Nest Health, a provider of in-home family healthcare for Medicaid beneficiaries, is rolling out a program for prenatal care and midwifery services.
The new offering, Nest Origin, aims to address the root causes of poor maternal outcomes. Women will get in-home and virtual prenatal visits with certified nurse midwives, including routine prenatal care, screenings and fetal monitoring. The program is available to select managed Medicaid members in New Orleans, with the goal of expanding to more markets.
Nest Health was founded in 2022 and serves 30,000 patients across Arizona and Louisiana. Prenatal care is the latest addition to Nest’s range of services that already include postpartum infant, reproductive, mental health and social care. Nest is contracted with two managed care plans in the state: Aetna and AmeriHealth Caritas. Those members are currently eligible for Nest services.
Louisiana had the highest maternal mortality rate in the U.S. in 2023, according to a recent report from The Commonwealth Fund. Being pregnant with unmanaged health and social needs increases the risk of complications, Nest executives said. But the traditional healthcare ecosystem does not make it easy to address these needs in an integrated way.
“We know that a major part of those poor outcomes in pregnancy is because women are not able to get care,” Rebekah Gee, M.D., M.P.H., Nest founder and CEO, told Fierce Healthcare. Most pregnancy deaths in the U.S. are preventable.
The American College of Obstetricians and Gynecologists recommends nine prenatal visits, which Nest Origin offers. That can be a considerable ask of women who may be juggling work and transportation or childcare challenges.
Gee was previously secretary of health in Louisiana, leading the state’s Medicaid expansion efforts. “My takeaway after a decade of doing that work is that if women aren’t healthy and supported before, during and after pregnancy, there's only so much we can do in an office setting for these patients,” she said. A patient with a hip replacement gets more resources than a new mom in the U.S., Gee noted. “We need to change the care model, and change the way that women think about being cared for in pregnancy,” she said.
In addition to home services, Nest provides virtual behavioral health, primary care and specialty care services. It offers some social services in-house, while outsourcing the rest to community-based organizations. Nest can also arrange pharmacy delivery to the home.
Being in the home can illuminate some real vulnerabilities that patients might never reveal in an office setting. A leading preventable cause of pregnancy-related death in Louisiana, Gee said, is intimate partner violence. Nest also offers longer visits at home, which allows trust to be built over time. Nest patients reflect the ethnic makeup of New Orleans, which is predominantly Black, and tend to skew toward the lower end of the economic spectrum and to have more social needs.
Since Nest does not oversee labor and delivery, it coordinates with hospital-based obstetric providers to ensure seamless transitions of care. Following birth, Nest clinicians return to the home within days to provide postpartum and infant care, including immunizations. Services include physical assessments, lactation support, mental healthcare and ongoing monitoring for postpartum complications.
Nest Origin outcomes will be studied by researchers at the University of Pennsylvania alongside a control group, Gee said. The company expects to serve 100 pregnant women in the first year.
Nest is seeing promising results already. The company has achieved a 60% reduction in ED use, and claims a 2:1 ROI for AmeriHealth Caritas Louisiana. It expects greater savings with Nest Origin. In all, 93% of calls to Nest’s virtual care line have avoided an escalation in care. Nest also achieves twice the state baseline on immunizations in Louisiana.
Managed care organizations pay Nest a case rate per pregnancy. Nest Origin, plus Nest’s reproductive care services, are also supported by the David and Lucile Packard Foundation. The grant funding allows the company to innovate on programming without necessarily dipping into the capital they’ve raised (about $43 million), per Gee.
“There’s so much focus on the pregnancy deserts and poor maternal outcomes,” Gee said, “but if we as a nation really want to improve maternal health outcomes, we have to focus on treasuring and supporting women.”