When Kirsten Kessler had her first child 10 years ago, she hired a doula to guide her through experience. Things didn’t go as planned.
Her water broke before she was full term and labor didn’t start. The doula provided resources and support as Kessler was confronted with a series of decisions about her care. “In the end, the labor went as close as possible to what I wanted: a natural birth,” Kessler says. “If I hadn’t had Maria by my side, I probably would have had a C-section.”
Kessler is the founder and CEO of an early-stage startup called Alimus. The company’s objective is to improve maternal-fetal health outcomes — before, during, and after birth — by providing quality-controlled birth doulas covered by health care payers.
Alimus is one of three startups chosen in the first cohort of the Blue Cross and Blue Shield of Illinois (BCBSIL) Innovation Accelerator program. BCBSIL teamed up with MATTER, a Chicago-based global health care incubator and corporate innovation accelerator, to identify solutions that can influence health care beyond the doctor’s office.
Kessler, a Harvard-trained business consultant, is an expert at research and financial analysis. She put those skills to work pursuing her personal interest in helping more women gain access to the support of a doula during pregnancy and childbirth.
Building the business case
Randomized controlled trials, she learned, showed doulas reduced the likelihood of medical interventions during childbirth. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have endorsed the conclusion that support from a doula is “is one of the most effective tools” to improve outcomes for mothers and babies.
Mounting evidence has made it clear that Black women are three times more likely than white women to die during and after childbirth — and that providing doulas helps address that disparity.
And, she contends, having a doula present reduces costs of labor and delivery — most of which are paid by employers, insurers and state Medicaid programs. “I couldn’t understand why we operated in a model where it’s the expecting parent who has to pay for the doula.”
The Alimus concept is to build a network of quality doulas that could be offered to health plan members as a benefit to reduce adverse outcomes, decrease costs and improve the overall experience.
Each company in the accelerator program received $25,000 and was teamed up with three senior leaders at BCBSIL to help inform their value proposition for health care payers. The three-month program culminated in a virtual Demo Day in October. Alimus and the other two startups gave overviews of their solutions and shared what they learned.
Refining the approach
The mentors assigned to Alimus have deep experience in key areas of the industry: Krishna Ramachandran is divisional senior vice president, Illinois health care delivery. Latonia Walker is a divisional vice president in clinical operations, helping ensure members get appropriate care, and also works on innovation and strategy. And Alicia Coronas is a divisional vice president in product solutions — meaning she puts together options for large employer customers to customize benefits for their populations.
Coronas says she liked Kessler’s idea. “I understood the need to focus on maternal health, especially given the inequities in that area. There’s starting to be increased awareness, but there’s not a full slate of solutions yet.”
She also thought the service could be attractive to employers eager to attract and retain women employees. Plus, Kessler’s analysis suggests health plans can save money by avoiding unnecessary medical interventions and complications.
The mentors connected Kessler with others in the company who work on BCBSIL’s program that supports pregnant women and new moms. “They explained how we measure success and gave her some examples of metrics she could use to ensure she’s really quantifying value in a way that could be compared with other types of programs we look at as an insurer,” Coronas says.
The mentors also helped Kessler think through different payment models and other considerations that may vary, for example, if women have their insurance through a large group plan or a small business. The differences — and challenges — may be even bigger for Medicaid, where there may be the greatest need, Coronas says.
Walker is a nurse and understands the services doulas provide and the impact they can have.
“I think it’s a high-priority need, and if it's not a benefit within their insurance plan, most people don't have the money to pay for it,” Walker says. “Being able to have this person who walks alongside them throughout their entire pregnancy — not a medical person, but someone arming them with the right information so that they can have a more successful birth — I thought this was a great idea.”
Walker adds, though, that it won’t be easy to put together and maintain a diverse network of doulas who reliably contribute to positive outcomes and experiences. “I do think it’s going to be a heavy lift for her,” she says. “But if she does it, it makes it easier for any payer to contract with her.”
