Rural RPM Program Is a Lifeline for Pregnant Women

Sanford Health’s remote patient monitoring program in northern Minnesota is giving pregnant women access to critical care services and resources

In rural and remote parts of the country access to care is limited. That’s a double whammy for pregnant women seeking care not only for themselves but for their children.

To Johnna Nynas, MD, OB-GYN, the rural landscape and challenging economy of northern Minnesota offers plenty of challenges for pregnant women in that region. The Sanford Health Bemidji doctor is not only dealing with climate, transportation, and lack of childcare, but also the closure of four labor & delivery clinics over the past five years.

“What we were seeing is fewer patients getting the minimum recommended number of visits or starting their prenatal care very late,” she says. “And there’s not a lot of other hospitals, (so) when patients choose not to come to Sanford for their women’s healthcare, they’re not going to another hospital system. They’re just not getting care, and that’s unacceptable.”

To address those challenges, Nynas helped to launch a remote patient monitoring program that allows Sanford Health care teams to monitor the health of those patients and gives those women access to local and state resources through a network of programs. The project is funded by a 2021 $3.67 million U.S. Department of Health and Human Services Rural Maternity and Obstetric Management Strategies (RMOMS) grant.

It also caught the eye of CNN, which recently named Nynas one of its Champions for Change.

Johnna Nynas, MD, OB-GYN, Sanford Health Bemidji. Photo courtesy Sanford Health.

Health systems and hospitals are embracing RPM and telehealth as a crucial strategy to connect with underserved populations. Residents of rural and remote areas, especially those in minority populations, often face a high risk of adverse health outcomes and elevated chronic care concerns. Through smartphones and connected devices, care teams can reach them on demand in their homes or communities, managing care and providing support.

“They can get their care from wherever they are,” says Nynas, whose coverage area includes three Native American reservations in a county whose population is 23% Native American.

A Multi-Layered Outreach

The program launched by Nynas through Sanford Health is multi-tiered, beginning with a communications platform that enables the health system to connect with patients at home and arrange rides to care appointments when necessary. It has also launched a connected care network with local and community physicians and clinics, equipping them with virtual care technology to facilitate telehealth visits when the women can’t make it to their in-person appointments or need an urgent virtual care visit. Those outlying clinics also act as hubs, enabling patients to use wi-fi services they might not be able to access at home, link up with specialists for virtual appointments and even download and send digital health data to their care teams.

Lastly, patients who agree to participate are sent home with a blood pressure monitor and fetal heartbeat monitor and are asked to have a weight scale handy. This enables Nynas and her team to monitor those patients daily, jumping in quickly if anything seems out of the ordinary or needs a closer look.

Nynas says the RPM platform gives her an opportunity to see a different side of her patients than she sees in the exam room.

“If I see a patient who looks polished – she’s showered, she’s dressed nicely, she looks well – in the clinic, I’m missing that … maybe there’s some really big struggles at home,” she says. “Maybe there’s a lot of stressors at home. Maybe she’s very depressed, and when I see that patient in her own environment, I get a better idea of how things are going for her and who she is. And that helps me be a better provider.”

The platform also encourages patients to be more engaged in their health. Nynas says the program is set up to educate patients about “red flag symptoms,” so they might identify those symptoms on their own; at the same time, they’re spreading the word with friends and family.

That community connection is important. A critical element of Nynas’ program is the collaboration between Sanford Health and other resources.

“We were really strategic,” she says, in joining forces with public health and Medicaid programs, non-profits, and other healthcare services. “We learned a lot about what each other does.”

A Lifeline for Women in Need of Help

The program can be a lifeline—literally—for high-risk mothers-to-be. Nynas says all patients are screened at the onset of the program and connected with a high-risk care coordinator to help them access additional services, including ride services, nutrition counselors and other resources addressing SDOH. That initial screening alone, she says, helped the health system boost referrals by 600%.

The health system also used some of the grant funding to add a home health nurse to help with screenings, education, and other tasks associated with a home visit. Nynas says the program’s 2023 goal was to arrange home healthcare visits for 40 pregnant women; they ended up connecting with more than 350 people.

And while the program creates a network of care for women during their pregnancy, that network continues past the baby’s birth. Nynas notes that many maternal health programs seem to forget about the mom at a crucial time: Right after the baby is born.

 “It’s kind of crazy to think that, when you have a baby, the baby has a visit in 24 or 48 hours after discharge, and then one week, and then two weeks, and six weeks, and so on and so forth,” she says. With the mothers, meanwhile, “we see them at six to eight weeks [for] one time, and that seems not in keeping with the spirit of what we should be doing as healthcare providers.”

Nynas mixes in stories of success amid the challenges. She references one former patient who was homeless and dealing with substance abuse when she was pregnant, and has since completed a treatment program and will soon have a home for herself and her children.

That said, the challenges are daunting. Providing medical care and support is the easy part, Nynas says. The hard part is “paperwork and firewalls”: Appealing to payers for any sort of coverage they can provide, and working with the Indian Health Service and other federal and state agencies to make sure all the boxes are checked and requirements fulfilled.

And then there’s the HHS grant, which is due to run out soon.

“Those of us in the collaborative, we meet in-person quarterly to talk about what’s next over the next three months, what are our goals over the next six months,” Nynas says. “At our last quarterly meeting it became really abundantly clear that people are anxious about the grant ending and what’s going to happen to our collaborative. When that was brought up [and we said] do you think we should keep meeting, there was a unanimous ‘yes.’ “

“There was a value to us continuing to work together, whether it was funded or not,” Nynas says, “because it was the right thing to do for the women and the right thing to do for our communities.”