A Pregnancy App Worth Prescribing
By Neal Ungerleider
In the world of pregnancy care, no-show rates for ob-gyn visits among pregnant Medicaid patients have historically been high. For some, it may be lack of transportation. Others may struggle to get the time off work. Whatever the reason, missed obstetric appointments mean that a pregnant woman isn’t getting the care that she needs. She may have unknown risk factors that are affecting her pregnancy. In addition, missed appointments create logistical issues and lost income for providers.
Aurora Health Care, one of the Midwest’s largest healthcare systems, tried a new approach to this challenge: Prescribe a smartphone app — Babyscripts — that allows doctors to remotely monitor pregnant women.
The intervention, a first for such a large health system, had a remarkable impact. Before the Babyscripts program, patients in the Medicaid group saw their ob-gyns, on average, only three times during their pregnancies. Those using the app met with their physicians seven times — more than double the rate.
When they started researching potential health care initiatives, Anish Sebastian and Juan Pablo Segura were not originally thinking about creating a pregnancy app. In 2013, the two bachelors knew they wanted to create an app related to a chronic health condition, designed to support short-term and long-term wellbeing. It would use biometric data to shape behavior and give physicians a wealth of information to better treat patients. They initially considered focusing on diabetes and heart disease.
In the process of examining possibilities, Sebastian and Segura had a conversation with Dr. Nancy Gaba, chair of George Washington University’s ob-gyn department. Gaba told them that expectant mothers were a perfect audience for the sort of wellness-nurturing, big data–based endeavor they wanted to launch. Sebastian recounts the conversation with enthusiasm. “My patients are young,” he recalls Gaba saying. “They are between the ages of 18 and 35. Pregnancy is a nine-month condition. These patients have a natural acclimation to change and behavior modification. And by the way, from a reimbursement standpoint, it’s all capitated. I don’t know what the real discussion is here, right?”
And thus BabyScripts was born. Sebastian is the company’s CEO and Segura is president. The business is based in Washington, DC, and its current clients include 15 health care systems operating in 13 states. Unlike many commercial pregnancy apps — the What To Expect and the Pregnancy+es of the world — Babyscripts is structured around a B2B (or B2MD) model that involves partnering directly with care providers or insurers. Although an expectant mom could hypothetically download the Babyscripts app to her phone, it wouldn’t be enabled unless her doctor had a partnership with the company.
Physicians in the Babyscripts fold give their ob-gyn patients access to iOS or Android versions of the HIPAA-compliant app; a kit is given or mailed to them, containing a bluetooth–enabled scale and blood pressure cuff. The patient checks her blood pressure and weight at home and the data is uploaded via her cellphone to Babyscripts’ servers, and the information is accessible to the physician. Data from the devices are used for early interventions — making sure expecting moms get the care they need and are monitored regularly between appointments. The medical teams are notified if the biometrics — weight, blood pressure — are off-kilter. “We can collect data remotely from the mom but then filter it appropriately through to her care team,” Sebastian says. “For instance, if weight gain is too low, that triggers an alert and the care team can react in real time and intervene.”
Alongside Aurora Health Care, other customers and partners include George Washington Medical Faculty Associates, Sutter Health, and Privia Health. Each organization offers patients a slightly different iteration of the Babyscripts app; care providers can add a diabetes module, for instance, or customize the messages patients receive.
Patients interact with their care providers through their smartphone app; on the other side, physicians use a web dashboard to analyze data and communicate with patients. Babyscripts’ customization capabilities were evident in the Aurora trial at Milwaukee’s Aurora Sinai Women’s Health Center. As part of the initiative, Babyscripts added a “care navigator” module to the app that connected a care specialist, typically a social worker, with patients. The functionality, Sebastian explains, is “very much targeted to underserved patient populations” like women receiving Medicaid, who make up approximately half of all pregnancies in the United States.
The Aurora Sinai trial centered around increasing touchpoints with Medicaid patients, reducing the no-show rate and increasing adherence to the prenatal schedule. Patients didn’t just more than double their attendance rate; they also sent an average of four messages a week through the app, and doubled the frequency of prenatal appointments.
For their Babyscripts collaboration, the Aurora team identified a subset of expectant mothers who they felt needed more intervention than a typical low-risk pregnancy, and they offered those patients the option to use the care navigator module. Social workers would write to patients directly through the app, which would also generate automated daily messages about pregnancy care.
Although one dimension of Babyscripts’ mission is to reduce unnecessary in-office visits, the goal for Aurora was slightly different: to make sure that patients made it to the office. In addition, says Sarah Nicholson, Babyscripts’ SVP of business development, the Aurora Sinai trial aimed to increase touchpoints with Medicaid patients and increase their adherence to the prenatal schedule. The collaboration was successful. Not only did patients come in more frequently for appointments, they sent an average of four messages a week through the app.
With a growing patient base, Sebastian and Segura intend to expand the company’s use cases and services for both patients and care providers. Since gestational diabetes presents significant risks during pregnancy, Babyscripts will be introducing an IoT glucometer that connects with the app, enabling patients and physicians to closely monitor blood sugar levels. The co-founders intend to expand their customer base to insurance firms. And since postpartum care is integral to the wellbeing of new mothers, Babyscripts is bulking up its postpartum offerings.
Babyscripts made its first acquisition earlier this summer when it purchased pregnancy app maker iBirth, which builds customized and branded digital patient education apps for care providers. Judith Nowlin, iBirth’s co-founder, is joining Babyscripts as chief growth officer; the company’s staff is joining Babyscripts as well. Terms of the acquisition weren’t disclosed.
Sebastian speaks highly of Nowlin and her work. A childbirth educator and doula, Nowlin first launched iBirth in 2009, during the first wave of smartphone healthcare apps. Among the pioneering pregnancy apps in the App Store, it offers extensive educational content about pregnancy and postpartum follow-up materials. “Over the course of almost a decade, Nowlin and her team have been able to create this incredible experience for patients with dynamic and rich content,” says Sebastian. Babyscripts intends to use this knowledge base to build out the educational portion of Babyscripts’ product.
Pregnancy is a unique market for entrepreneurs, since customers will inevitably phase out of their potential audience. The fact that pregnancy typically lasts for nine months makes it different from chronic conditions like diabetes. Even taking postpartum use into account, the Babyscripts’ consumer uses the app for slightly more than a year, at most, and moves on.
In June 2018, Babyscripts announced their acquisition of iBirth, underscoring their place as a leader of provider-prescribed technology for pregnancy and postpartum.
Although there are hundreds of mostly customer-facing pregnancy apps in the Android and iOS app stores, concrete numbers about the size of the pregnancy app market are limited. There’s plenty of anecdotal evidence — and lots of listicles in magazines and websites — about the use of pregnancy apps, yet industry-wide statistics remain a bit elusive.
Despite that, pregnancy apps and digital pregnancy services remain a hot business. Thanks to developer-friendly innovations like Apple’s HealthKit and a wave of APIs for consumer wearables, the barriers for entry to the pregnancy tech market are lower than ever.
Babyscripts’ decision to partner with healthcare providers sets it apart from the competition. Instead of being an unknown quantity that patients assess through crowdsourced reviews, the app gets its stamp of approval directly from physicians.
Considering the pervasiveness of smartphones, it’s inevitable that wearables and smart devices would make their way into the realm of pregnancy care. The fact that doctors and health systems are giving Babyscripts their endorsements show that in the world of IoT devices and apps, Babyscripts makes an invaluable contribution to care, to the wellbeing of babies and moms alike.
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