multispecialty virtual medical practice that cares for mothers and babies from preconception to one year postpartum. They discuss payer contracting and Medicaid, career advice for those joining startups, why maternity care is such a pressing issue in the US, and more.
(0:00) intro
(0:47) maternity outcomes in the U.S.
(5:39) clinician supply issue
(6:56) how Pomelo Care works
(12:20) how patients find Pomelo
(15:21) how Pomelo fits into the healthcare journey after pregnancy
(17:06) pitching Pomelo to payers
(24:16) Pomelo’s Medicaid focus
(26:59) state-by-state differences in maternity care
(30:30) constraints to growing Pomelo
(31:34) team-based maternity care
(34:19) how to sell to payers
(40:43) advice for people early in their health-tech careers
(45:32) Flatiron and EHRs
(51:17) over-hyped/under-hyped
(53:06) NOT hiring Nikhil
Out-Of-Pocket: https://www.outofpocket.health/
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