Juan Pablo Segura (Ep. 14, 2020)

On this week’s program, In Black America producer and host John L. Hanson, Jr. discusses the high rates of maternal mortality among African American women with Juan Pablo Segura, co-founder of Washington, DC.-based mobile app Babyscripts.

Intro [00:00:08] The In Black America theme music, an instrumental by Kyle Turner.

Announcer [00:00:15] From the University of Texas at Austin, KUT Radio, this is In Black America.

Juan Pablo Segura [00:00:23] The first thing we did, myself and the other founder, we we actually went and got a chief medical officer. And so we we very quickly brought in an open two way and the chair of obstetrics at a hospital here in D.C. called Sibley Hospital. And, you know, we started putting together a team of technologists. So, you know, developers, you know, health care specialists. And very slowly, you know, we we have we had a big vision, which was how could we get not just smartphones, but Internet connected medical devices to the whole Internet of Things revolution. How could we get those devices in the patient’s home and start to catch problems earlier through remote patient monitoring so that less moms have to die in this country when it comes to them going through their pregnancy?

John L. Hanson Jr. [00:01:11] Juan Pablo Segura, co-founder of the Washington, DC based Babies Groups. In recent years as high rate of maternal mortality in this country have alarmed researchers. One statistic has been especially concerning. According to the Center for Disease Control, African American mothers die at 3 to 4 times the rate of white mothers, one of the widest of all racial disparities in women’s health. Put another way an African-American woman is 22% more likely to die from heart disease than a white counterpart, 71% more likely to perish from cervical cancer. But 243% more likely to die from pregnancy on childbirth related causes. In a national study of five medical complications that are common causes for maternal death and injury. African American women were 2 to 3 times more likely to die than white women who had the same condition. Segura and his team at Babyscripts have been working tirelessly to improve maternal health in the District of Columbia, as well as around the nation. I’m Danielle Hinton, Jr, and welcome to another edition of In Black America. On this week’s program, African-American D.C. mothers are Dying and we Can Save Them. With Juan Pablo Segura, co-founder of Babyscripts In Black America.

Juan Pablo Segura [00:02:28] I really think as we think about trying to solve the problems that we have here in the district, since there are very few doctors offices in Ward seven and eight, which are the very economically disadvantaged wards here in DC, there actually are no hospitals and maternity hospitals in Wards seven and eight. So if someone wants to deliver, they have to cross town. So think of the cost of doing that the time. You know, if there’s an issue. Complications that could occur by having to wait so long. So what we’ve been talking a lot about here in DC and a lot of work that I’ve been doing is how can we get digital tools that can make care available at any time, any place? How do we make them more accessible and how can we get doctors to give them more to their patients?

John L. Hanson Jr. [00:03:11] Washington, DC, like many cities in this country, experienced the lack of access for quality health care in certain neighborhoods. This has created a unique problem for African-American pregnant women. With that in mind, Juan Pablo Segura, co-founder of Babyscripts, designed the platform to help expectant mothers. Two years ago, Wisconsin based health care provider as baby script to develop a strategy to reach that population. They realized they had to focus on technology and target ease of access via smartphone and to text messaging for women having trouble getting health care. What began in 2014 with the hope of transforming both how doctors and patients think of and use technology to improve their health care has now provided meaningful access to health care in underserved communities and improve the status quo of pregnancy care. Recently In Black America spoke with Juan Pablo Segura.

Juan Pablo Segura [00:04:07] So I actually was born in that in the D.C. area, in Northern Virginia. My family’s actually from Argentina. So I’m a first generation American, and yet where I have stuck around D.C. haven’t really fallen too far from the tree here. Love of the district. And I started my company Babyscripts here in the in the D.C. area as well. So very, very proud of what we’re doing here in the district.

John L. Hanson Jr. [00:04:35] What led you to start the company?

Juan Pablo Segura [00:04:38] It’s really interesting. I used to be a consultant working for a big company called Deloitte. And, you know, I, I was I still am, you know, a lost millennial. Right? And so I just couldn’t I really couldn’t jive very well with with a big company. I was looking for meaning, looking to do something impactful. And a friend of mine had had a real tough health care experience that just opened my eyes to how broken the U.S. health care system was. And so, you know, I decided to do what anyone that’s watched Shark Tank. To do. I started a company and I ended up choosing pregnancy care because of my mom. I come from a big Hispanic Catholic family. You know, I had five siblings, so I’m one of six kids. And as I kind of reflected on my mom’s journey in health care, she actually had three miscarriages. And, you know, just the memories I had of the pain, the lack of answers. You know, I really believe that I believed back then, and I still believe to this day that technology and data and all these new tools that we have at our disposal can really start to solve and answer some of these tough questions for women especially.

John L. Hanson Jr. [00:05:59] Now, I understand that you started this, what, in 2014?

Juan Pablo Segura [00:06:02] Yup. 2014. Five very long years ago.

John L. Hanson Jr. [00:06:06] And how did you put the group together? I guess you got designers and engineers and marketers and doctors and sciences.

Juan Pablo Segura [00:06:14] Yeah. So the first thing we did. So, you know, I’ve. I’ve got big ideas and wanted to make a big impact. But the first thing we did, myself and the other founder, we we actually went and got a chief medical officer. And so we, we very quickly brought in an open to way and the chair of obstetrics at a hospital here in D.C. called Sibley Hospital. And, you know, we started putting together a team of technologists. So, you know, developers, you know, health care specialist. And very slowly, you know, we we have we had a big vision, which was how could we get not just smartphones, but Internet connected medical devices to the whole Internet of Things revolution. How could we get those devices into patients homes and start to catch problems earlier through remote patient monitoring so that less moms have to die in this country when it comes to them going through their pregnancy? And so, you know, it took a long time to get to where we’re at today. But what’s really exciting is we’re now in more than 50 health systems in 23 different states, and we touch around 200,000 pregnant women across the country. So, you know, it’s you know, I think anything’s possible in this country with a big idea and a lot of energy and a lot of hope.

John L. Hanson Jr. [00:07:32] You would think in the nation’s capital, you know, health care will probably, you know, you’ll be one of the best. But what are some of the root causes of the high infant mortality rate that’s going on in the nation’s capital?

Juan Pablo Segura [00:07:45] Yeah. So that’s definitely a loaded question. Okay. And, you know, there are a lot of issues going on in D.C. But for those that might not know in D.C., you know, when you start to look at the breakdown of of maternal mortality, especially amongst racial groups, black women in this country, you know, have about a 70. It’s all measured out of 100,000 people. But, you know, our rate is about 70 out of 100,000. That’s almost three times the national rate of maternal mortality. And it’s double the national rate of black maternal mortality. So when you start looking at the outcomes that we’re getting in the D.C. area, they’re really abysmal. And it’s a travesty. And, you know, there are a lot of reasons for that. Some a lot of them are tied to poverty and economic inequality. A lot of it is tied to, you know, also, you know, racial bias and dumping in black women, not getting the care that they need when they need it because of the color of their skin. And there are also a lot of issues around structural barriers, lack of transportation to go see a doctor, not enough hospitals where, you know, either the black women or the disadvantaged, economically disadvantaged women live. And so it’s almost impossible to really get good care so that, you know, you can have a healthy and happy pregnancy and delivery and postpartum journey.

John L. Hanson Jr. [00:09:18] I understand there’s a bill before Congress or has it has it passed?

Juan Pablo Segura [00:09:22] So there’s some pretty interesting nationwide. There actually are a couple of bills that are being led by some incredibly progressive and really innovative Congress, women and men. For example, Congresswoman Underwood from Illinois is is pushing some really important national, you know, whether it’s maternity bills in the in the Congress, but here at home with the D.C. council. So the local kind of legislative organization here in the nation’s capital that covers the D.C. residence, there’s actually been a couple incredible bills. For example, the maternal health Care Improvement and Expansion Act that are really focusing both the government and local business and organizations to start to address these massive gap in outcomes for. For black women here in the district and for all women as well, but especially for for for minorities. And so we’ve been actually trying to work really hard to get this bill passed and to be approved. And so now it’s in the House committee here in the D.C. Council.

John L. Hanson Jr. [00:10:31] I was looking at some of the literature in which you all said, and I want to go through some of them. Digital health tools such as remote patient monitoring. How does that work?

Juan Pablo Segura [00:10:42] Yeah. So so I think maybe to kind of separate what what, what we do as a company and then what we’re trying to do here in the district. Okay. So, yeah, a lot of digital health, you know, in mobile health. When you think of innovation in health care through technology, there’s kind of two main categories of, of of tool sets. The first is something called telemedicine, which, you know, imagine doing a video visit with your doctor where they can see you, You can see them and you talk about your symptoms or problems and, you know, they could prescribe you something. And that’s what a lot of people have thought innovation in health care is or it’s made up of through technology. There’s actually into many people’s surprise. There’s also and I would say a much larger category of innovation that we call digital health, which isn’t a video visit. It’s either a smartphone app that patients have access to. It could be the use of a Bluetooth or a cellular enabled medical device, like a blood pressure cuff, a blood glucometer or weight scale that you know, can connect directly to a doctor’s electronic medical record. And so all of these tools that aren’t video visits but can remote monitor a patient, can deliver through a chat, a kind of interaction or intervention. This is a very fast growing space in health care. And traditionally there’s been no reimbursement for those tools. So for digital tools, it’s very hard for doctors to get paid to give them to patients like a prescription or like telemedicine video visit, because not a lot of people really understand it. And, you know, I really think as we think about trying to solve the problems that we have here in the district, since there are very few doctors offices in Wards seven and eight, which are the very economically disadvantaged wards here in D.C., there actually are no hospitals and maternity hospitals in Wards seven and eight. So if someone wants to deliver, they have to cross town. So think of the cost of doing that. The time, you know, if there’s an issue, complications that could incur by having to wait so long. So we’ve been talking a lot about here in D.C. is a lot of work that I’ve been doing is how can we get these digital tools that can make care available at any time, any place? How do we make them more accessible? And how can you get doctors to give them more to their patients? And so, you know what? What we’ve been trying to work on and what we’ve been trying to enhance in this build the Maternal Health Care Improvement Extension Act is to create the first digital health mandate where insurance in the district would cover these new technologies like remote patient monitoring, so that we can start to give women care if they can’t see a doctor immediately.

John L. Hanson Jr. [00:13:30] How would these particular services work outside of the D.C. area, or can it work outside the D.C. area?

Juan Pablo Segura [00:13:37] I mean, I think there’s huge opportunity outside the D.C. area when you start to look at, for example, rural health care. Mm hmm. So what you’re seeing here in D.C. is there’s structural inequality and there’s structural kind of transportation barriers that are making it really hard for women to get the care they need. That further complicates the pregnancy rate. But, you know, you’re talking about smaller distances. Obviously, it’s very complex in a big city. But, you know, you’re not talking about miles or tens of miles of distance. You’re talking about a small area and you think about rural health care. 50% of counties in the United States lack a practicing OB-GYN. And that’s a really scary number. So when you look at, okay, well, women are pregnant and they have to drive 3 hours to get to the closest doctor. Think of, you know, how, for example, if there’s a blood pressure related issue, I don’t know how much you know about blood pressure problems, but blood pressure problems account for 10 to 15% of maternal deaths. And so when you think about, you know, a rising blood pressure that could be tied to something called preeclampsia, that could lead to a stroke and death, if women have to go see three, go to go travel 3 hours to just get a consultation with a doctor. There are huge issues in catching problems early, getting help when it’s needed. And so I think technology, especially digital health tools, have a big role in starting to address these big issues and moms getting the care they need.

John L. Hanson Jr. [00:15:09] As you mentioned, you know, high blood pressure. I was also reading that, you know, heart disease and stroke. May be related to the infant’s death or the mom’s death sometime after after delivery.

Juan Pablo Segura [00:15:23] Oh, absolutely. So there’s kind of a when you look at the maternity journey, there’s obviously the time that you’re pregnant, but there’s the time after you’re pregnant, the postpartum journey. And, you know, in many ways, the postpartum journey can be just as dangerous than the actual pregnancy. So, for example, the number one reason for postpartum readmission. So mom getting released from the hospital and then having to go back to the hospital after they deliver is blood pressure. It’s the number one reason blood pressure problems like preeclampsia somewhere. Where is the number one reason for maternal death is blood pressure in the postpartum time period. And so when you think about those issues and the fact that what if you were to give a mom a blood pressure cuff that has a Bluetooth or cellular chip inside, so every time they take their blood pressure, that data goes back to their doctor. And if something is wrong, the doctor can automatically know that the patient does have to call the doctor. They don’t have to do anything. That data automatically goes back to the doctor, and the doctor can obviously follow up, get the patient to come in, say, Hey, you’re not okay, come in now. And we’re talking about real life saving interventions. And, you know, that’s that’s what we focus on as a company or a baby scrubs. But we’re not the only ones. And, you know, we testified in front of the D.C. Council on Wednesday, And, you know, what we were sharing was the doctors. They know that these tools exist. They know that they can make a big impact. But the problem is no one pays for them from an insurance perspective. And the doctors just don’t have money to pay for these kinds of experiences. And so that’s why, you know, we have to start having insurance companies started covering these services because these are real life saving services that can also reduce costs, improve quality, and really make a huge impact in in all of our moms. So, yeah.

John L. Hanson Jr. [00:17:23] That brings me to my next question with insurance companies, How do you are going about articulating the level of their involvement and as you say, reducing costs in the long term?

Juan Pablo Segura [00:17:37] Yeah. Yeah. So, you know, and this is it’s unfortunate that that, you know, we have to we have to put together a return on investment analysis to, you know, essentially what that has, you know, an internal rate of return or, you know, 100% of your money back kind of thing. It’s unfortunate that we have to do that to to get to get some kind of action or movement. And and so, you know, number one, the state of of of health care and how we make decisions I think is very broken. You know, we need to be doing the right things. And that’s taking care of our moms, especially our African-American moms. So, you know, I think that’s point number one. But what I’m seeing and there is a lot of change happening. You have some very early adopters that are doing some incredible work on the insurance side. A great example that someone I will applaud to the day I die is the CEO of America Health Care to us here in D.C.. Her name is Karen Dale and she has decided to reimburse these tools. Obviously, there isn’t a why, but she reimbursed these tools because it was the right thing to do for providers in Washington, DC. Now, that’s one insurance plan of many. And so we need to get the other ones to come in and start paying for this. But but I think the leadership of the more progressive and really intelligent, emotionally intelligent people that understand the problem and understand that there’s a need, you know, you’ll really see the improvements that will happen in those areas, but it’s still a very long wait to get these things reimbursed. I think we need a lot of awareness. There’s this whole concept called social determinants, and we know that it’s just not a, you know, a one visit with a doctor that will change the the outcome journey of a mom or of any patient for that matter. Right. When you start to look at where patients live, right, they’re geographies, access to healthy food that they might have or that they don’t have stable housing, access to transportation, all of these factors contribute to a patient’s overall and inevitable health. And so a lot of kind of traditional health care has never really focused on, you know, a patient living environment. They only ask, what’s your blood pressure? How much do you weigh and what’s your temperature? Right. And if everything checks out, it’s like, okay, good luck. You look great. Goodbye. When we know that, how can a mom have a healthy pregnancy If she doesn’t have healthy food? How can the mom have a healthy pregnancy? If, you know, she’s suffering from domestic violence. All of these things are contributors to preterm birth, for example. And so a lot of what we’re doing as a technology company is, yeah, we can remote monitor things like blood pressure or we can remove monitor things like weight or blood sugars to lead to better immediate interventions. We also have to start identifying some of these social determinant issues. So, for example, if a mom does have issues with transportation, our app actually will connect her to a free rideshare service through Lyft that will allow them to go see their doctor if they have issues with healthy food or not having access to healthy food. We actually ask those questions through the app and the response is not, okay, we’re going to help you. We actually immediately connect them to a program that, for example, America Health might reimburse for. So so, you know, as we look at building technology to make a direct impact to mom’s health and into the baby’s health, we know that we can’t just focus on one or two or three clinical factors. We have to start addressing all the environmental factors that she’s surrounded by. And, you know, when you start looking at the facts in in in the U.S. and in D.C., you know, for example, black women have they’re either have or are in an environment where seven times more likely to either smoke, they are six times more likely to be overweight. They obviously do have four times more likely this to have a preterm birth. And so when you start looking at the dynamics, I mean, it’s not just one visit to a doctor that’s going to make the ultimate impact. It’s all of these things together.

John L. Hanson Jr. [00:22:00] When you look at what you all are doing, what are some of the steps the process happens when they come to you.

Juan Pablo Segura [00:22:08] Or are you saying a patient, for example?

John L. Hanson Jr. [00:22:10] Yes. Yeah, A patient, Yes.

Juan Pablo Segura [00:22:12] Yeah. So? So our company is constantly evolving. So right now what happens with baby scrubs is if a patient goes and sees their doctor for the first time. Mm hmm. And it’s not all doctors right now. For example, in D.C., we only work with George Washington Medical Faculty Associates and MedStar. They’re the two largest health systems in the district. But there are a lot of other groups after these small practices, etc.. But when a patient does see one of our participating providers that are using baby scrubs don’t automatically get put on our app experience that has all this education connection, the resources. It actually in certain instances, we’ll have a bi directional chat that will help direct patients to specific resources in the community. And then if they’re at higher risk, we might give them what’s called a mommy kit that is a connected blood pressure cuff, for example, that allows us to remote monitor their blood pressure and alert the doctor if anything’s wrong. And so, yeah, like I mentioned, we work with 50 health systems across the country. And so we’re continuing to grow our footprint. But this really I think at the end of the day, patients should start to look at, okay, what tools is my provider offering to me so that I can have the best possible pregnancy outcome? And I do believe that groups like GW MedStar are first movers and really are leading the way in better treating their moms of color and obviously all moms that they serve as well.

John L. Hanson Jr. [00:23:51] When looking at the number of maternity deaths. What is you also long term outcome to to reduce some of those numbers?

Juan Pablo Segura [00:24:01] So we have something called a moonshot. And and this might sound a little kind of Elon Musk Tesla crazy space X but but I think it’s important to have a shining star. Our goal is by 2025 to eliminate every blood pressure related maternal death in the United States of America. And I believe that we can do that as a company. And if we do that, we can reduce the maternal death rate by at least 10%, probably more like 15%. And I would mention that nobody really talks about what’s called near-misses. So obviously, we track which moms die during their maternity journey or after their maternity journey. But very few people talk about what’s called near misses, which is say a mom believes too much and almost dies. She doesn’t die, but she might have an issue that that goes far beyond the pregnancy. Let’s say a mom gets a stroke, she doesn’t die, but she gets a stroke and is severely affected for the rest of her life, you know? And so in some estimates, for example, by the CDC. Five times. We have a five times rate of near-misses. So think of 70 moms die, but 200 and and, you know, around 250 to 300 moms, you know, are severely affected negatively after their pregnancy. And a lot of those near-misses are tied to blood pressure. So so again, I want there to be zero complications tied to blood pressure in this country. I think we can do it. We obviously need more health systems, more health insurance companies that want to participate in this journey and everyone benefits. And I think that’s that’s the case that we all have to make the providers deliver better care. Patients get better care, insurance companies get less complications. Guess how much a preterm birth costs? A breach of birth cost $250,000. If we can eliminate those kinds of complications, everyone wins, especially the insurance companies as well. So that’s our shining star. Well, once we hit that one, that moonshot, well, we’ll do another moonshot and eliminate all maternal deaths. You know, I don’t know how much one company can do, but we’re going to try our best. But that’s definitely what we’re shooting.

John L. Hanson Jr. [00:26:28] For before we run out of time. Juan Pablo, we’ve been talking about the physical aspects of pregnancy, but we have yet to talk about the psychological changes just brought on by pregnancy that can be exacerbated by underlying health problems.

Juan Pablo Segura [00:26:44] Oh, I mean, absolutely. I mean, something that is now getting a lot of attention is something like postpartum depression. 50% of women suffer, 40 to 50% of women suffer from a kind of a category called the Baby blues. So it’s not necessarily severe depression, but it’s a change in mood. It’s it’s not a positive experience. And then when you start looking at actual depression, you know, we will see numbers one of eight women suffer from from severe postpartum depression. So when you start looking at these numbers and the fact that we’re all you know, it’s not just, you know, number one, we have to we have to give women the care and the resources they need right now. When you look at the structure of pregnancy, women see the doctor six weeks after their postpartum visit. They get 15 minutes, 15 minutes to dissect and unpack the huge change that’s happened in their life. They now have a screaming baby at home. Their partner might be helping or not helping.

John L. Hanson Jr. [00:27:45] Juan Pablo Segura, co-founder of the Washington, DC based Babyscripts. If you have questions, comments or suggestions about the future In Black America programs, email us at In Black America educated that org. Also, let us know what radio station you heard is over. Remember to like us on Facebook and follow us on Twitter. The views and opinions expressed on this program are not necessarily those of the station or of the University of Texas at Austin. You can hear previous programs online at Kuchi that ohaji. Until we had the opportunity again for technical producer David Alvarez. I’m John L. Hanson Jr. Thank you for joining us today. Please join us again next week.

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