Shyamali Choudhury is the VP of Partnerships at Pomelo Care, where she spearheads the company’s relationships with health plans and employers looking to address their populations’ maternity care gaps. Under her leadership, Pomelo has expanded its services nationally and is delivering measurable improvements in maternal and neonatal health. Pomelo has grown its covered lives to over 15 million, including over 1 in 6 Medicaid beneficiaries nationally, and recently acquired The Doula Network, the largest network of credentialed, in-network doulas in the United States.

Shyamali Choudhury, VP of Partnerships at Pomelo Care

The Pulse: Can you tell us about how Pomelo Care came about, what drew you to the mission, and your role at the company?

Shyamali Choudhury: I lead the growth and customer success of our partnerships with health plans and employers. I joined Pomelo as one of the first employees because I was excited about the potential to impact patient outcomes at scale. I believed this was possible because Pomelo has a unique model: we are a medical practice delivering 24/7 virtual multi-specialty care coupled with in-person doula care. This hybrid model offers holistic support to both moms and babies. Our virtual care teams are nurse-led, and we include OBs, midwives, perinatal mental health and nutrition, lactation, and then on the baby side we have pediatrics as well as a neonatal intensive care unit (NICU) specialization. And this holistic approach is new – there’s far too much siloing in healthcare.

As to how Pomelo came about: we all know there’s a maternal health crisis in this country, unfortunately. Outcome trends are moving in the wrong direction. We see higher rates of preterm birth and NICU utilization across the country, and the disparities are getting larger – particularly for Black families, where outcomes are worsening at a faster rate. So, the need for innovation is really clear. Across different types of medical care, there’s been incredible innovation. Oncology is a great example with so much investment and change in the standard of care and improvements that have made a difference for patients. Prenatal care hasn’t been like that. The standard of maternal care has remained the same over the past several decades. We saw the opportunity to better use data to power a virtual care delivery platform to address some of those gaps and better personalize care.

One of the most important ways to drive transformative change is to address all segments of the market and to be able to do so within the existing system. For healthcare delivery, that means through insurance coverage, which is how most patients are receiving their care. We do that by serving both Medicaid and commercial patients in our model.

The Pulse: What about Pomelo’s approach has resonated with payers and can you share any wisdom on best practices for contracting with these stakeholders?

SC: Just about every payer we speak with is so acutely aware of the challenges. Everyone is focused on the maternal health crisis, and payers have a front-row seat. They see growing maternal care deserts. They see members who have trouble accessing timely care, and they know that there’s often limited availability of the types of specialists that are needed. With Medicaid, it’s often the states that are setting goals around outcome improvements or needs to be addressed. In the commercial space, it’s the payer itself or employers who recognize the added support that’s needed or the challenges of rising NICU costs and seeking ways to move the needle.

One of the things that resonates most is how holistic our approach is, meaning that because we’re a medical practice and we can actually deliver care, we are able to not only identify risks, which is something that we do with the data that we have, but to actually deliver the care that addresses risk. If you take an example of a high score on a mental health screening, it can be really challenging, or often not possible, for a patient to find timely perinatal mental health care in-network near them. We’ve built that care into our care teams, so we’re able to close the loop very directly. A crucial component of how we do this is that we have fully employed care teams – payers recognize that means we’re accountable for the care we deliver. The training and quality management of the care we deliver as a medical practice is critical.

The reality of payer contracting is that it takes time and there are many constraints that payers must operate within, financially and operationally. It means that once you have that unmet need identified, there’s still a lot of work to do to build alignment on all of the pieces that have to come together for an effective partnership. Value-based care (VBC) is a great framework for doing this, but it’s important to acknowledge that it’s complex. There hasn’t been a lot of VBC in maternal health so the way we’ve approached this is working very closely with our payer partners to develop how we define what that value looks like and how we measure it together. That might differ based on each payer and their specific population.

The Pulse: Can you elaborate on the company’s data and results to date, and how Pomelo has been able to drive such impactful maternal health outcomes?

SC: We’re serving patients in 46 states and our covered lives are over 15 million, including over 1 in 6 Medicaid beneficiaries nationally. We’re excited to be significantly expanding access; high-quality prenatal, postpartum, and pediatric care for our patients is a very meaningful gap we’ve been able to address. We also specifically think about who the patients are that we’re reaching through our services, with a goal of making sure that we’re reaching those who have been historically and presently underserved. Today, our patient population is about 60% patients of color and about 20% rural patients who may have less access to care or who face other barriers. That’s important to how we improve outcomes – we have to reach those patients in need.

We’ve published a bunch of data this year that shows how we’re doing on both quality and other outcomes. We’ve been able to reduce the total cost of care and lower NICU and emergency room (ER) utilization for both moms and babies. We’ve also been able to show our improvements in population health interventions. That includes things like screening and follow-up care for perinatal mood and anxiety disorders and utilizing aspirin, which is very effective for preeclampsia prevention. As to how we’ve been able to do it, it really is a laser focus on the quality of care we deliver, making sure that we are first reaching patients in need and assessing their risks. And we do that with data and then by delivering high-quality care that’s personalized to each patient’s risks.

The Pulse: Pomelo Care recently acquired The Doula Network, creating a unique hybrid model of virtual and in-person care – what was the vision behind this acquisition and how do you see this integration transforming the maternal care landscape?

SC: We’ve seen an exciting national conversation around doula services. Recently, we’ve seen a big movement among states passing Medicaid coverage for doula services, along with employers and commercial plans doing the same. The reason is that there’s extensive research that shows that doula services can improve maternity outcomes and health equity. In facing this maternity care crisis, we need every available tool that’s been demonstrated to make an impact, and doulas are an important piece of that puzzle. Patients who have doula care are two times less likely to have a birth complication, four times less likely to have a low birth weight baby, less likely to have cesarean deliveries, and have lower rates of preterm birth. Patients are also happier with the care they receive and less likely to have anxiety and depression. The Doula Network, which we recently acquired, has demonstrated the ability to deliver those outcomes. When we think about bringing together two sides of a hybrid model, it’s a first in the space to be able to bridge the 24/7 multi-specialty virtual model with the depth and community-based aspects of in-person doula services. We believe both of those things are critical to improving outcomes.

The Pulse: As it relates to implementing value-based care in Medicaid and scaling services nationally, what tips do you have on navigating some of the bigger challenges in the pursuit of truly lasting transformation?

SC: The most critical component is to have a clear alignment around what’s driving the unmet need and be very specific about how we can solve it. Building alignment is always going to mean it has to work for the patient, the payer, and for all providers involved. Alignment across all parties and the ability to customize care for specific payer populations are necessary for scaling to be possible. In value-based care, the investment in data and engineering to drive insights is critical. Making those investments early has enabled our ability to scale.

The Pulse: What are key maternity care trends to bring awareness to and how do you see the market evolving in the next 5-10 years?

SC: The maternal health crisis has brought so much attention to this area, but unfortunately, outcomes are poor, and disparities are growing. There’s been so much activity in this space as a result, with postpartum extension in Medicaid and coverage of doula services as examples, which has been exciting to see. One of the things that we’ve observed is that those types of policy shifts need to be accompanied by real implementation. It’s one thing to have a postpartum extension, but who’s going to deliver the care in that time and do providers on the ground have the capacity? This gap between policy shifts and capacity has been a challenge but is also an area of opportunity.

The movement on doula coverage is indicative of an evolution around an integration of holistic services. There’s a lot of recognition that we need a system that better integrates across medical, behavioral, and social needs so that it doesn’t fall on the patient to navigate and so that care is less likely to fall between the cracks. Improvement in coordinated care is something I’m excited about because it can bridge the gaps and help avoid duplication or confusion, which are some of the challenges that cause poor patient experience and lead to cost challenges today.

Interviewed by Vikram Chari, December 3, 2024.