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of mothers before preg na ncy impact maternal and child health outcomes and, under Dr. Cuyler's leadership, Excellus BCBS is working to address negative outcomes such as severe maternal mor- bidity (SMM). The Centers for Disease Control and Prevention defines SMM as "unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health." The many drivers of maternal hea lth include socioeconomic status, access to materna l hea lth providers, geographic location, structural racism and implicit provider bias. "Women of color are particularly at risk for negative maternal health outcomes independent of socioeconomic status, education or other factors. A Black mother with a college education is likely to have worse maternal health outcomes than a white mother without a college education," notes Dr. Cuyler. A Blue Cross Blue Shield Association study on racial and ethnic disparities in maternal health revealed that preexisting health conditions, such as hypertension, diabetes and asthma, strongly correlate with higher SMM. The study found that Black women ages 35–44 have a 66% higher rate of SMM and are more likely to suffer pregnancy-related complica- tions than white women in the same age range. The U.S. maternal mortality rate is the highest among similarly developed countries, with 17.4 deaths per 100,000 live births. "With all of the wealth, resources and knowledge in our country, we must do better," Dr. Cuyler says. Maternal health affects more than just mothers and their babies; it also affects the community as a whole. When preg- nancy complications arise, premature birth, low birth weight and prolonged stays in neonatal intensive care units increase as well. There is a societal cost when maternal health is not a top priority, Dr. Cuyler says. From the family members who suffer the loss of their loved one, to employers and co-workers bearing the burden when a parent has to take time off to care for their child, or worse, when an employee dies from pregnancy complications, maternal health affects families, businesses and communities. "It has a comprehensive impact on everyone," Dr. Cuyler says. "We all bear the cost." Dr. Cuyler is addressing the drivers of higher SMM in a data-driven way. "Health equity work requires metrics," Dr. Cuyler says. "You can't manage what you can't measure and you can't measure what you can't define." After creating a health equity strategy for Excellus BCBS, Dr. Cuyler brought on health equity data analysts to help her capture and analyze the metrics required t o det er m i ne a c t ion a ble solut ion s . Collecting robust data is also dependent on identifying the attributes of the people in underserved communities, and that requires patients to submit complete attribute information so they ca n be identified appropriately in the data. The COVID-19 pandemic highlighted health disparities in our nation, especially for people of color and, Dr. Cuyler says, the narrative surrounding health equity is expanding. Aligning with the health equity frameworks of New York state, the Nationa l Committee for Qua lit y Assurance and the Centers for Medicare & Medicaid Services, Excellus BCBS is advancing equity along with quality in the healthcare arena. Dr. Cuyler's goal is to embed health equity in every part of the organization. "Health equity is an enterprise initia- tive, and we work in a cross-functional manner. I have deputized an army of a mba ssadors in our orga nization to understand how their work contributes to being able to provide meaningful health outcomes a nd improve hea lth equity for all." In Oc t ober 2022 , E xcel lu s BCB S announced the first round of recipients of Member a nd Com mu n it y Hea lt h Improvement grants to address SMM and related health equity issues in upstate New York. Eight nonprofit organizations were selected within the Health Plan's 39-county service area to share $1 million in grant funding over the next three years. " We assembled a cross-functiona l, interdisciplinary team to determine these grant recipients to address depression, education, safety, lactation and home- lessness," Dr. Cuyler says. "We are very " Health equity is when each person has a chance to have optimal health. — GINA CUYLER, MD Gina Cuyler, MD, FACP M D N E W S . C O M /// M D N E W S C E N T R A L N E W Y O R K n 2 0 2 3 1 5