Rural Maternity and Obstetrics Management Strategies: Avera Health 

The Georgia Health Policy Center recently spoke to Kimberlee McKay, M.D., an obstetrician-gynecologist and clinical director of the Avera Health obstetrics service line, and Juanita Ruiter, director of women’s clinics here at Avera Health, about how the Rural Maternity and Obstetrics Management Strategies (RMOMS) program is transforming care in rural South Dakota. 


To date, what has been the biggest accomplishment or win in your program?  

Kimberlee: I am most proud of the really deep and hard conversations we have had with our network partners, with the state of South Dakota Medicaid, and the Department of Health and Urban Indian Health. We all had to dig deep and figure out what we can do better. I am really proud that we all came to the table, have been really open, and want to make things better. 

Juanita: It was pretty seamless how we got all the network partners to the table and really listened and heard about their needs and how they align well with some of the challenges that we face within our health care system. It will be a good partnership trying to figure out how to come together to collect the information that we need and use this information to develop something sustainable that will help our patients have healthy outcomes. 


What is a tip or early learning that you would share with an organization launching a similar program?  

Kimberlee: This was our third application for this grant, and I think the strength of our application really had to do with our data plan. We dedicated a significant portion of our budget to meeting the data needs. The data piece of this is extremely important. Previously, we had not put as much thought into it, and I really think that that is what made a compelling argument to fund our ideas. 


How do you see participation in the Federal Office of Rural Health’s RMOMS program impacting your broader health improvement efforts? 

Juanita: RMOMS is building from that larger picture of what we are already doing in terms of connections to telemedicine, referral pathways, and being one Avera. We are making sure that we have a name brand promise so that patients, whether they are Mitchell or Sioux Falls, we are giving them the highest quality of care that we can. RMOMS provides additional resources and pathways to connect patients to the right services. As part of the RMOMS we are working on a virtual platform to help people in rural communities monitor their fetal heart tones, so that we know that all these moms and babies are safe with an extra eye on them. We had already done something similar with gestational diabetes, so RMOMS lets us build on some of those care models that we are already doing. 

Kimberlee: We have known that for a really long time that in South Dakota infant mortality rates in our rural areas are high. The South Dakota Maternal Mortality Review team released some findings where we really need to focus our efforts. That includes a push, in particular, around our American Indian population in South Dakota, which is our largest minority population. Our Indigenous citizens have the great disparities in terms of outcomes, and we have facilities in our region where one-third to half of their patients are Indigenous. We view this as an opportunity to build relationship and heal some wounds by surrounding the patient with everything that they need to have a healthy pregnancy and a healthy outcome. 


What will your organization be doing more of or differently to emerge stronger from the pandemic? 

Juanita: We learned from the pandemic that virtual health platform is an acceptable way to provide health care and it is safe. It made everybody a little bit more flexible in how we deliver health care, and to recognize we do not have to do everything the same way that we have always done it. A challenge that the pandemic brought that we are still dealing with are the expenses of equipment and staffing. 

Kimberlee: All of the things that we learned about remote patient monitoring and pregnancy occurred during COVID. We had patients who were using a software system that had some connected devices, like a pulse ox and blood pressure cuff and we used that model to talk to pregnant patients and get them set up for home health care. That was all part of an entirely protocolized program again that, we, as a health system used.  Patients really liked it and it helped ease their worries. I am curious to see the data on how it impacted things like readmission to the hospital, being able to control blood pressure, and to prevent delivery before 37 weeks.

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