In 2022, Independence Blue Cross (IBX) began working with
Cayaba Care
to help improve maternal health outcomes for our most at-risk members,
particularly Black and Brown people. Cayaba provides support for people
during and after pregnancy, to help them overcome some of the challenges
that increase their risk of maternal morbidity and mortality.
In 2024,
Dr. Adaeze Enekwechi
joined Cayaba as the company’s new Chief Executive Officer. Recently, I sat
down with her to ask about the vision and strategies she has for Cayaba, and
I’d like to share highlights from our conversation.
Promoting Equitable Maternal Care
Dr. Ross: Tell us about your background and your interest in
maternal health.
Dr. Enekwechi: I’m a health policy and economics
professional by background. In addition to working in the private sector, I
spent many years in government, including serving as head of health programs
for President Obama at the White House Office of Management and Budget. I’ve
spent my career making sure resources are being spent and directed in ways
that ultimately make a difference in people’s health and well-being.
When it comes to maternal health outcomes, I’ve stopped quoting statistics
on
how badly the United States is doing. Suffice it to say, it’s shameful that a country this wealthy is performing
as poorly in this area as developing countries.
And some of the most vulnerable people are women who look like me. Often it
doesn’t even matter what their income and education levels are, as long as
they’re Black or Brown.
Personally, I know this struggle from every perspective — through
my direct experience, my work, and my education. And I’m just as terrified of these bad outcomes
as anybody else. So it’s an honor to have an opportunity to try to solve
this huge issue with Cayaba.
Dr. Ross: What are the challenges people of color face in
accessing equitable maternity care?
Dr. Enekwechi: When you’re a person of color, in some ways
the health care system is just not equipped to hear you. We call this
implicit bias…but sometimes it’s not implicit, it’s just plain bias. It’s
explicit.
Even Black women physicians often report being actively dismissed, ignored,
and gaslit when they have health issues — even though they actually have the
medical training to articulate what they’re experiencing in terms that other
providers understand. So imagine how it is for someone who doesn’t have the
vocabulary to describe their health problems!
Sometimes you just need someone to tell you that everything is going to be
okay. But Black women tell me, “Nobody ever thinks to say that to me.”
Establishing Trust Is the “Secret Sauce”
Dr. Ross: How is Cayaba addressing these challenges?
Dr. Enekwechi: Effective health care ultimately comes down
to a couple of things. It’s local, it’s based on trust, and it’s based on
empathy.
That’s what Cayaba’s
Maternity Navigators
bring. They’re deliberately hired from the communities they serve. So our
clients feel like they’re talking to someone who hears them, can connect
with them, and, importantly, gives them agency, helps them frame their
questions as they interact with their obstetrician.
But Cayaba provides a lot more — like lactation consulting. Recently a man
told me, “After my wife had her baby, having a lactation consultant wasn’t
just support — it was a mental health intervention.” These new parents based
their whole self-worth on
being able to breastfeed their baby. And because their baby wasn’t able to latch on and wasn’t feeding, things
started to go awry pretty quickly. We were quick to intervene before things
got worse, and it helped the dad as well as the mom. Lactation support meant
everything to them.
We also make durable medical equipment very easily accessible, like breast
pumps. Where appropriate, we equip our clients with blood pressure cuffs,
train them in using them, show them how to record their readings. We teach
them how to really take care of themselves in ways that most of us may not
learn at home.
Dr. Ross: How does Cayaba select its staff?
Dr. Enekwechi: We hire people from the community, medical
assistants and community health workers, and train them in the Cayaba Care
model. Our Maternity Navigators are all doula-certified — we facilitate that
training. But we also screen them for empathy. The people we hire for these
roles speak the language of those they are caring for, they understand them.
The reviews we get from people who work with our Maternity Navigators say,
“I trusted her. She trusted me. She held my hand. She was never
condescending. She respected me.”
That’s what we bring. That’s our secret sauce.
Going Where the Need Is Greatest
Dr. Ross: How does Cayaba work with providers like
obstetricians, midwives, and nurse practitioners?
Dr. Enekwechi: We are in Philadelphia, where many people
giving birth are at high risk for poor outcomes, and we talk with health
care providers. Providers are our partners; they refer their patients, we
share data with them, we have an active partnership with them. Provider
practices know their patients could use wrap-around services and support. We
show them that we can help prevent NICU visits, maternal morbidity and
mortality, and preterm deliveries. We have the data to back that up; we have
real evidence.
Our kind of support is not something pregnant people are accustomed to
because it usually does not exist. We need our providers to tell them, “Hey,
talk to Cayaba. Engage with them and see. This could be quite useful to
you.”
Dr. Ross: What are your immediate and long-term goals for
Cayaba?
Dr. Enekwechi: I don’t want anyone who could be
working with us to not be working with us. That’s my goal. There
are too many women we know, too many people and families, that would hugely
benefit from Cayaba’s support. And they deserve it. That’s my big goal, to
serve all the people and families we should be supporting. I also want to
deepen and expand our partnership with IBX, and serve our members over a
long period of time as a member of this community.
Spread the Word
Health outcomes are unacceptably poor for pregnant people of color. That’s
who is at the at highest risk for poor outcomes. We strongly encourage them
to take advantage of this service, which is available at no cost to IBX
members, as well as our
other maternal health resources
and services.
If you, or someone you know, might benefit from this kind of support, please
contact Cayaba. Everyone deserves the best possible chance of a healthy and successful
pregnancy, delivery, and postpartum period.
This content was originally published on
IBX Insights.
About Dr. Seun Ross, DNP, CRNP-F, NP-C
Dr. Seun Ross is the Executive Director of Health Equity at Independence
Blue Cross. Dr. Ross is a clinician whose work is focused on systems
innovation to decrease health inequities. She is an ardent proponent of
health equity and is committed to achieving health justice for all
vulnerable populations.