Cayaba Care is aiming to improve ‘abysmal’ maternal health outcomes in Philly and beyond

Adaeze Enekwechi recently became CEO of Cayaba Care, whose aim is to improve pregnancy outcomes for underrepresented and high-risk individuals.

An executive with experience in government and in the private sector, Enekwechi leads the venture-capital-backed Philadelphia company that has supported nearly 2,000 births in the city since 2021. Cayaba has cut costs for health insurers by 20%, it says, because clients went to the emergency department less often and had fewer preterm births.

“Maternal healthcare in America is broken: people who have the highest risk for complications rarely have access to the best care,” Enekwechi said.

Cayaba provides what it calls maternity navigators to people with private and Medicaid insurance with Independence Blue Cross companies. The navigators, who are certified as doulas, check in with their clients between OB/GYN visits to provide support that continues after the birth. Cayaba employs 35, including six maternity navigators and two nurse practitioners.

The Inquirer spoke with Enekwechi about Cayaba Care’s approach, its expansion ambitions, and the role of private capital in solving problems in health care. Questions and answers have been lighted edited for brevity and clarity.

Maternal health outcomes in this country are pretty abysmal.

Women who are giving birth in this country are more likely to give birth to preterm babies, low birth-weight babies. Maternal death is extremely high. We are competing with developing countries on some of these measures. And when you think about how much we spend on health care, to do so poorly in this area is really unacceptable.

When we unpack that performance and look at who is most adversely affected, we find that it is people who are Black, brown, and moderate-to-high risk. That can encapsulate people with diabetes, hypertension, people from underserved communities. Not only are the results or performance much, much worse [for people in these groups] than if you were to look at the aggregate, it is really at catastrophic levels.

We want to arm and equip our members with the right questions, the right supports in the community, the right relationship with someone to hold their hand as they go through this pregnancy journey. So we go from pregnancy into postpartum, where we know a breakdown often occurs in our medical system.

We are literally measuring this as we go. How are we doing on the reduction of C-section rates? How are we doing on preterm deliveries? How are we doing on low-weight delivery? Those numbers have been going down pretty consistently since we started.

Maternal mortality, of course, is also on the list as well. We’re also measuring patient satisfaction.

It’s a pretty treacherous experience for a lot of women to have children. And that’s from the perspective of someone with resources, with educated parents, pretty advantaged in many ways. When you add on layers of disadvantage, displacement, behavioral health issues, seriously comorbid conditions, if you’re diabetic, if you’re hypertensive, it only gets worse.

Health care, as I tell people, you get it right when you have a heavy dose of empathy as part of the on-the-ground delivery of the service. That’s why the maternity navigators are so powerful. They understand the people they are serving.

There is no better place to get this right. We don’t have a homogenous group of people. Even if you just look at Black women, you have a very diverse group of Black women. You have a West African population, some of whom are Anglophone, many are Francophone. How do you reach them? The outcomes are just as bad.

We need to make sure that we’re reaching everyone that we can reach. That’s what IBC expects us to do, because again, the payers are the ones on the hook. When things go awry and you’re spending $40,000 on a NICU visit that you could have avoided if you had done just a couple other things that were drastically less expensive, it seems useful to really try to over-index on some of those social supports, the nonclinical stuff.

There is no way we can solve everything in health care through federal and state dollars only. If there is a market solution, venture capital can come in and say, ‘Let’s fund the innovation and make sure it’s a scalable asset, a scalable company.’ That, to me, is a healthy equilibrium, because then it can augment the investment of Medicaid with its meager state resources.