PROBLEM STATEMENTS:

(a) Tennessee had the highest aggregate maternal mortality rate from 2019 to 2023, with 42.1 deaths per 100,000 births, followed by Louisiana (40.7) and Mississippi (39.7). California had the lowest, 10.1, and Minnesota was second-lowest with 14.1.

(b) A lack of access to quality maternity care is a critical component of maternal health and positive birth outcomes, especially in light of the high rates of maternal mortality and severe maternal morbidity in the U.S.

(c) Access to care during pregnancy and around the time of birth is not consistently available across the country. Hospital closures and a shortage of providers are driving changes in maternity care access, especially within rural areas and among Black, Indigenous, and people of color (BIPOC). The level of maternity care access within each county is classified across Tennessee by the availability of birthing facilities, maternity care providers, and the percentage of uninsured women. In Tennessee, 32.6 percent of counties are defined as maternity care deserts compared to 32.6 percent of counties in the U.S. overall.

(d) In Tennessee, there was a 6.3% decrease in the number of birthing hospitals between 2020 and 2019. •

(e) In Tennessee, there were 5,651 babies born in maternity care deserts, 6.9% of all births. 4.7% of babies were born to women who live in rural counties, while 1.3% of maternity care providers practice in rural counties in Tennessee.

(f) In Tennessee, 32.6 percent of counties are defined as maternity care deserts compared to 32.6 percent in the U.S. 27.0 percent of women had no birthing hospital within 30 minutes compared to 9.7 percent in the U.S. 

(g) Overall, women in Tennessee have a moderate vulnerability to adverse outcomes due to the availability of reproductive healthcare services.

(h) 17.0 percent of birthing people received no or inadequate prenatal care, greater than the U.S. rate of 14.8 percent.

(i) Women with chronic health conditions have a 50 percent increased likelihood of preterm birth compared to women with none.

In response to the lack of pediatric care in rural counties, Atwater will launch new telehealth programs: a virtual consultation with a pediatric specialist, a smartphone app that encourages healthy behaviors, and technology that allows a doctor to track a child’s vital signs from hundreds of miles away.

Using digital tools and programs, caregivers can provide long-distance clinical care and health education. With telecommunications technologies, they reach patients in homes, schools, workplaces, and local primary care practices. More than half of U.S. hospitals now have a telehealth program, according to the American Telemedicine Association. 

The growth in telehealth comes when millions of Americans face challenges accessing health care. Many rural areas lack child and maternal health providers, even as studies show that kids treated by caregivers with pediatric training and experience have better health care outcomes. Moreover, research indicates that children and pregnant mothers receiving treatment closer to home fare better than those traveling long distances.

RURAL MATERNITY CARE DESERTS:

Tennessee is considered a state with significant maternity care deserts, with roughly 32% to 36.8% of its counties lacking access to adequate maternity care, particularly in rural areas. Nearly half of Tennessee counties lack OB-GYNs, and over 27% of women live more than 30 minutes from a birthing hospital.

Tennessee Maternity Care Data:

• High Desert Prevalence: More than 30% of Tennessee counties have no hospital-based obstetric care or obstetric providers.

• Rural Access Crisis: Over half of all rural Tennessee hospitals no longer deliver babies, contributing to a "maternity care desert".

• High Risk Factors: 17% of birthing people receive inadequate prenatal care.

• Poor Outcomes: Tennessee is among the states with high maternal mortality rates.

• Impact on Care: Pregnant individuals in rural Tennessee face increased risks of preterm birth, delayed care, and higher transportation challenges, with over 5,600 babies born in these deserts annually.

ATWATER'S GOAL AND STRATEGIES:

• Change the poor trajectory of the quality of care rural mothers and babies are receiving. Health care should be a human right.

• The allocation of approximately $100 Million from TANF funds would be distributed to all rural counties where hospitals have closed. Wrap-around holistic programs, such as food SNACK kiosks, hearing and eye vision screening, would be integrated to address the nutritional aspect of these rural children.

• This innovative strategy to meet the needs of rural counties with hospital closures could be the largest provider of acute and specialty telemedicine, which would work with hospitals, outpatient clinics, and physician practices to provide telemedicine services in neurology, behavioral health, hospitalist medicine, pulmonary and critical care, maternal-fetal medicine, infectious disease, cardiology, nephrology, and endocrinology.

• Dependable Tennessee Pediatric TeleHospitalist Services: The Tennessee telemedicine hospitalists will manage all aspects of an inpatient’s care and are the hospital’s partners in directing hospital utilization to optimize outcomes and quality. The TeleHospitalist service line will consist of purely telemedicine and hybrid (in-person and telemedicine) programs for both daytime and nighttime coverage.

• Improving access to rural communities is one of the greatest benefits of telemedicine.

• Specialty telemedicine could address rural hospital closures due to workforce shortages, Medicaid's downfalls, reduce transfers, and care for more patients close to home, which would not otherwise have any medical care.

• To reduce costs and barriers to receiving care while also improving outcomes.

• To develop partnerships with rural providers across the region, allowing them to more easily consult with our expert sub-specialists on complex pediatric health issues.

• Work with every partner hospital to make telemedicine programs financially feasible to implement and, more importantly, to sustain.

• Obtain and maintain partnerships with a pediatric practice in large metropolitan districts, which would give virtual access to pediatric specialists in rural counties for area children with complex care needs using digital otoscopes and stethoscopes. Specialists could conduct full exams on patients hundreds of miles away. 

• Using modern technology, to view real-time ultrasound images in a clinic in Tennessee, where the patient is sitting with an ultrasound technician 250 miles away. By using video conferencing technologies, specialists and physicians could see live imaging of the baby in rural counties.

  This “virtual clinic” for fetal heart anomalies has saved expectant mothers hundreds of hours of driving time and countless moments of worry.

• This Rural Pediatric Telehealth will be about innovation and stretching the limits of what is possible in struggling rural areas that deserve ample medical care for children. This strategy will be one of the most life-altering things we do to better the livelihood of rural children.

• EHR Compatibility and Integration

  Tennessee Rural Pediatric Telehealth Access will focus on the importance of working natively in each facility’s EHR. All of the specialists or physicians, without exception, document in real time in the hospital’s EHR. This approach would decrease the time to implementation. More importantly, it would build rapport between onsite and online clinicians, reducing waste and inefficiency, which led to rural hospital closures. As part of the training program for new participating physicians to excel in telemedicine, the telehealth program would include knowledge of and familiarity with all leading EHRs.

• Billing and Revenue Cycle

  Tennessee Rural Pediatric Telehealth Access would have a dedicated in-house team to manage payer contracting and payer credentialing. Have the capacity to acquire payer contracts and participate in Medicare and Medicaid programs interchangeably with rural counties and municipal districts. Tennessee Rural Pediatric Telehealth Access will have an acute telemedicine provider with an in-house strategy for payer contracting and credentialing. The offsets gained by maximizing billing and collecting will help make the telemedicine programs more affordable for hospitals and rural participants.

• Community Engagement

  The rural community will be a key stakeholder in the Rural Pediatric Telemedicine Program’s success. If partner hospitals want to retain more of their rural patients by offering a telemedicine service line, potential rural patients need to understand that service, how it works, and the level of care they can expect. Partner hospital providers would meet with potential patients before program launch to answer questions, allow meetings with the doctors, specialists, or technicians, and demonstrate the technology.

• Critical Assessment for Rural Counties: The U.S. projects a shortage of more than 34,000 specialty physicians by 2034. Forty percent of physicians will reach retirement age in the next decade, and in rural communities, nine percent of physicians will be asked to care for almost a quarter of Americans.

WRAP-AROUND SERVICES:

1. Affordable Housing

2. Rural Broadband Accessibility

3. Satellite Food Kiosk Services

4. Hearing and Eye Vision Screening

5. Autism Outreach Care

6. Prenatal and Postnatal Care Programs

7. Postpartum Depression Outreach

8. Doula Training

9. Midwife Accessibility Program

10. Diaper and Formula Pantry

11. First Aid and CPR Training - Introductory and Advanced

12. Mental Health Counseling

13. Domestic Violence Outreach

14. Drug Addiction Counselling

15. Continuing Education Programs - AI-Infused Certificates & Solar Panel Installation Certification

16. CNA and Medical Billing Certification