Contributor: Maternal Health Outcomes Are a Systemic Signal

Maternal mortality in the United States is rising.¹ The US maternal mortality rate was more than 50% higher than the rate in the next closest country studied.² Maternal deaths climbed from 754 to 1205 from 2019 to 2021. That is an increase of more than 60% in just 2 years. Racial disparities remain stark; Black women are nearly 3 times more likely to die from pregnancy-related causes than White women. Indigenous women face similarly elevated risks.

These disparities persist across income and education levels, highlighting the ongoing failures of traditional maternal health systems. These are not anomalies.³ These racial disparities are systemic signals of how social and economic instability erodes maternal health long before a crisis begins. For health plans and payers, the takeaway is clear: improving maternal outcomes requires a shift upstream. The most effective perinatal strategies are those that address risk before it becomes a cost.

Traditional Obstetric Models Don’t Capture Risk Early Enough

The current system is reactive and fragmented; it is often limited to clinical touchpoints. Prenatal appointments are brief, and postpartum follow-up is inconsistent. The model depends heavily on patient-driven access. That leaves critical social determinants of health (SDOH) risks—such as food insecurity, transportation gaps, or unstable housing—undetected and unaddressed until they result in adverse events. This delay not only worsens maternal outcomes, but it also drives up avoidable costs across inpatient, neonatal intensive care unit (NICU), and emergency care.⁴

Care Coordination Anchored in SDOH Changes the Trajectory

Adobe Population Health’s perinatal care coordination program is designed to interrupt that cycle. The model blends in-home and virtual care coordination with trimester-based education, early enrollment, and postpartum follow-up. Every member is assessed for SDOH risk using MASLOW, Adobe’s proprietary platform that geolocates social support resources tied to real-time patient needs.

Jayme Ambrose, DNP, RN, CCM, CEO, Adobe Population Health

When a new mother is afraid to report a broken stove for fear of eviction, MASLOW flags the risk, a care coordinator intervenes—not with a pamphlet, but with a replacement stove. The intervention is not just compassionate, it is clinically and economically strategic: the mother can now safely prepare meals and care for her newborn; a basic SDOH gap has been closed; a cascade of downstream complications has been avoided.

Impact Across Clinical and Cost Metrics

In Adobe’s recent perinatal cohort in New Mexico, from July 2024 through May 2025, 11,119 members were referred, and nearly 1380 were successfully engaged. Among those:

• NICU stays: 7.6%
• Preterm birth rate: 6.6% (compared with 10.1 percent statewide)
• Underweight newborns: 8.2% (compared with 9.7% statewide)
• Maternal death: 0.4% (compared with 4.6% statewide)

Each of these indicators reflects the effectiveness⁵ of upstream, SDOH-aligned interventions. There were fewer preterm deliveries, fewer low birth weight cases, reduced intensive care utilization, and lower mortality.

Delivering Scalable Risk Intelligence

MASLOW is not just a directory; it is an embedded risk intelligence system that aggregates assessment data, stratifies risk based on SDOH exposure, and supports action through automated resource matching. Integrated into the Adobe electronic health record, MASLOW enables rapid reporting, population-level analysis, and outcome tracking. These are essential capabilities for plans operating under value-based maternal health strategies.

How Payers Benefit by Addressing SDOH

Addressing SDOH in the perinatal period is not just about equity; it is a cost-control strategy. Research shows that well-targeted SDOH interventions can yield returns of higher than 2-to-1 on investment in Medicaid populations​. Adobe’s care coordination model delivers this value by reducing unnecessary utilization, improving maternal engagement, and closing care gaps that would otherwise drive claims costs higher.

Enrollment Timing, Education Make or Break the Model

The earlier the enrollment, the greater the impact. Adobe’s model prioritizes first-trimester engagement, supported by trimester-specific education and postpartum check-ins. This staged structure ensures that education and support align with each pregnancy and recovery cycle phase. It reinforces adherence, trust, and continuity of care.

A System Built on Dignity, Safety, and Trust

Outcomes reflect that people are more than numbers. When systems are designed to see the whole patient, payers can support a safe birth, a fed baby, and a mother who is not alone in a critical moment.

When care coordination meets social need, the return is exponential. There are fewer complications, lower costs, and healthier beginnings. For health plans committed to improving maternal health, investing in SDOH-focused perinatal care coordination is imperative.

References

1. Tran P, Jreij B, Sistani F, Shaya FT. Disparities in maternal mortality. J Clin Transl Sci. 2023;7(1):e192. doi:10.1017/cts.2023.520
2. Johnson SR. Maternal mortality: how the U.S. compares to other rich countries. U.S. News & World Report. June 4, 2024. Accessed May 19, 2025. https://www.usnews.com/news/best-countries/articles/2024-06-04/how-the-u-s-compares-to-other-rich-countries-in-maternal-mortality
3. Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and structural determinants of health inequities in maternal health. J Womens Health (Larchmt). 2021;30(2):230-235. doi:10.1089/jwh.2020.8882
4. Hasan A. Addressing social determinants of health for pregnant and postpartum Medicaid beneficiaries. National Academy for State Health Policy. June 24, 2024. Accessed April 30, 2025. https://nashp.org/addressing-social-determinants-of-health-for-pregnant-and-postpartum-medicaid-beneficiaries/
5. McCarthy D, Tabbush V. Health care access now: calculating the ROI of a care coordination program to address social determinants of health. The Commonwealth Fund. March 2020. Accessed April 30, 2025. https://www.commonwealthfund.org/sites/default/files/2020-10/McCarthy_HCAN_ROI_Calculator_Use_Case_v2.pdf