Steve Calvin M.D. on pregnancy care, health care reform, and innovation

News about shopping in pregnancy

Even though I live where Target Corp is headquartered I missed this:

New York Times: How Companies Learn Your Secrets

We know that retailers know a great deal about us.   Apparently Target developed a tool that diagnoses pregnancy based on shopping habits – much to the surprise of the father of a teenage girl in Minneapolis.   Since this story broke Target has been mum.

This story raises all kinds of concerns.  Many are addressed in Doc Searls’ fabulous new book,” The Intention Economy”.   But the topic of shopping and pregnancy makes me wonder whether (and how) mothers shop for pregnancy care.  Given that the current pregnancy care system is a classic confusopoly it is not likely to be easy.   I’d be happy to hear any insights on the topic.

What is the goal of pregnancy care?

Yesterday we met with the president of Minnesota Community Measurement ( to discuss what pregnancy care measurements would be most valuable as Minnesota leads the way in pregnancy care reform.  Cesarean section rates are obviously a major focus but it occurred to us that there is a more valuable measure that would help mothers choose care and to help providers and systems improve.  That measure would be the percentage of mothers who are able to accomplish a vaginal birth at term – maybe we could call it the “optimal pregnancy outcome” measure.   This goal seems self-evident but sometimes our real priorities get buried in the confusion of the current system.

It’s always better to be known for what you are for than for what you are against.  We should all be for safe, satisfying, and cost-effective pregnancy care.  And we all know that cesarean section birth for more than one in three mothers is a bad thing.  The recent focus on maternal and newborn risks of elective induction of labor as well as support for the option of vaginal birth after cesarean section will be helpful in slowing the growth in the cesarean section rate.   But our efforts to stop the behaviors that increase cesarean sections should be accompanied by active promotion of the things that will increase the chances for an optimal pregnancy outcome (OPO) of vaginal birth at term.   Read Henci Goer and Amy Romano’s book.

What is real pregnancy care innovation?

Some innovations are real steps forward and some just sustain the current system.  A recent interview with a high tech pregnancy care company CEO is revealing:

The interview is a bit long but it is pretty clear that this CEO actually believes that his company is involved in real innovation.  All the buzz words are used,  such as “solution” and  “disruptive innovation”.   Essentially this company provides algorithms to read continuous fetal monitoring strips and to suggest clinical responses.  As a maternal-fetal medicine specialist I know that some babies clearly benefit from continuous monitoring.  Unfortunately this company’s business model is based on the assumption that this is the case for every baby.  There is no mention of the clear evidence that continuous fetal monitoring for normal pregnancies has risks for iatrogenic harm to mothers and babies.

Two other things caught my eye.  The interview discusses the concept of a “remote OB hospitalist” as one solution to the decreasing number of OB MDs.  No mention of midwives and a team approach.  The CEO also acknowledges that budgets are tight but then goes on to say that, “Our ability to show that there were complications in the labor portion, we think, is going to allow hospitals to correctly charge and code their DRGs and establish some top-line revenue growth as well.  Obstetrics is one of the biggest offenders in “innovating” its way to a more costly and complicated system.   This won’t be a step forward.


Breaking up the confusopoly in pregnancy care

Confusopoly is a term given to us by the cartoonist creator of Dilbert.

It is well described here:

Confusopolies deserve our laughter, but they are a serious problem in all areas of commerce.  Especially in healthcare.  Nearly every mother has horror stories about confusing billing experiences with insurers, providers, and hospitals.  Only in medical care do you embark upon a 9 month journey with so little idea of what things will cost.  The future of pregnancy care is going to look very different.   Comprehensive care by a team for a single package price is where we are headed.  Stay tuned.