Latest / CareTalk: Healthcare. Unfiltered. / The Maternal Health Crisis America Can’t Ignore w/ Dr. Neel Shah, Maven Clinic

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The Maternal Health Crisis America Can’t Ignore w/ Dr. Neel Shah, Maven Clinic · CareTalk: Healthcare. Unfiltered.

• 0:07
  Welcome to Care Talk, America's home for incisive debate on healthcare, business, and politics.
• 0:12
  I'm John Driscoll, the chair of the UConn Health System, and this morning we have Dr.
• 0:17
  Neel Shah.
• 0:18
  Welcome, Neel.
• 0:20
  Thanks for having me, John Neel is the founding chief medical officer at the famed Maven Health Clinic, but is now involved in some pathbreaking work, we hope, um, to deliver better maternal and child outcomes in the United States.
• 0:35
  And we're gonna dig into all of that in the show today.
• 0:38
  But Neel, perhaps we could start with a little bit about your background.
• 0:42
  I mean, where'd you grow up, and how'd you get interested in medicine?
• 0:45
  I grew up in New Jersey.
• 0:47
  Uh, and as an Indian kid from New Jersey, obviously I went to medical school.
• 0:51
  So my parents came here on an H-1B visa in the late 1970s.
• 0:54
  My dad is an engineer.
• 0:55
  My mom's a dentist.
• 0:57
  Um, my, my dad's one of five, my mom's one of seven, so a lot of cousins.
• 1:02
  In fact, our mutual friend, Kate Ryder, may be the only person with more cousins than me.
• 1:06
  Um, and, uh, you know, the-- I, I went to medical school because, um, I had a lot of examples in my Indian uncles and aunties of, of people who, who took that on as a noble profession.
• 1:20
  Um, but that was actually the last predictable thing that happened in my career.
• 1:24
  Um, uh, about halfway into medical school in the mid-aughts, there was this freshman senator from Illinois who wanted to run for president, and he had no chance of winning 'cause Hillary Clinton was obviously gonna be the nominee in 2008.
• 1:37
  Um, but I signed up for that campaign early.
• 1:39
  Uh, it was my first startup.
• 1:41
  It was the first-ever digital campaign.
• 1:43
  It was the first time 18 to 22-year-olds were a meaningful voting bloc.
• 1:46
  Um, and even though I hadn't finished medical school yet, I learned that policymakers are like astronomers looking through a telescope at a planet that I lived on, and I could tell them things that they didn't know.
• 1:58
  Um, and in particular, one of the things I took away from that was that so much of the lead-up to the Affordable Care Act was about Medicare recipients, people over 65.
• 2:08
  And I was in a phase of life where my friends and family were starting and growing their families, and I thought all that work should apply to that generation of people, too.
• 2:17
  And my take to this day is that our politics can be well explained by how we do and don't attend to the needs of people in that phase of life.
• 2:26
  Um, but that's ultimately what, what brought me into OBGYN as a field and, uh, kind of propelled a career where I was working on fixing that part of the system.
• 2:35
  So why didn't you stay in politics?
• 2:37
  It sounds like you were quite inspired and, and then the good guys won.
• 2:41
  Oh wait, my view.
• 2:42
  Yeah, I mean, my, my side won.
• 2:43
  And you know, it's funny, um, back then it was the early days of Facebook, um, and so your friends on Facebook were your actual friends and everything was very linear.
• 2:52
  And I remember being an intern at Mass General, like overnight, working really, really hard and seeing my friends doing really inspiring thing.
• 2:59
  I was like, "Why, why did I go back to practicing in the trenches?" But I got great advice, uh, from a mentor who told me-- I thought it was my generation's crack at healthcare reform, and he told me that if I wanted to be a doctor, now was the time to do it, and that there'd be plenty to do uh, when I finished my training, and he turned out to be right.
• 3:17
  So… For our listeners, maybe explain what Maven is.
• 3:21
  Yeah, sure.
• 3:23
  Uh, so Maven is the world's largest virtual clinic for women and families.
• 3:26
  We take care of nearly 30 million people around the world in 175 countries.
• 3:30
  Um, we're not a condition-based company, we're a phase-of-life company.
• 3:34
  What that means, we care for people when they're, uh, trying to conceive and start their family, when they're pregnant.
• 3:40
  We have a parenting and pediatrics product all the way up through midlife.
• 3:44
  When you guys-- What you guys built is a pathbreaking female-focused he- online healthcare clinic, which, you know, we all-- But any, any wonks, nerds know, healthcare nerds know that women are perpetually underserved by the healthcare system.
• 4:00
  It was a really pathbreaking company for you.
• 4:04
  Yeah, in many ways.
• 4:05
  I would say a glass ceiling-breaking company in many ways too, because as a category, women's and family health hadn't been invested in in that level, and that's one of the ways that I think Kate really broke ground.
• 4:15
  Um, and when I joined the company, actually, we were well underway.
• 4:19
  Um, I spent the first part of my career as a professor at Harvard Medical School.
• 4:23
  I was one of the people who surfaced the fact that maternal outcomes in our country are not only not good, but they're getting worse.
• 4:29
  And, um, the opportunity at Maven was to take all of this capability in the digital world and use it to give people better access and ultimately make outcomes better.
• 4:40
  And were you at, um, the, the sort of the Ariadne Labs before you got to Maven?
• 4:48
  Yeah.
• 4:49
  Yeah, so I- And maybe, maybe just, just de-describe, you know, the Checklist Manifesto guy and kinda what Ariadne Labs is.
• 4:57
  Yeah.
• 4:57
  So I was, um, you know, a resident in OBGYN at Mass General and Brigham Women's Hospital.
• 5:02
  Um, I was-- There, there was 11 residents per class, and I'm pretty sure I was the 11th.
• 5:07
  I was like the black sheep experiment.
• 5:09
  Um, and, uh, Atul Gawande was a surgeon at my hospital who, uh, was most famous, I think, for being a writer at The New Yorker and writing a number of books.
• 5:19
  But he created something called the Surgical Safety Checklist, where in the same way that a pilot has to run a checklist before they hit the throttle, a surgeon has to run a checklist before they pick up a scalpel.
• 5:29
  And it turns out doing that dropped mortality in half for every surgery on every continent.
• 5:35
  And after the smallpox vaccine, the WHO thought it was the most impactful thing they ever did.
• 5:40
  But pause there, and I mean, that's remarkable because it's literally just organizing and creating a checklist of what, what should be done.
• 5:51
  Yeah.
• 5:51
  And what, what's- It really had-- It cut mortality in half?
• 5:54
  In half.
• 5:54
  Yeah, because the biggest cause of suffering then and now is not lack of knowledge, John.
• 5:59
  It's lack of execution on the knowledge we already have, right?
• 6:02
  And it's literally just taking the things we know should happen for every person every time and actually making sure they happen.
• 6:08
  And Atul ended up becoming a great mentor of mine.
• 6:11
  We started a innovation institute called Ariadne Labs that was focused on bringing public health change at large scale.
• 6:19
  Uh, and I spent the first decade of my career, um, aiming to take lessons from the Surgical Safety Checklist and bring it to maternal health.
• 6:27
  And so you get to Maven.
• 6:30
  What kind of an impact have you had at Maven deploying the insights you had from teaching and doing research and, and taking sort of not just the lessons learned that I think Atul Gawande h-has, has-- writes about, but the practical lessons that he's recommended embedded in stories, but ultimately, uh, what's most impressive to your point are the results?
• 6:56
  Yeah.
• 6:56
  I mean, when I joined Maven, um, it was, you know, we were in the thick of the pandemic and, um, this is sort of my version of pandemic on Wii maybe or a midlife crisis.
• 7:09
  But, uh, I realized that health is not produced in the four walls of my hospital.
• 7:15
  It's produced in people's homes and in their communities and in their workplaces, and you could see who was most impacted by the pandemic with your naked eye.
• 7:22
  You know, it took every inequity in our society and threw it into a pressure cooker.
• 7:26
  And I started to see digital health not as Zooming with a doctor, but as a way of giving people access in the places where healthcare was produced.
• 7:34
  And so Kate and I had been talking for a number of years, but when the opportunity came, she was looking for a chief medical officer.
• 7:41
  Um, it's kind of funny because I think, you know, chief medical officer jobs can be a little bit fungible in digital health companies, and so we had a conversation about what a chief medical officer even was.
• 7:50
  Uh, and we decided there's two kinds.
• 7:52
  There's outdoor cats and indoor cats, you know, and the outdoor cats are very focused on like sales and growth and thought leadership, and the indoor cats were focused on the actual product and the operations of it.
• 8:03
  Uh, and we decided that I would be an indoor cat that was trusted to go outside.
• 8:07
  And honestly, it seemed like the greatest job in the world.
• 8:09
  I could, I could take all that digital capability and figure out how to wrap it around someone to make them healthier.
• 8:14
  And how effective were you guys at engaging folks digitally?
• 8:18
  'Cause one of the big challenges with, with digital engagement is while it exploded during the pandemic, it, it, it, it, you know, tipped the other direction post.
• 8:29
  And yet in the, in the, the post perpetual, perpetual and structural inconvenience of healthcare is that it's the opposite.
• 8:40
  I mean, listen, you can't deliver a baby through a screen, so there's real limits to what you can do in the digital world.
• 8:46
  Um, and you need brick-and-mortar infrastructure in healthcare.
• 8:51
  And also, there are things you can do in the digital world that you can't do in the physical world.
• 8:56
  For example, one of the capabilities we created at Maven was the ability to connect somebody to an expert within an hour, no matter where they are and no matter what time of day it is.
• 9:05
  That is nearly impossible without the economies of scale of the digital world, and what it creates is the ability to connect with a mom who's
• 9:13
  struggling to breastfeed at 2: 00 a.m.
• 9:13
  struggling to breastfeed at 2: when she actually needs the help, which otherwise would be impossible.
• 9:19
  struggling to breastfeed at 2: Or to find, um, you know, we, we served the Medicaid and exchange population in Arkansas, um, in parts of the country, uh, where you don't have access.
• 9:29
  struggling to breastfeed at 2: And if someone has gestational diabetes, for example, in that part of the country, they may not always have a nutritionist.
• 9:36
  struggling to breastfeed at 2: Um, but we can connect them to a nutritionist who can look through their phone at the refrigerator and help them plan a meal.
• 9:41
  struggling to breastfeed at 2: And, and just to give people a sense, gestational diabetes is a huge risk factor for, you know, pregnant, pregnant moms.
• 9:49
  struggling to breastfeed at 2: How common is it?
• 9:51
  struggling to breastfeed at 2: It's very common.
• 9:52
  struggling to breastfeed at 2: Um, about 15% of pregnancies, but much higher in certain parts of the country, like in the Heartland and the Southeast, and it's a strong driver of prematurity.
• 10:02
  struggling to breastfeed at 2: One of the leading causes, uh, associated with childbirth is babies that end up in the NICU.
• 10:07
  struggling to breastfeed at 2: A day in the NICU is like a week at the Ritz.
• 10:09
  struggling to breastfeed at 2: Um, and not to mention it's bad for everyone when the baby can't go home with their mom.
• 10:14
  struggling to breastfeed at 2: Um, and just connecting somebody with an expert that can support their nutrition can make the difference between going home with your baby and not.
• 10:22
  struggling to breastfeed at 2: And so how effective were you guys at Maven at c- at, at engaging folks digitally and keeping them engaged enough to actually drive better outcomes?
• 10:31
  struggling to breastfeed at 2: I'm really proud of this.
• 10:32
  struggling to breastfeed at 2: Uh, we not only were effective at, um… You know, a standard care management program, especially in a Medicaid plan, might engage 5 to 10% of people.
• 10:43
  struggling to breastfeed at 2: And in our populations, we were well over 50%, which is, uh, almost an order of magnitude better from an engagement perspective.
• 10:51
  struggling to breastfeed at 2: We also were able to lower C-section rates, um, and NICU rates and ER utilization.
• 10:57
  struggling to breastfeed at 2: We were able to improve mental health.
• 10:58
  struggling to breastfeed at 2: But the most, uh, exciting thing about the work is that we're able to do that at scale in very different populations, because at Maven, it was like sitting in the panopticon.
• 11:07
  struggling to breastfeed at 2: You know, we served retail businesses and technology businesses, and, uh, one of our clients, Amazon, has a baby every 12 minutes in Athens, Georgia, and Maharashtra, India, and we were able to produce those outcomes in all of those places.
• 11:20
  struggling to breastfeed at 2: Across multiple payers, medic, medic, uh, commercial as well as Medicaid?
• 11:25
  struggling to breastfeed at 2: That's right.
• 11:25
  struggling to breastfeed at 2: Yeah.
• 11:26
  struggling to breastfeed at 2: We worked with, uh, Medicaid plans, with fully insured plans, with self-funded insurers, and again, across really different sectors of the American economy.
• 11:35
  struggling to breastfeed at 2: And so how, uh, uh, you know, you're, you're in a unique position because of that to kinda give us a sense as to how the US is doing in terms of maternal and child outcomes versus the rest of the industrialized world.
• 11:47
  struggling to breastfeed at 2: How's the US doing in terms of maternal and child outcomes?
• 11:50
  struggling to breastfeed at 2: Man, John, we got a long way to go.
• 11:52
  struggling to breastfeed at 2: But, you know, part of the reason why I think the single best investment we can make in American prosperity is in maternal health is because maternal health- But wait a second.
• 12:01
  struggling to breastfeed at 2: We're the wealthiest country in the world.
• 12:03
  struggling to breastfeed at 2: We spend more money on, on healthcare than anyone else in the industrialized world.
• 12:08
  struggling to breastfeed at 2: I mean, only I think Norway is close, and, you know, the, the Norway's doing much better.
• 12:13
  struggling to breastfeed at 2: Like, how could we have poor, um, maternal and child and baby outcomes?
• 12:19
  struggling to breastfeed at 2: Well, uh, let me just say what the outcomes are first.
• 12:22
  struggling to breastfeed at 2: A mom today is 50% more likely to die in childbirth than her own mother was.
• 12:28
  struggling to breastfeed at 2: So it's not just that our outcomes are poor, but we have a generational erosion in outcomes.
• 12:33
  struggling to breastfeed at 2: When I was born in 1982, there were 41 hospitals or 4,100 hospitals in the country that delivered babies, and now there's half as many.
• 12:41
  struggling to breastfeed at 2: And it's because the economics, um, of healthcare in general, as you know better than anyone, John, are insensible.
• 12:48
  struggling to breastfeed at 2: But in childbirth, they're particularly rough because absurdly, a hospital loses money when they deliver babies.
• 12:56
  struggling to breastfeed at 2: Um, they carry the costs of having to wait for something to happen, but the top-line reimbursement has, uh, basically stayed flat as costs have gone up.
• 13:05
  struggling to breastfeed at 2: And so most hospitals that deliver babies are in the red, and we see hospitals shuttering.
• 13:09
  struggling to breastfeed at 2: So we have a big access issue, particularly in parts of the country where I'm spending a lot of time these days, where you have to drive farther to get to a hospital that's qualified to deliver your baby than you do at any point in Kenya, uh, in the middle of our country right now.
• 13:23
  struggling to breastfeed at 2: In the middle of U- the US, you have to drive farther to get to a hospital than- Than you might in Kenya the, than the average Kenyan would in the middle of Africa.
• 13:33
  struggling to breastfeed at 2: Well, the farthest that a, that a Kenyan would have to drive is three hours.
• 13:38
  struggling to breastfeed at 2: Um, and in our country, there are people who have to drive farther Insane.
• 13:43
  struggling to breastfeed at 2: So is the problem access or how the pregnancies are actually managed by the system or how moms, moms, you know, the, the, the, the, the illness or lack of preparation for moms going into pregnancy?
• 13:59
  struggling to breastfeed at 2: Well, maternal health is a bellwether for societal health, and so a lot of our deeper structural issues in our country, like poverty, are reflected in maternal health.
• 14:09
  struggling to breastfeed at 2: Racial inequity, all of that.
• 14:11
  struggling to breastfeed at 2: A Black mom is four times more likely to die consistently.
• 14:15
  struggling to breastfeed at 2: Um, that being said, there are three pieces of the puzzle.
• 14:19
  struggling to breastfeed at 2: One is you can't fix what you can't see, and our public health surveillance is a century old, and there's a two-year lag in even knowing what the maternal m-mortality rate is.
• 14:29
  struggling to breastfeed at 2: And we weren't even systematically measuring it until eight years ago.
• 14:33
  struggling to breastfeed at 2: So that's the first piece is our-- we need the right data infrastructure to see what the problem is.
• 14:39
  struggling to breastfeed at 2: The second piece is access, but it comes down to both hospitals and workforce, where we're losing both in this area.
• 14:46
  struggling to breastfeed at 2: And I would argue one of the highest value health services to society is probably helping families get started.
• 14:52
  struggling to breastfeed at 2: 25% of all hospitalizations are either a mom or a baby.
• 14:55
  struggling to breastfeed at 2: It's a big chunk of it.
• 14:57
  struggling to breastfeed at 2: Um, but we don't, we don't physically have the hospitals or the people to deliver the services.
• 15:03
  struggling to breastfeed at 2: And then the third part is what you're saying, and it gets back to the checklist manifesto, is making sure people are actually doing the right things.
• 15:10
  struggling to breastfeed at 2: So where do you start to solve that problem, Neel?
• 15:15
  struggling to breastfeed at 2: I think we've gotta hit all three.
• 15:17
  struggling to breastfeed at 2: And so, John, I was telling you before we jumped into the podcast part of this that, uh, three weeks ago I took a new role as the president of a bipartisan campaign called Healthy Moms, Healthy Babies America.
• 15:28
  struggling to breastfeed at 2: Um, it was seeded with an initial $100 million gift from Olivia Walton and Tom Walton.
• 15:34
  struggling to breastfeed at 2: And, uh, we plan to grow that, by the way, so it's the most capitalized philanthropic effort in the history of our country.
• 15:41
  struggling to breastfeed at 2: But then the question that you're asking is how you deploy those resources to get things done, and it really is along those three strategic pillars.
• 15:48
  struggling to breastfeed at 2: We're gonna invest in modernizing our data systems so that we can actually see in an actionable and contemporaneous way where, uh, we need to be paying attention.
• 15:58
  struggling to breastfeed at 2: We're gonna be investing in our workforce, and that means thinking holistically, not just OBGYNs like me, but midwives, which are the frontline, uh, professionals in the rest of the developed- Yeah, you're a lot more expensive to educate, Neel.
• 16:11
  struggling to breastfeed at 2: Yeah, and we're surgeons.
• 16:12
  struggling to breastfeed at 2: I mean, we take 99% of American women, we put them in environments that look like ICUs, and then we surround them by surgeons.
• 16:19
  struggling to breastfeed at 2: And so we do too much surgery and we create too much cost.
• 16:23
  struggling to breastfeed at 2: Um, so, uh, uh, and then of course we're gonna, um, invest in making sure hospitals are doing the right things.
• 16:31
  struggling to breastfeed at 2: I gently push back.
• 16:32
  struggling to breastfeed at 2: Neel, my understanding is that our maternal and child outcomes kinda suck for wealthy people a- as well as poor people, that if you hold income constant, the outcomes for people of color are still bad, even if you're a rich person living in the Upper East Side of New York City, uh, surrounded by some of the best healthcare in the world.
• 17:02
  struggling to breastfeed at 2: Like, why do you need better data?
• 17:04
  struggling to breastfeed at 2: I mean, don't we just know that we need to flood the zone with resources and actually execute better?
• 17:11
  struggling to breastfeed at 2: Because frankly, we're… I, I mean, my sense is we're in a crisis in America right now with that 50% decline in, in outcomes in one generation when we're spending- Let me be clear probably four times as much.
• 17:25
  struggling to breastfeed at 2: Now let me be clear, we're not waiting on data a- to act.
• 17:28
  struggling to breastfeed at 2: The CDC says 87% of these deaths are preventable, and we know exactly what we need to do to go after it.
• 17:35
  struggling to breastfeed at 2: Um, at the same time, let me give you an example.
• 17:37
  struggling to breastfeed at 2: My home state of New Jersey, where I grew up, um, highest per capita income in the country, like you're saying, also had the third highest maternal mortality rate in the country 10 years ago.
• 17:48
  struggling to breastfeed at 2: Um, and one of the reasons was that a lot of the burden was focused in Trenton, Camden, and Newark, three cities where there were huge racial disparities.
• 18:00
  struggling to breastfeed at 2: And by focusing there under Tammy Murphy's leadership when she was First Lady in New Jersey, and using the data to know where we had to focus, we brought New Jersey from 47th out of 50 states to 26, uh, in just a few short years.
• 18:15
  struggling to breastfeed at 2: That's where data- You know, Tammy is gonna be really happy.
• 18:18
  struggling to breastfeed at 2: I'm gonna send her this podcast.
• 18:19
  struggling to breastfeed at 2: She's gonna be delighted that somebody noticed in addition to the moms.
• 18:24
  struggling to breastfeed at 2: Yeah.
• 18:24
  struggling to breastfeed at 2: Because honestly, that move within a relatively short period of time was remarkable, Neel.
• 18:30
  struggling to breastfeed at 2: Were you involved there?
• 18:32
  struggling to breastfeed at 2: I was.
• 18:33
  struggling to breastfeed at 2: I had, I had the great honor- You were of being able to work a little bit with Tammy and really, um, you know, Tammy took her leadership in New Jersey to the National Governors Association.
• 18:41
  struggling to breastfeed at 2: And just again, contextually, Tammy was the First Lady of New Jersey.
• 18:44
  struggling to breastfeed at 2: She's married to Phil Murphy, who was a two-time g- Democratic Governor of New Jersey.
• 18:48
  struggling to breastfeed at 2: But it, the, what was remarkable to me is taking on a really hard issue, but one that's solvable, and putting her and the state behind it.
• 18:58
  struggling to breastfeed at 2: And it was really the focus on, on low income, the, the, the, the, the, the toughest communities that got the, that drove th- th- those outcomes, because it is pretty amazing.
• 19:07
  struggling to breastfeed at 2: Yeah.
• 19:07
  struggling to breastfeed at 2: It w- it was, it was a lot, a l- big part of it was concentrating in the places that need the most help, but then also putting the right programs in place.
• 19:13
  struggling to breastfeed at 2: For example, um, most of the mortality happens after the baby is born, um, in that full year postpartum.
• 19:21
  struggling to breastfeed at 2: And one of the programs that she invested in was home nursing services, which by the way, is something that happens automatically in parts of the world where they get much better outcomes, that you have somebody come to you to check in on you in that year.
• 19:33
  struggling to breastfeed at 2: And by the way, in that year, all the average American gets is a 15-minute visit six weeks later that only half of people bother to show up for, 'cause by the way, they're busy taking care of a newborn.
• 19:44
  struggling to breastfeed at 2: Uh, and so that simple paradigm shift, uh, made a really big difference.
• 19:49
  struggling to breastfeed at 2: And so now you're on, uh, on, um, the perch of what sounds, uh, uh, uh, of a great job to actually lead a nonprofit that's going to do what?
• 20:03
  struggling to breastfeed at 2: We're going to decrease maternal mortality in half within five years.
• 20:06
  struggling to breastfeed at 2: And the reason that that's possible, and it's not a moonshot, is that America can do hard things.
• 20:11
  struggling to breastfeed at 2: We eradicated polio when, uh, tens of thousands of kids were being crippled by polio by, uh, creating a vaccine and then having a mass inoculation campaign.
• 20:21
  struggling to breastfeed at 2: The difference here, though, is we don't need a scientific breakthrough.
• 20:24
  struggling to breastfeed at 2: We know what to do.
• 20:25
  struggling to breastfeed at 2: What we actually need is follow-through.
• 20:27
  struggling to breastfeed at 2: Uh, and so that's what we're gonna invest in.
• 20:30
  struggling to breastfeed at 2: So are you asking for a lot of money from the federal and state governments to do this?
• 20:35
  struggling to breastfeed at 2: Is it a money problem?
• 20:36
  struggling to breastfeed at 2: We're to take the money that's already appropriated and, uh, focus and coordinate it.
• 20:42
  struggling to breastfeed at 2: And so from an advocacy perspective, we're looking at federal legislation.
• 20:46
  struggling to breastfeed at 2: We have a, you know, legislative agenda, an administrative agenda.
• 20:49
  struggling to breastfeed at 2: We're also looking at what can get done at the state level.
• 20:52
  struggling to breastfeed at 2: Um, uh, but, you know, to your point, we're already outspending everyone else, and we're getting worse outcomes.
• 20:59
  struggling to breastfeed at 2: Um, uh, and so a big part of this is making sure that we're using the dollars that are appropriated in more sensible ways.
• 21:09
  struggling to breastfeed at 2: So maybe a, a quick lightning round to, to, to close us out, Dr. Neal.
• 21:15
  struggling to breastfeed at 2: What's your advice to the, to the, the, the, the first-time pregnant mom to help drive a better outcome?
• 21:25
  struggling to breastfeed at 2: I think that, um, you know, in 2026, most moms, most families are being inundated with hot takes on what they should do and what they shouldn't do, and they're coming in from all sources.
• 21:38
  struggling to breastfeed at 2: When I was in practice, we used to worry about Dr. Google, and now, like, we wish that it was Dr.
• 21:42
  struggling to breastfeed at 2: Google 'cause it's actually, like, TikTok and other secondary sources.
• 21:47
  struggling to breastfeed at 2: And so one of the things that I would, uh, recommend is as we're-- as people are being inundated is, um, to make sure that you're going to trusted sources of information, um, because I really do believe that being informed is, uh, um, uh, empowering in navigating, uh, um, a service that right now is underperformed.
• 22:10
  struggling to breastfeed at 2: But people are going to trusted sources.
• 22:12
  struggling to breastfeed at 2: You're sort of suggesting they're going to the wrong ones.
• 22:13
  struggling to breastfeed at 2: What's a trusted source that you would, that you would recommend?
• 22:17
  struggling to breastfeed at 2: I think that, um, you know, right now, uh, the standard public health sources are not the most trusted.
• 22:26
  struggling to breastfeed at 2: I understand that.
• 22:27
  struggling to breastfeed at 2: I also think that, um, the American College of OBGYN has done a remarkable job of navigating, uh, this moment where, you know, they may have a different point of view than the administration, but they're really staying l- laser-focused on what's in the best interest of the health of moms and babies.
• 22:48
  struggling to breastfeed at 2: So, okay, the American College, that-- Great.
• 22:51
  struggling to breastfeed at 2: Now, you're-- you, you, you-- we g- you-- we give you a magic wand, and you can do one thing at the federal level to change the arc of maternal and child outcomes, which are getting worse.
• 23:03
  struggling to breastfeed at 2: What would make it better?
• 23:06
  struggling to breastfeed at 2: Modernize Title V. Title V is something that most people have not heard of.
• 23:11
  struggling to breastfeed at 2: It's a state block grant.
• 23:12
  struggling to breastfeed at 2: It was created during the Franklin Delano Roosevelt administration.
• 23:16
  struggling to breastfeed at 2: It hasn't been updated since the '80s.
• 23:18
  struggling to breastfeed at 2: Um, but it is a primary source of funding at the state level for programs that support moms and families.
• 23:25
  struggling to breastfeed at 2: Uh, and I think there's a huge opportunity to take those already appropriated dollars and concentrate them in the ways that are most likely to move the needle.
• 23:33
  struggling to breastfeed at 2: For example, to get nurses, um, to be able to visit people's homes in that really difficult year after having a baby.
• 23:41
  struggling to breastfeed at 2: Okay, you're governor of a state.
• 23:42
  struggling to breastfeed at 2: You wanna drive the same kind of outcomes that you were able to participate in driving in New Jersey What are you gonna do?
• 23:51
  struggling to breastfeed at 2: We're gonna make sure that, uh, midwives are licensed in our state because only 37 out of 50, uh, offer licenses to all the types of midwives.
• 24:01
  struggling to breastfeed at 2: We're gonna make sure they get paid at parity, and we're gonna fix some of those structural issues that, uh, right now get in the way of having the workforce that we need.
• 24:09
  struggling to breastfeed at 2: Because at the end of the day, we need people to actually care for pregnant women in order to get our outcomes better.
• 24:15
  struggling to breastfeed at 2: Dr. Neel Shah, a full agenda, but one that America is screaming to pursue based on the, the, the, the horrible outcomes we've got.
• 24:24
  struggling to breastfeed at 2: There's, there's no more bipartisan, uh, issue, I think, than we all want healthy moms and healthy babies.
• 24:30
  struggling to breastfeed at 2: I think you couldn't be on a more important issue, but also one where we can make progress 'cause to your point, we know how to fix it.
• 24:36
  struggling to breastfeed at 2: Thanks for joining "Care Talk." Thank you, John.
• 24:38
  struggling to breastfeed at 2: I appreciate it.
• 24:40
  struggling to breastfeed at 2: If you like what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 24:45
  struggling to breastfeed at 2: I'm John Driscoll, the chairman of UConn Health, and this morning we've had the privilege of, of a, a great conversation with Dr. Neel Shah, who's leading a, a crucially important campaign to improve maternal and child outcomes in the US.
• 24:58
  struggling to breastfeed at 2: Thanks again.
• 25:00
  struggling to breastfeed at 2: Thank you.