Health equity in motion with Dr. L’Tricia Chery
Through conversations with Point32Health colleagues, our Health Equity in Motion series shines a light on health inequities happening within our communities and across the United States, as well as ways that we’re aiming to advance health equity for our members.
Dr. L’Tricia Chery, MD, is a medical director in clinicals reviews for Point32Health and a board-certified obstetrician and gynecologist. Having worked in both the both provider and health plan settings, she has a unique understanding of what an individual might experience as a patient and as a health plan member—particularly when it comes to maternal health care. We recently spoke with Dr. Chery to learn more about her role at Point32Health and gain better insights into the state of maternal health, including how we, as an organization, are working to improve maternal health disparities.
Q: At Point32Health, you currently work as a medical director in clinical reviews. What does your role entail?
Dr. L’Tricia Chery, MD: The medical directors in clinical reviews at Point32Health are board-certified physicians of various specialties who use their medical knowledge and clinical experience to assist members of our health plans in determining when a requested health care service is considered medically necessary for a member’s medical conditions. My specialty is in obstetrics and gynecology so, at times, I am focused on maternal health care services and conditions.
With the support of medical nurses and behavioral health specialists from our utilization management team who refer cases in which there is a question of whether a covered service is medically indicated, the medical director reviews the clinical information submitted by the member’s providers and the member to evaluate whether the requested service meets standards of medical practice or if a member has a unique clinical circumstance which warrants coverage of the requested service. In some cases, we discuss requested health care services with the provider, as a discussion can provide a more individualized perspective of the member’s medical, behavioral health and social conditions and needs.
Additionally, we provide a clinical perspective to various functions within the company, such as reviewing adverse health outcomes to assist in providing recommendations to individual providers and health care systems. We also provide clinical expertise in our specialty for medical policies implementation, including discussing the various aspects of the policies with external medical consultants.
Q: As a board-certified OBGYN, why is it important for a health plan to have clinicians within its workforce?
LC: Clinicians not only have medical training within their specialty, but we have experiences with individual patients, patient populations, colleagues (providers), health care systems and public health and research. When working on the health plan side, our experience is a great tool to pull from to help develop and advocate for benefits, programs, initiatives, policies—and ultimately, better health outcomes—for members. Point32Health clinicians, which include licensed clinical social workers, licensed mental health providers, nurses, pharmacists, physical and occupational therapists, physicians and psychologists, have an essential role to support the organization’s vision in connecting all people in our communities to personalized solutions that empower healthier living.
As clinicians at Point32Health, we collaborate with various departments from claims to actuary, member services to providers services, clinical innovations to medical polices and utilization management. We assist in facilitating external communications and productive interactions to create bridges to external stakeholders, including government agencies, provider groups and health care systems that allow the company to better serve our members and impact the health of the communities in which they live.
Q: Maternal health disparities continue to occur in the United States. In your opinion, what are some of the biggest barriers pregnant people face when it comes to accessing health care?
LC: Maternal health care is technically covered and therefore accessible to all patients in the United States when they become pregnant. Yet, the quality of care and extent of the access of care—and, as a result, the quality of health—differs amongst patient populations. For example, in the United States, American Indian and Alaska Native individuals are two times more likely—and Black women are three times more likely—to die of pregnancy-related causes than white women.
Optimizing the quality of life of those who have less resources, which is directly related to the health outcomes, benefits the overall health of everyone in the population.
The quality of maternal health starts prior to pregnancy, beginning with the conception of the individual who eventually becomes pregnant. Optimizing the quality of life of those who have less resources, which is directly related to the health outcomes, benefits the overall health of everyone in the population. The social determinants of health, which reflect the quality of living, identify some of the barriers to overcoming adverse health outcomes of all people, including those who are pregnant. A prosperous living environment with lack of violence, air and noise pollution, as well as access to safe, affordable, and high-quality housing, food, education, transportation, employment and medical care (particularly behavioral health services and for those in rural areas), is the framework for promoting holistic well-being with healthy pregnancies and infants.
Another major barrier is the societal infrastructure that propagates discrimination, whether based on education, economics, ethnicity, gender, language, race or other numerous factors. As the infrastructure penetrates all aspects of society, interactions between patients/members and individuals who contribute to the access and provision of care (from the front desk personnel of a medical office to the physician in the hospital to the administrator of health care systems who implements policies) can positively or negatively influence the health of the patient/member. Can a patient/member trust the individuals within the health care system to listen and understand their individual medical, behavioral health and social needs? Can the patient/member trust health care providers to treat them in the same manner that health care providers would treat a beloved family member? Will the provider tailor evaluations and interventions that optimize outcomes for a single person who is pregnant, without a health care provider’s biases influencing their action or inaction? As those in health care take steps to examine programs, initiatives and policies to increase the quality of care, there is still the factor of 1:1 interactions that are required to implement every intervention and requires some person to have the heart to respect the well-being of a fellow person.
Q: Within our health plans, Harvard Pilgrim Health Care and Tufts Health Plan, are there any programs in place to support members who may be experiencing complicated pregnancies or have other maternal health needs?
LC: To improve and address disparities within maternal health, Point32Health has several programs and initiatives that are constantly evolving to enhance the care that we facilitate for our members and community. We have a dedicated team of obstetric care managers (nurses that specialize in obstetrics) who identify members with high-risk pregnancy conditions and provide additional support throughout their pregnancies. The team works to educate members about their individualized condition and recommendations that are advised by the member’s provider. They assist the member in accessing benefits and health care services, and focus on topics such as increasing prenatal and postpartum visits and screenings for postpartum depression. Point32Health care managers have a 24-hour nurse line where members can reach out with any questions or concerns. Care managers also assist eligible members in accessing doula services. Additionally, Point32Health has community health workers, who aide members with addressing social determinants of health needs, such as housing, accessing healthier foods and transportation to health care appointments.
Whether a member is currently pregnant, trying to get pregnant, has recently delivered or is experiencing a pregnancy loss, Point32Health offers support through our collaboration with Ovia Health to eligible members. Ovia Health is an online platform for family health including fertility, pregnancy, parenting and menopause. The Ovia Health app offers educational resources including live seminars, as well as unlimited support via the app’s asynchronous messaging service to ask health care experts questions anonymously and get connected to in-network providers.
We [at Point32Health] work to understand and address social determinants of health for members in all life stages, including those seeking maternal health care.
We work to understand and address social determinants of health for members in all stages of life, including those seeking maternal health care. The Harvard Pilgrim Health Care Institute’s Department of Population Medicine, which is a collaboration between Point32Health company Harvard Pilgrim Health Care and Harvard Medical School, is also focused on innovative teaching and research to address health care issues like maternal health.
Q: What’s one piece of advice you’d give those who are either pregnant or postpartum?
LC: My advice is applicable to not only those who are pregnant and postpartum, but all patients or members who have a health condition:
Create a support system of people who not only have sincere intentions to elevate you through words and deeds, but also have knowledge and experience in guiding you to your health care goals. Your support system can include friends and family but can also come in other forms like online or in-person maternity support groups. Health care providers, including social workers, therapists, doulas, certified midwives and physicians can be sources as well. Some providers even offer group prenatal visits—and there are childbirth classes and breastfeeding classes, in which the instructor and fellow attendees can be a source of knowledge and direction. The importance lies in selecting people who can provide sound insight and encourage you to make health care and other types of life choices that are best for your individual situation.
To hear more from Dr. Chery on the state of maternal health, check out “Expanding Care Options for Mothers of Color,” a virtual panel discussion part of the Boston Globe’s Health Equity Week: