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How Patient-Centered Communication Can Address Maternal Health Inequities

August 2023

This article was written by Eden Brownell, Director of Behavioral Science at mPulse Mobile, and was originally published on on August 9, 2023.

The United States is among the most dangerous wealthy nations for women to give birth.

Disturbingly, it’s even more dangerous for women of color. Black women are about three times more likely to die from pregnancy-related complications than white women, while maternal mortality rates among American Indian and Alaska Native (AIAN) women are two times higher. The COVID-19 pandemic only exacerbated these issues.

Maternal mortality rates underscore this country’s deep-rooted health inequities. Although this problem is endemic, it’s not intractable. In fact, more than 80% of pregnancy-related deaths in the U.S. are preventable.

The healthcare system must work to address all of the factors that contribute to maternal health inequalities, including barriers to care, systemic inequities, and how health plans communicate with consumers.

We can improve maternal health outcomes with digital trends by breaking down these barriers and improving communication.

How poor health communication adds to maternal health inequalities and risks

There are myriad factors that contribute to the disproportionate rates of maternal deaths among Black women and women of color.

They include

  1. structural racism and biases within the healthcare system,
  2. limited access to quality providers and facilities in marginalized communities, and
  3. socioeconomic barriers (such as lack of insurance coverage and financial constraints)

And these are only a few of the challenges.

Inadequate patient communication exacerbates many of the inequalities in maternal health problems. For example, marginalized communities often have lower rates of health literacy and higher levels of distrust of health providers, making it difficult to navigate our complex healthcare system.

Or consider someone with limited transportation options. They may be more likely to delay or miss prenatal check-ins or obtain necessary interventions, treatments, and prescriptions that providers recommend. It does little good for a health plan to send follow-up reminders or other messages that don’t consider this barrier. Instead, messages should prompt follow-up conversations that urge people to arrange other transportation options, if necessary.

Likewise, if educational materials and health content don’t provide clear, accessible, and culturally relevant information, health plans will struggle to connect, engage, and build trust with vulnerable populations. That includes addressing language barriers and offering materials in different languages, along with interpreters and translation services that are readily available. Without these supports, marginalized communities may be more susceptible to misinformation and less likely to understand all of the facets of prenatal and postpartum care, whether it’s the stages of pregnancy, warning signs of potential complications, birthing options, or more.

How to build a better patient communication strategy

The stark disparities in maternal health outcomes for marginalized populations highlight the importance of intervention.

Targeted patient health communications and engagement can help

  1. overcome the socioeconomic barriers associated with prenatal and postpartum care,
  2. reduce health risks, and
  3. empower pregnant individuals to actively participate in their healthcare decisions

Consider taking the following steps to build a patient-centered communications strategy that will address the needs of marginalized populations and improve maternal healthcare outcomes for all patients throughout your health system:

1. Promote cultural competence throughout the organization

Cultural competence that respects and understands all communities’ diverse backgrounds and experiences should be the standard for all health plans today. Health equity should be prioritized as a strategic goal and a central component of your mission. Leaders must acknowledge existing disparities and build a clear plan to address them.

It’s encouraging that many health plans have created roles specifically to focus on health equity issues. Still, these initiatives must be backed by tangible action and dedicated resources organization-wide. Developing cultural competence and addressing implicit biases through routine training and ongoing education for all employees should be part of your larger DEI goals.

These efforts are the first step toward building the right internal culture throughout your organization and ensuring all touchpoints — whether digital or in-person — will be informed by cultural competence.

2. Actively collaborate with impacted communities

The best way to ensure your digital health solution resonates with marginalized communities is to collaborate directly with impacted community members. Key community stakeholders can help identify specific needs, cultural preferences, and barriers to care that your organization may overlook or fail to understand.

For example, one client at mPulse — a digital health solutions provider where I lead behavioral science — is a medical system that serves low-income populations and individuals struggling to access care. This medical system worked directly with pregnant mothers to develop a prenatal texting care program. Members of the group came up with key phrases and terms to avoid, such as messages in an overly authoritative voice that could trigger psychological resistance to information. By actively involving community members in the planning and implementing healthcare programs, as our client did, you

can build rapport and develop tailored approaches that connect with the populations you aim to serve.

3. Incorporate behavioral science principles

Behavioral science has become a crucial component of health engagement programs. Incorporating behavioral science into maternal healthcare communications can directly impact health outcomes during your patients’ pregnancies.

For example, mPulse worked with mothers and maternal care experts to develop a prenatal engagement campaign incorporating the behavioral science principles of “social proof” and “storytelling,” with videos of mothers from various communities sharing their stories and experiences.

By highlighting the experiences and stories of pregnant individuals within the community, health plans can foster greater trust, dispelling many common concerns from mothers and increasing the likelihood that they would engage and respond to outreach materials.

4. Prioritize data-driven decisions

Health plans collect an abundance of data about their members — so it’s important to use that information. Data enables you to better understand the barriers and needs of marginalized populations so you can tailor interventions and outreach efforts to address barriers more effectively and build more personalized, relevant experiences that resonate with patients. For example, knowing that someone recently joined Medicaid can inform which educational healthcare content you send them, like how they can navigate insurance throughout their pregnancy.

Data analytics can also help in deploying behavioral science methods. For instance, cognitive overload often causes members to become overwhelmed and tune out vital information. Analyzing viewership and engagement with online videos can inform the length and substance of those videos. If you find a majority of members stop watching content about the risks of aspirin during pregnancy, you may start to develop shorter, quick-hit videos optimized for Facebook, TikTok, or other social media platforms.

5. Use multiple communication channels.

In today’s digital landscape, consumers interact with health plans through various touchpoints, such as

  • online,
  • on their phones,
  • at telehealth visits,
  • at the clinic or
  • in a provider’s office

You should leverage a variety of patient communication channels to reach marginalized populations no matter how they interact with your organization.

Beyond traditional channels like phone and email, you can broaden reach and engagement through community events, social media, and partnerships with trusted community leaders and influencers. Multiple avenues for engagement are particularly important when addressing underlying social determinants like homelessness or unstable housing—these members may not have access to a single, consistent communication channel.

Improving maternal healthcare among marginalized populations demands a multifaceted approach centered on cultural competence and active engagement with communities. And today’s advanced digital tools offer new opportunities to put these tenets into practice within your health plans.

By embracing these approaches and adopting a patient-centered mindset, health plans can begin to bridge the gaps in maternal health inequalities and achieve better outcomes for all. Together, we can work toward a future where every pregnant individual receives the care and support they need to experience a healthy pregnancy and childbirth.

mPulse Mobile Achieves Strong YoY Revenue Growth in Q2 2023 Driven by Outcomes-Driven Engagement Solutions

LOS ANGELES–(BUSINESS WIRE)–mPulse Mobile, a leader in conversational AI and digital engagement solutions for the healthcare industry, today announced strong momentum in Q2 2023, with 159% new revenue growth over the prior year (Q2 2022) and over 80 million unique health consumers engaged through its SMS programs in Q2 2023. The company also announced the launch of its Emergency Department Diversion solution aimed at addressing overuse of the ED to reduce costs and help members access appropriate channels of care.

Value Based Care and Emergency Department Use

Value based care (VBC) strategies require a high level of member engagement, proactive outreach, and seamless coordination of care to scale across diverse populations and drive a successful business model. mPulse is supporting the needs of VBC organizations such as Accountable Care Organizations (ACOs) and managed services providers by deploying Conversational AI solutions that integrate streaming content to educate members and drive better health behaviors.

Reducing inappropriate or overuse of the Emergency Department (ED) offers a key opportunity to improve the performance of value based care plans. Today, mPulse announced the launch of its Emergency Department Diversion solution, which targets large populations and “high utilizers” to adopt more efficient and appropriate care channels. The solution is an optimized version of in-market programs, which have already reduced improper Emergency Department use by almost 70% and directed 60% of patients to visit their primary care provider (PCP) instead of the ED.

Medicaid Continuous Enrollment

As individual states manage the resumption of Medicaid re-enrollment, mPulse is supporting 24 health plans with omnichannel digital engagement that activates members to complete the redetermination process. Recently reported data shows procedural disenrollments account for 75% of beneficiaries losing coverage. This highlights the importance of providing support to individuals to help overcome barriers and connect them to appropriate resources. mPulse has leveraged its Redetermination Solution across SMS, IVR and email channels and launched over 110 tailored Redetermination engagement programs to over 7 million Medicaid beneficiaries at risk of losing coverage. mPulse’s solution uses conversational AI to generate engagement rates in excess of 30% by automatically interpreting member’s responses, aligning with language preferences and integrating high-impact streaming content into the outreach. Historically, mPulse’s redetermination outreach solutions have driven 42% increases in redetermination rates and a 93% completion rate after engaging with the program.

mPulse Recognized by Gartner® in Multiple Categories

mPulse was recognized by Gartner in its July 2023 report, “Hype Cycle™ for U.S. Healthcare Payers, 2023” as a Sample Vendor in two categories identified as having transformational benefit rating: Consumer-Centric Health Products and Community Resource Network Management (CRNM). Both categories are forecast to have a transformational impact and mainstream market adoption within a two- to five-year time horizon.

In addition, mPulse was mentioned in a new July 2023 Hype Cycle report, “Hype Cycle for Consumer Engagement and Experience in Healthcare and Life Sciences, 2023.” We believe its mention in this report demonstrates mPulse’s growing presence in the life sciences market segment, as its engagement solution increases in adoption to help support clinical trial engagement and participant retention over time.

“Through our extensive partnerships across the healthcare ecosystem, we are closely attuned to the needs of leading healthcare organizations, which continue to seek innovative technologies to support core business strategies,” said Bob Farrell, CEO of mPulse Mobile. “The innovative health plans we work with recognize the need for technology-driven member engagement that go beyond what traditional outreach can offer, and our flexible conversational AI and digital engagement solutions move the needle for their value based care goals, even among the hardest to reach populations. We feel both our customers’ results and our recognition by Gartner in key technology categories illustrate mPulse’s ability to deliver lasting improvements in the consumer health experience and member outcomes.”

To provide a forum to discuss trends in digital engagement across the healthcare industry, mPulse Mobile is hosting the Activate2023 conference September 27-28, 2023 and today announces new speakers, including Dr. Reed Tuckson, a physician and public health research advocate, and Craig Kennedy, President & CEO of Medicaid Health Plans of America (MHPA). The full agenda and registration page can be found at

mPulse Mobile recognized in 2023 Gartner® Hype Cycle™ for U.S. Healthcare Payers

LOS ANGELES — August 9, 2023 mPulse Mobile, a leader in conversational AI and digital engagement solutions for the healthcare industry, today announced that it was named by Gartner in its “Hype Cycle for U.S. Healthcare Payers, 2023” report as a Sample Vendor in both the Consumer-Centric Health Products and Community Resource Network Management categories. These categories help “connect members to the broader healthcare ecosystem” and “[close] health disparities and advance health equity,” respectively.

This recognition marks the second consecutive year mPulse Mobile has been identified as a Sample Vendor for the Consumer-Centric Health Products category—a market segment providing solutions that “encourage early and ongoing health and wellness engagement.” . As per Gartner, the years to mainstream adoption for the category is ‘two to five’ years with benefit rating as ‘transformational’.

This Hype Cycle identifies and describes key capabilities payers must adopt to overcome a particularly volatile business and societal environment while staying on target to achieve enterprise goals. Though health plans have historically seen slow progress in digitalization efforts, the disruption they have been experiencing since 2020 has led to an urgent demand for new technologies to create efficiencies and drive competitiveness in the market. We believe mPulse Mobile’s inclusion in the report demonstrates the company’s expertise and technology can support the significant transformational strategies being implemented by leading health plans. 

“We are honored to be identified as a Sample Vendor for two categories in 2023 Gartner Hype Cycle for U.S. Healthcare Payers,” said Bob Farrell, CEO of mPulse Mobile. “We believe the dual recognition within two important categories demonstrates mPulse Mobile’s ability to impact the broader healthcare ecosystem and deliver innovative solutions at scale that address potential barriers to improve access to care and resources. We work with over 200 healthcare organizations who leverage our digital solutions to focus on these strategies, and it is clear that when healthcare organizations invest in the right technologies, they can deliver outcomes that provide value to members and consumers, improve health outcomes while increasing profitability.”

Learn more about how mPulse Mobile transforms member and patient engagement on our website or at the upcoming annual conference, Activate 2023, where industry leaders will gather to discuss actionable health equity and digital health engagement strategies. Activate 2023 registration is free for health plans and healthcare organizations.

View the full press release here »


Gartner, Hype Cycle for U.S. Healthcare Payers, 2023, Mandi Bishop, Connie Salgy, and 1 more, 10 July 2023

Gartner is a registered trademark and service mark and Hype Cycle is a registered trademark of Gartner, Inc. and/or its affiliates in the U.S. and internationally and are used herein with permission. All rights reserved.

Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

Gartner, Hype Cycle for U.S. Healthcare Payers, 2023, Mandi Bishop, Connie Salgy, and 1 more, 10 July 2023

Gartner is a registered trademark and service mark and Hype Cycle is a registered trademark of Gartner, Inc. and/or its affiliates in the U.S. and internationally and are used herein with permission. All rights reserved.

Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

Health Equity, Part 2: Optimizing Digital Strategies to Increase Data Representation

From as early as the 16th century, humans have been using the scientific method to collect data points and make decisions based on objective observations. As societal systems have advanced, methods for data collection have also expanded, ranging from surveys, interviews, focus groups, and secondary data analyses. Still, these methods were not designed to adjust for the stratifying systems of our current society—such as ableism, racism, sexism, classism, and colonialism—leaving significant room for error to exclude historically marginalized populations, and in the case of health outcomes, lead to larger health disparities. 

We look to data to counter inaccurate beliefs with science and facts. Building a strong evidence base of data has become a precursor to driving important, strategic decisions. Today, data is everywhere. How do we make the most of it?

Principles For Data Equity 

The solution is twofold: we must 1. find ways to make the data more representative of the populations being served and simultaneously 2. include the narrative around the data that cannot be collected. For a more equitable dataset, the CDC Foundation’s Principles for Using Public Health Data to Drive Equity provides tools to center equity in the data life cycle, hinging on recognizing and defining systemic factors, using equity-mindedness for language and action, and allowing for cultural modification.

At mPulse mobile, we embed these equitable practices throughout our data lifecycle to bring a focus on health equity, prioritize deeper community engagement strategies, and address the social and economic factors that affect health outcomes.

When Numbers Don’t Tell the Whole Story 

When a group is not represented in data collection—whether they are accidentally excluded, non-responsive, or dropped out because they have more barriers to engagement—there is a sampling bias in the data that can have long-lasting consequences for entire communities. 

This happens when data is unavailable for a marginalized group and is not accounted for in adjustment methods. It translates into data analyses and reporting, and consequently, excludes these groups from key decisions. This can lead to already marginalized groups being overlooked in program design, policymaking, resource allocation, funding, and more, systemically putting them at an even further disadvantage. Historically, this has led to race neutral policies, such as grandfather clauses, literacy tests, and redlining. When these decisions are made across housing and built environment, education access, economic stability, and food policy they also affect an individual’s overall health outcomes.  

An example of this is the race and ethnicity data collection process. As the US population demographic has diversified, the racial designations on surveys have not: all Asians are grouped together along with Pacific Islander. They do not account for the many various identities that exist within these populations. Inclusivity needs to intentionally be built into data collection methods, to ensure that people who are not a part of the demographic majority are also represented within the data. 

In a data-driven world, it is crucial to use an equity lens throughout data collection, analyses, and reporting. This can drive better decisions, efficiency, increase revenue, and arguably most importantly, even help lower premature illnesses and preventable deaths.

Overcoming Barriers: Reducing the Burden 

Health equity work is a gradual process of undoing harmful, institutionalized rules and making new rules striving toward justice. This begins with making sure everyone’s data points are included: 

  1. Recognizing the barriers that prevent populations from being a part of the narrative and 
  1. Providing means to overcome these barriers 

Digital outreach has vastly improved data collection methods—it overcomes multiple barriers such as the time it takes to get to a location, saves on transportation, can offer multiple languages, etc. 

mPulse Select Outcomes
mPulse Select Outcomes

Data Equity: Building Trust and Striving to Justice 

One barrier that has proved harder to overcome is medical mistrust. Stemming from the adverse treatment dating back to exploitation of enslaved Black bodies to do scientific research, there is a deep-rooted distrust among Black Americans towards medical professionals. This medical mistrust results in underutilization of services, weathering, and missing data. While there is no quick fix, promoting and supporting doctors of color, teaching cultural humility, and updating medical guidelines are a start to building more equitable practices within health systems. 

Black and brown patients are now poorly represented in clinical and drug studies, leading to a large data—and knowledge—gap, that translates to misdiagnoses. For example, literature has taught medical professionals what skin symptoms look like on white skin, but have not shown how they may look different on black and brown skin. The missing data points result in missing information and knowledge gaps for providers, subsequently leading to misdiagnoses, and ultimately creating greater health disparities for people with darker skin.

Data to Impact Journey (famously known as Information vs Knowledge)— Source: Gaping Void

Data to Impact Journey (famously known as Information vs Knowledge)— Source: Gaping Void

When looking at data, we cannot rely on the raw numbers alone. It is equally important to analyze who is not fairly represented and qualitatively share the barriers that have led to their data exclusion. If we cannot remove barriers in data collection, there are other ways to uplift the unheard voices into the overarching narrative. To glean more useful insights from the population trends and patterns we collect, it is critical to understand the context behind the numbers.

Digital Solutions: Practical Approaches to Representational Fairness 

Health equity is central to the creation of our HEDIS gap-closure oriented Engagement Solutions: they promote health literacy, demonstrate cultural competency, increase accessibility, and address social determinants of health by: 

Our engagement strategy intentionally uses data disaggregation to ensure representation of marginalized populations and address social determinants of health (SDoH). Using a proprietary SDoH Index, which leverages a weighting system to maximize its predictive ability, we provide tailored, relevant, and empathetic conversations to members. These solutions are designed to be comprehensive, multilevel, adaptable, and culturally appropriate for populations experiencing health disparities. Insights gained from outcomes can be funneled back into existing Engagement Solutions to provide targeted, relevant outreach to maximize gap closure potential. These tailored digital Engagement Solutions implement an equity-minded approach to close health gaps for groups that have been historically excluded, exploited, and marginalized, and ultimately promote a fair and just opportunity for everyone to reach their optimal health. 

To learn more about using digital engagement to build more equitable health data, register for Activate2023: Designing Customer Journeys for Health Equity.