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The Impact of Social Determinants of Health on Maternal Health

Jul 26, 2024

Understanding Social Determinants of Health (SDOH)

Social determinants of health (SDOH) encompass the social, economic, and environmental conditions in which people live, significantly affecting their health, functionality, and quality of life. Factors such as financial strain, housing instability, food insecurity, and lack of access to healthcare and education contribute to serious health conditions like heart disease, stroke, mental health issues, and diabetes. Importantly, these factors also have a profound impact on maternal health, from pregnancy through childbirth and postpartum.

Maternal Health Crisis in the U.S.

The U.S. faces a maternal health crisis, with maternal death rates increasing from 754 in 2019 to 1205 in 2021, reflecting a rise in the maternal mortality rate from 20.1 to 32.9 per 100,000 live births. Barriers such as economic, educational, and geographic challenges delay or prevent prenatal care, increasing risks for preterm birth, low birth weight, and maternal mortality. Financial insecurity, lack of social support, and precarious living conditions also contribute to prevalent mental health issues like depression and anxiety during and after pregnancy. Food insecurity further doubles the odds of mental health problems in mothers and behavioral issues in children, while postpartum depression increases the risk of suicide, a leading cause of death during pregnancy and postpartum.

Additional Negative SDOH Factors

Several other SDOH factors negatively impact maternal health, including limited or no access to the internet, crowded housing, high housing costs, and lack of high school diplomas among individuals over 25. Nearly 10% of households lack internet access, especially in rural and tribal areas, limiting educational and economic opportunities and healthcare delivery via telehealth. High housing costs, affecting over 40 million households, are associated with poor health outcomes. Additionally, over 10% of adults over 25 lacked a high school diploma in 2022, restricting employment prospects and wages, thereby increasing the risk of chronic conditions and early death. 

Disproportionate Impacts on Minority and Vulnerable Populations

In 2022, approximately 66.2 million people lived below 150% of the poverty level, with higher risks seen among racial and ethnic minority groups, rural residents, and people with disabilities, all of which limit access to education, employment, healthcare, and food. Nearly 42.3% of the U.S. population identified as a racial or ethnic minority, linked to poorer health outcomes, higher infant mortality rates, higher blood pressure, and lower quality healthcare access. Over 7 million single-parent households reported poorer physical and mental health and higher mortality risks, with children in these households more likely to experience food insecurity and depression. As of September 2023, the national unemployment rate was nearly 4%, with higher rates among those negatively impacted by SDOH, correlating with higher risks for chronic conditions like stroke, heart disease, and arthritis.

Chronic Conditions and Maternal Health

Chronic conditions such as hypertension, diabetes, and obesity, significant risk factors for maternal health, are exacerbated or caused by SDOH. Chronic exposure to social and cultural stressors can lead to miscarriages, preterm births, and preeclampsia. Increasingly, women are becoming pregnant with pre-existing conditions, raising the risk of worsening these conditions and developing new ones. It is particularly tragic when 84% of pregnancy-related deaths are highly preventable.

Adobe’s Strategy for SDOH Support

The Adobe Perinatal Nurse Case Management Program is dedicated to reducing infant mortality and improving perinatal outcomes through continuous education, support, and advocacy. Our case managers are committed to enhancing overall prenatal care, reducing low birth weights, reducing preterm delivery rates, increasing postpartum visit return rates, and facilitating access to social service agencies.

What We Offer:

  • Personalized Care: Tailored care plans to address individual needs and preferences.
  • Comprehensive Support: Guidance on prenatal care, nutrition, and healthy lifestyle choices.
  • Mental Health Support: Screening for depression and providing emotional support.
  • High-Risk Pregnancy Management: Specialized care for conditions like gestational diabetes, addiction issues, and behavioral health concerns.
  • Educational Outreach: Informing women about preterm labor risks, hypertension symptoms, and signs of potential complications.
  • Resource Navigation: Assistance in accessing community resources such as education programs, food pantries, diaper banks, and more.
  • Transportation Coordination: Ensuring access to medical appointments and addressing nutritional needs.
  • Empowerment and Advocacy: Encouraging women to voice concerns, make informed decisions about birth control and breastfeeding, and understand their insurance benefits.
  • Continued Support: Following patients through pregnancy, the postpartum period, and beyond (the “fourth trimester”) to ensure ongoing health and well-being.

Dr. Alina Walden – Vice President Clinical Services

Dr. Alina Walden is a highly accomplished professional with an impressive academic background. She holds a Bachelor of Science degree in Biochemistry and Molecular Cellular Biology from the University of Arizona Honors Program. Subsequently, she obtained her medical degree from New York Medical College and earned her MBA from the University of Phoenix.

With over 15 years of experience in clinical practice, Dr. Walden has specialized in risk adjustment, disease management, and utilization management. Her expertise as a physician executive, combined with an in-depth understanding of the CMS HCC-Risk Adjustment Model and Quality STAR measures, enables her to develop and implement effective population health programs. She is also certified as a Certified Professional Medical Auditor (CPMA), Certified Professional Compliance Officer (CPCO), Certified Professional Coder (CPC), and Certified Risk Adjustment Coder (CRC) from AAPC. These credentials align perfectly with the goals of Adobe Population Health.

Dr. Walden is committed to delivering exceptional customer service to the entire care team, consistently striving to enhance and promote positive patient experiences. She firmly believes that every individual involved in the healthcare process plays a crucial role in advocating best practices. Outside of her professional endeavors, Dr. Walden cherishes spending quality time with her family, which includes her loving husband and four children. Her personal interests include reading and traveling.

Gail Lara – Vice President Strategic Outreach

With extensive experience in healthcare marketing, operations and management, Gail has made a career of developing and growing service lines and businesses from large health systems and specialty practices to wellness and ambulatory services.

As a VP at Adobe Care & Wellness, she oversees outreach to physicians and identifies opportunities for growth that align with the needs of the community and its members.
Gail earned an associate degree in business at Midland College followed by a bachelor’s degree in marketing from the University of Texas. She then worked in operations and business development with a national company upon moving to Arizona and joining the state’s largest urgent care organization where she was instrumental in its growth, identifying new locations, opening clinics, and overseeing licensing, staffing, and compliance. Gail then built and grew service lines at a local hospital group and oversaw marketing and business development for another.

With a commitment to innovative thinking, Gail’s wide range of experience is enhanced by her ability to foster collaborative relationships to achieve goals.

Residents of Arizona, Gail, and her husband have three children. She is passionate about community service, has served on the board of the Arthritis Foundation, and regularly volunteers at The Society of St. Vincent de Paul.

Maria Martinez – Vice President Population Health

Maria Martinez started with Adobe Care & Wellness in the call center, making health risk assessment (HRA) calls to members. She soon took on new responsibilities, learning the ins and outs of Salesforce and helping to build the company’s initial technology platform. Maria never expected that her first post-college job would lead to a career in health care solutions. Maria was born and raised in Phoenix and earned a Bachelor of Science in justice studies with a minor in women and gender studies, graduating Summa Cum Laude. She quickly rose to Senior Director of Clinical Services at Adobe Care & Wellness and later to Vice President of Operations. As VP of Operations, Maria oversees the nurse practitioner scheduling and in-home assessments program to ensure members receive the care needed. She is passionate about making health care more accessible to those living in rural areas or lacking the mobility to get to a doctor’s office helping the company grow and expand its ability to help others.

David Heinrich – Vice President, Integrated Care

A Chicago native with more than 20 years of management experience, David began his management career in the retail industry, quickly working his way up to Store Manager and then Regional Manager. While overseeing multi-million dollar retail stores, David felt the pull to venture into the medical field. He began working for an ambulance company providing pre-hospital care to the sick and injured which inspired him to further his education in nursing school. As he earned his degree, David worked full-time doing organ and tissue recovery for one of the nation’s largest not-for-profit body donation programs.

Since graduating as a registered nurse, David has worked in medical-surgical, trauma, and telemetry units as well as in home health, hospice, and nursing education. He has held clinical leadership roles including Clinical Manager and Director of Nursing.

When Adobe Care and Wellness started their Special Needs Plan in 2019, David joined the team and quickly helped grow the program. He was promoted to Director of Case Management and then to Senior Director of Integrated Care. David, who is also a Certified Case Manager, now serves as Adobe’s Vice President of Integrated Clinical Services.

Alex Waddell – Chief Information Officer

Alex Waddell is an Arizona native and graduate of Arizona State University, where he earned a Bachelor’s in economics. Alex began his career in IT as a software developer for a home health and case management provider. Over the next four years, Alex took on increasing responsibilities and began earning certifications as a Salesforce developer. In 2018, he was hired as Director of Software Development for Outreach Health Services, where he worked for two years before accepting the position of Executive Vice President of Technology at Adobe Care and Wellness. Alex has continued his drive for excellence and is now a Certified Salesforce Application Architect as well as a member of the Forbes Technology Council. In his current position as CIO,  Alex manages and directs a team of developers and oversees the design and development of the proprietary software that supports the expanding healthcare solutions Adobe Care and Wellness offers. Alex and his department, provide internal staff and external entities with analytics that measures results and helps drives decisions. He and his team also ensure data security for the company’s hardware and software.

Chad Wolver – Chief Financial Officer

36-year-old Arizona native Chad Wolver brings nearly a decade of commercial banking, strategic finance, and management experience to the Adobe Population Health leadership team. Phoenix-based Adobe Population Health ranks 2,271 on the 2023 Inc. 5000 annual list of the fastest-growing private companies in America.

A graduate of the University of Arizona’s Eller College of Management, Chad earned an Executive MBA with a focus in Accounting and Finance. While serving as Vice President at Bank of America, Chad was the banker for Adobe Care & Wellness (rebranded as Adobe Population Health in 2022), which has experienced 242% three-year growth from 2020 to 2023.

CFO since 2021, Chad has managed Adobe Population Health’s strategic financial strategy, overseeing its budget by using technology to create efficiency, synergy, scalability, and deeper insight to grow the organization efficiently as it expands as a multi-state provider.

Chad serves on the boards of some of Arizona’s most well-recognized philanthropic organizations, including Arizona Community Foundation’s Kellenberger + Tollefson Center for LGBTQ Philanthropy Advisory Council and ONE Community’s Millennial Advisory Board. He’s a past board member of ASU Lodestar Center’s Leadership Council, Human Rights Campaign Arizona, Southwest Center for HIV/AIDS and Phoenix Community Alliance’s Social & Housing Advancement Committee.

In his free time, Chad enjoys traveling with his partner and spending time with their beloved Italian greyhounds.

Challas Ray – Chief Operating Officer

Challas Ray has spent more than a decade building a career in the health care industry. Challas holds a Master’s in Clinical Kinesiology from Eastern Illinois University. After completing his education, he began work with Sara Bush Lincoln Health System, where he helped create and expand an external wellness program for companies interested in providing wellness programs to their employees. Challas is originally from Toledo, Illinois, but now calls Arizona home.  He moved to the Valley of the Sun seeking warmer weather and new opportunities. Joining The Beech Group as a Transitional Specialist, it was there Challas met and began collaborating with Jayme Ambrose. In 2017, he joined Jayme’s team to help launch Adobe Care & Wellness. As Adobe Care & Wellness COO, Challas provides oversight of the operational process to improve efficiencies and conducts the cost-benefit analysis of new and existing initiatives.

Pat Duryea, PhD – Chief Inspiration Officer

Patricia (Pat) Duryea earned her bachelor’s in Business Administration with an emphasis in Human Resource Management from Arizona State University. She then served as a Human Resource Director for nearly six years before returning to school to earn a Master of Educational Psychology from Northern Arizona University and a Doctorate in Counseling Psychology from Walden University.  Through her career spanning three decades, Pat has worked as a clinical manager, employee assistance program director, an adjunct professor at ASU and she’s owned and operated multiple small businesses. She has extensive knowledge in developing health and wellness programs, and experience in trauma-related counseling. As Chief Inspiration Officer at Adobe Care & Wellness, Pat manages human resources and the development of company culture.  She also serves as the compliance officer, receiving complaints, solving issues and reporting them to Arizona Complete Health.  She works directly with the management team on leadership development within the organization and monitoring morale. Pat’s overall focus is to ensure that employees feel included and valued in their contributions to the company’s success and to provide them with the opportunity to be the best they can be.

Jayme Ambrose DNP RN CCM – Chief Executive Officer

Jayme Ambrose, DNP, RN, CCM, is the visionary Founder and Chief Executive Officer of Adobe Population Health, an Arizona-based company offering an innovative, first-of-its-kind solution to the issue of health equity. Founded in 2018, Adobe employs a technology-driven model for interventional care management and takes a holistic approach to population health by closing care gaps, reducing costs, and caring for the whole person.

Armed with a Master of Science-Nursing from Arizona State University, Jayme was accepted into the Doctoral program for Nursing Science & Leadership at Case Western University. It was there, she developed an integrated case management model, as part of her doctoral thesis, with the objective of addressing the social determinants of health that often contribute to poor health outcomes for at-risk populations. After completing her doctorate in 2012, Beech Medical Group agreed to pilot her model, if Jayme agreed to accept a position as VP of Clinical Services. In 2016, she signed her first insurance company contract and initiated a holistic approach to case management for Medicare members. Her model integrates data analysis and risk assessment with a human touch to deliver proactive and preventative care that improves health outcomes, decreases hospital and ER visits, and reduces overall healthcare costs. In 2018, Beech Medical Group sold the company but not before giving Jayme the opportunity to purchase her division. On that day, Adobe was born with one mission: To positively impact the lives we touch.

As part of an innovative technology platform, Adobe utilizes proprietary risk stratification tools to identify the issues of those at greatest risk including food insecurities, financial hardships, transportation issues and even loneliness. And then through a proprietary and ground-breaking application called MASLOW™, members are invited to answer questions related to social determinants of health and then are connected to for-profit, non-profit, and governmental resources based on geolocation. To ensure impact, a qualified team member through a hybrid care model reaches out to offer assistance, closing the care loop. It is this human touch that sets Adobe apart from other case management organizations. Today, Adobe employs 300 nurses, nurse practitioners, social workers, support coordinators, dieticians, care navigators, and transition specialists and serves more than 200,000 elderly and underserved patients across three states.

Jayme has served on several boards including The Arizona Homecare Association, The American Association of Occupational Health Nurses and the Case Management Society of America where she is currently a member. She also currently serves on the PAC board of the Arizona Nurses Association. In addition, Jayme is currently adjunct professor for Arizona State University where she teaches RN to BSN and MSN students and develops curriculum.