The gap
The riskiest weeks fall between hospital and primary care.
Hypertensive disorders of pregnancy, including preeclampsia, are a leading contributor to maternal deaths. Guidelines call for a blood pressure check within 10 days of delivery, yet many mothers miss it.
Home blood pressure programs help, but most end two to six weeks after birth.
The risk does not end there. Thirty to fifty percent of these mothers still have high blood pressure a year later, and a hypertensive pregnancy raises lifelong heart disease risk about as much as smoking or diabetes.
VitalFourth covers the full first year and hands each mother off to long-term primary care.
Care model
A virtual care team, with technology working quietly in the background.
Our maternal-fetal medicine physicians, nurse practitioners, social workers and care assistants deliver the care. Hospitals stay informed; our team handles the escalations.
Enroll before discharge
Mothers with a hypertensive pregnancy enroll during their delivery stay.
Monitor at home
A cellular-connected blood pressure cuff sends readings automatically. No smartphone or app needed.
Act on every reading
Two-way text messaging and a clinical dashboard flag high readings, and our clinicians start or adjust medication remotely.
Bridge to primary care
We follow mothers for up to a year and connect them to preventive heart care.
Every mother is also screened for anxiety, depression, post-traumatic stress and social needs, with referrals to perinatal mental health and social work. About one in four screens positive at delivery.
Evidence
More than 4,000 mothers enrolled in Rhode Island.
Early results from the NIH-funded randomized trial of RI-SPHEREs, compared with standard care before the program.
Source: RI-SPHEREs program data from the ongoing NICHD-funded randomized controlled trial (R01HD116695), more than 850 participants randomized, compared with historical standard care. Learn more at rispheres.com.
Benefits to partners
What our partners gain.
Health systems
Mothers stay connected to a care team they know through the weeks after discharge, when risk is highest, improving patient satisfaction with your postpartum care. Our own clinicians deliver it, with no added staffing burden on your units.
Health plans
Catching dangerous blood pressure early at home reduces emergency department presentations among your highest-risk postpartum members. The program fits the remote patient monitoring benefits many state Medicaid programs already offer.
Funders and communities
Your support brings the program to new communities, and the VitalFourth Fund extends the same care to mothers whom insurance does not reach.
How we are organized
Two aligned entities, one clinical model.
VitalFourth PBC
Operates the program and holds health system and payer contracts, sustained by Medicaid remote monitoring reimbursement.
VitalFourth Fund
Extends the same care to uninsured and underinsured mothers whom reimbursement does not reach.
Team
Founders
Adam Lewkowitz, MD, MPHS
Maternal-fetal medicine physician and Associate Professor of Obstetrics and Gynecology at Brown University. Director of Maternal-Fetal Medicine Research at Women & Infants Hospital and Principal Investigator of RI-SPHEREs.
Keegan Bailey, MS
More than two decades in health IT and value-based care, including as Chief Executive of Acuitas Health and roles at NextGen Healthcare and the New York State Department of Health. University at Albany faculty member for more than a decade.