South Chicago is a maternity health desert with a significant proportion of patients with poor access to prenatal care. Through community engagement, we found several gaps in continuum of care during pregnancy and postpartum. The University of Chicago (UChicago Medicine) is the only Level III perinatal hospital in this region, but the role of a tertiary-level academic institution in improving community level obstetrical care is undefined and unclear.
In 2023, UChicago Medicine appointed the inaugural chief obstetrical transformation officer, Sarosh Rana, MD, who also leads the section of Maternal Fetal Medicine. The chief obstetrical transformation officer's mission is to support pregnant people on the southside in achieving access to the highest level of prenatal care, delivery care and postpartum care possible. Under this umbrella, the purpose of the role is to lead, facilitate and contribute to collaborative efforts within an ecosystem of labor and delivery healthcare providers in service of establishing more efficient and supportive care delivery systems for the full continuum of pregnancy care. The southside obstetrical transformation has four domains:
- High-risk specialty pregnancy care: community-based access to Maternal Fetal Medicine specialists.
- Ultrasound access: community-based access to ultrasound services.
- Labor and delivery partnerships/transitions: strong partnerships with labor and delivery sites to facilitate transitions of care from and back to the prenatal setting.
- Evidence-based supportive programs: standardized treatment of conditions like preeclampsia and diabetes, with community health worker models.
Following is an example of establishing a relationship with Friend Health Center, a federally qualified health center located close to the UChicago Medicine and our work under the four domains described above. The collaboration aimed at creating a comprehensive, patient-centered and efficient system for maternal health, with support from the South Side Healthy Community Organization, a Medicaid Healthcare Transformation Collaborative project, UChicago Medicine, and the department of obstetrics and gynecology at the University of Chicago.
Components of the model can be used by health systems attempting to address maternal healthcare gaps, as they offer adaptable strategies tailored to overcome specific systemic challenges. Below are four challenges we faced in addressing gaps in care and how the four domains helped us arrive at solutions.
Challenge: Lack of continuity of care antepartum to delivery and postpartum
Solution: Collaborative hiring between an FQHC and a hospital
In a collaborative OB/GYN hiring model, FQHCs and hospitals ensure physicians meet site-specific needs and share patient outcome goals. Physicians employed by Friend Health work collaboratively at UChicago Medicine covering essential labor and delivery services. The hospital sets a coverage model agreement, outlining inpatient service schedules and compensation to Friend Health as the primary employer. Physicians are credentialed at both sites, ensuring broad patient coverage. This enables the providers to maintain a high level of competency and participate in ongoing clinical improvements conferences and maternal morbidity and mortality reviews as part of being a UChicago Medicine provider.
Challenge: High risk specialty care access barriers
Solution: Community-based Maternal Fetal Medicine
The community-based high-risk pregnancy care program we launched increased access to specialized services by bringing UChicago Medicine Maternal Fetal Medicine specialists into the FQHC, reducing insurance barriers. The hospital hires these specialists, and both sites participate in training. Maternal Fetal Medicine specialists are credentialed at both sites, ensuring broad patient coverage and insurance access. The obstetrical transformation workgroup developed high-risk escalation clinical protocols, trained staff and provided education at the FQHC. The specialists bill services under the FQHC, with the hospital compensated for the physician's time.
Challenge: Fragmented prenatal care
Solution: Community-based ultrasound
In our region, the FQHCs that provide prenatal care do not have ultrasound machines on site. That requires patients to be referred to a number of different clinics, which can vary depending on patients’ insurance. Ultrasound access is crucial for ongoing high-risk pregnancy care and general prenatal care. UChicago Medicine will employ, train and oversee sonographers at the FQHC, allowing flexibility to provide and bill for services at both sites. Immediate consultation is available by either on-site Maternal Fetal Medicine or remote read, leading to a significant reduction in time to manage high risk fetal issues. UChicago Medicine purchased ultrasound equipment for Friend Health, which will subsequently lease the equipment. While the South Side Healthy Community Organization is subsidizing the equipment lease, sites can leverage philanthropic support and grants for equipment. All billing is done under the FQHC, currently as an OB/GYN clinic visit until specific billing codes can be made available.
Challenge: Patients lost to care
Solution: Community health workers
As part of this model, we launched community health worker programs at both UChicago Medicine and the FQHC, each with distinct priorities but unified in enhancing patient care. The hospital focuses on inpatient support and connections to prenatal care, while the clinic emphasizes outpatient care and addressing social determinants of health. Both prioritize patient health throughout pregnancy, ensuring timely treatment, shared accountability and maintaining open communication to ensure continuity of care.
Hospitals Play a Major Role in Obstetrical Transformation
Hospitals have an opportunity to drive transformative change in maternal health by layering diverse solutions within community-centered systems of care. By knitting together fragmented services and fostering collaborative ecosystems, we can ensure that patients receive comprehensive, compassionate and continuous care. This will lead to sustained improvement in maternal health and reduction in excess maternal morbidly and mortality.
Sarosh Rana, MD, is professor of obstetrics and gynecology, section chief of maternal fetal medicine/chief obstetrical transformation officer, UChicago Medicine.
Laura Markin is executive director, Transformation and Strategy, Urban Health Initiative, UChicago Medicine.
Acknowledgements: The chief obstetrical transformation officer position was created by sponsorship from Ernst Lengyel, MD, PhD, chairman, Department of Obstetrics and Gynecology, UChicago Medicine; Brenda Battle, RN, senior vice president, Community Health Transformation/chief equity officer, UChicago Medicine; and Tom Jackiewicz, president, University of Chicago Health System and University of Chicago Medical Center.
UChicago Medicine is a member of The Equity Collaborative, an initiative of The Carol Emmott Foundation. The Equity Collaborative is an active, self-driven learning community of large, leading healthcare organizations committed to fully inclusive gender equity within their own organizations and across the health industry.