Reimagining Maternal Health Through Technology,Community,and System Partnership: Lessons from the InovCares Care Model

Abstract

Introduction:

The United States continues to face a maternal health crisis characterized by racial, ethnic, and socioeconomic inequities. Many current interventions lack comprehensive integration of technology, community engagement, and payer partnerships needed to address both clinical and structural drivers.

Approach:

This article describes InovCares, a digital maternal health intervention developed to be implemented in under-resourced clinical settings. Adapted from Kaiser Permanente’s Cocoon Pregnancy Care Model, InovCares integrates mobile-first technology, artificial intelligence-assisted assessments, culturally responsive care, and wraparound social services. A 12-month pilot was carried out in two federally qualified health centers in Texas, enrolling 605 pregnant people through partnerships with a payer and local community organizations.

Lessons Learned:

Strong patient and provider engagement came from codesign, bilingual tools, and the integration of artificial intelligence to flag risks and coordinate referrals, although training and digital literacy support were critical. Also, payer and institutional partnerships made it possible to connect technology with reimbursement and workflow systems but required time and flexibility. Finally, artificial intelligence and digital tools can promote equity if developed intentionally, but they also expose gaps in infrastructure and resources.

Conclusion:

InovCares offers a promising model that blends technology, clinical care, and social support in under-resourced settings. Its early lessons show that equity-informed design and cross-sector collaboration are essential for building sustainable, digital maternal health solutions.

Introduction

The United States has the highest maternal and infant mortality rates among high-income nations and performs poorly in key measures of maternal health care quality and access.^1,2 Non-Hispanic (NH) Black, Hispanic, and American Indian/Alaska Native birthing people experience higher rates of hypertensive disorders of pregnancy. ³ gestational diabetes, ⁴ unplanned cesarean deliveries, ⁵ preterm delivery, ⁶ and perinatal mood and anxiety disorders. ⁷ These disparities are rooted in structural, systemic, and institutional racism, including long-standing gendered racial injustices embedded in the policies, practices, and norms of health, workforce, and social systems.^8–10 Accordingly, birthing people, especially those who are publicly insured, face systemic barriers such as limited postpartum coverage, provider shortages and low reimbursement rates, and health insurance administrative complexity.^11–14

Despite the urgent need, existing interventions remain fragmented—often focused on single outcomes, confined to clinical settings, and lacking partnerships with payers and community organizations to address social determinants.^15,16 Few integrate technology-enabled platforms for real-time monitoring or closed-loop referrals, and digital tools rarely apply equity frameworks, limiting cultural relevance, trust, and engagement among patient populations most affected.^17,18 Closed-loop systems that support continuous monitoring and care coordination are especially scarce in safety-net settings such as federally qualified health centers (FQHCs).^19,20 These gaps underscore the need for equity-informed, multifaceted models that combine clinical care, social support, technology, and payer partnership.

Models like Cityblock Health ²¹ and Kaiser Permanente’s Cocoon Pregnancy Care Model ¹⁵ integrate technology and care coordination but are largely tied to large health systems, limiting adaptability in resource-constrained environments. InovCares was designed specifically with safety-net settings in mind, embedding equity principles into platform design and implementation. In contrast to Cityblock’s and Kaiser Permanente’s Cocoon Pregnancy Care Model, which rely on robust infrastructure and vertically integrated systems, InovCares combines mobile applications, remote biometric monitoring, Artificial Intelligence (AI)-assisted risk assessments, and closed-loop referrals to external community partners for social needs with payer partnerships to enable reimbursement for nonclinical services—features tailored to address structural barriers in under-resourced contexts.

While detailed intervention outcomes are beyond the scope of this article, we describe the platform’s model and core components, including mobile-first technology, closed-loop referral systems, and community partnerships, as a pragmatic and scalable framework for addressing clinical and structural drivers of maternal health disparities. Process and outcome evaluation data will be presented in a forthcoming publication.

Approach

Overview of the intervention and core components

InovCares is a technology-driven maternal health platform founded in 2020 after the pregnancy-related death of the founder’s sister, a tragedy that underscored systemic failures in care for birthing people, particularly Black birthing people. The platform integrates digital technology, clinical services, and community partnerships to deliver culturally responsive, equity-informed care. Conceptually, InovCares builds on integrated care models like Kaiser Permanente’s Cocoon Pregnancy Care Model, ¹⁵ which combines traditional prenatal care with telehealth, psychosocial support, and remote monitoring to improve maternal and perinatal outcomes. InovCares extends this approach by embedding digital technology, artificial intelligence, and closed-loop information and referral systems directly within community clinic settings (see Fig. 1).

FIG. 1.

InovCares pregnancy care model. The model integrates digital tools, clinical care, and social support to improve maternal health in under-resourced settings. Key components include telehealth and remote monitoring, medication and grocery delivery, transportation, and legal assistance, alongside clinical services from certified nurse midwives and maternal-fetal medicine specialists. Partnerships with payers and federally qualified health centers enable reimbursement and workflow integration. The model spans preconception, prenatal, intrapartum, and postpartum care.

The InovCares platform consists of two bilingual mobile applications—one for patients and one for clinicians—enabling secure, real-time communication and integration with electronic health record systems. Patient-facing features include appointment scheduling, video consultations, symptom tracking, peer messaging, AI-powered assessments for monitoring mental and metabolic health, and automated alerts for elevated biometrics. The platform also screens for social determinants of health and enables in-app requests for food assistance, rideshare, and prescription delivery. AI-powered assessments analyze patient-reported data to support clinical decision-making and route patients to relevant services such as transportation, housing, and behavioral health. Patient-facing app features are presented in Figures 2–4.

FIG. 2.

InovCares maternal health platform interface view 1. The figure displays the InovCares mobile application interface, designed to support maternal health through integrated digital tools. Key features include access to care teams, health communities (“My Tribes”), and real-time health monitoring for blood pressure and glucose. The platform enables scheduling with providers, secure communication, and personalized health tracking, offering a centralized hub for clinical and wellness services within an equity-informed digital care model.

FIG. 3.

InovCares ride booking feature for clinic transportation. The figure shows the InovCares mobile application’s ride booking interface, which enables patients to schedule transportation to and from clinics. Users can enter their address, select a clinic, choose ride type (immediate or scheduled), and check availability. This feature addresses transportation barriers by integrating real-time scheduling within the maternal health platform, supporting access to prenatal and postpartum care in under-resourced settings.

FIG. 4.

InovCares remote blood pressure and glucose monitoring interface. The figure shows the InovCares mobile application feature for tracking blood pressure and heart rate. Users can view current readings, monitor trends over time, and record new measurements directly in the app. This functionality supports real-time health monitoring and facilitates data sharing with care teams, enhancing personalized maternal care and early risk detection.

Provider-facing features (see Fig. 5) streamline workflows and enhance engagement. Providers can conduct telehealth consultations, manage patient scheduling, collaborate with care team members (e.g., doulas, midwives, and nutritionists), document care using Health Insurance Portability and Accountability Act (HIPAA)-compliant tools, facilitate mail-order prescriptions, and access real-time patient health data and engagement metrics.

FIG. 5.

InovCares blood pressure alert notifications (provider view). The figure shows the InovCares mobile application’s notification interface, which alerts care teams when patients record hypertensive blood pressure readings. Each notification includes the patient’s name and measurement values, enabling timely clinical response and care coordination. This feature supports proactive monitoring and early intervention for high-risk conditions during pregnancy and postpartum care.

To strengthen care coordination, the platform offers Health Tribe, a peer support feature linking patients to doulas and clinicians, and gamified wellness tools such as yoga, meditation, sleep tracking, and step tracking. Behavioral health screening and counseling are integrated throughout, reflecting a whole-person approach. Telehealth and remote monitoring are central, with Bluetooth-enabled devices for blood pressure and glucose tracking and comprehensive gestational diabetes management, including glucometer integration, dietitian support, and video education sessions. Cultural and linguistic responsiveness is foundational, with materials in English and Spanish and ongoing input from the community advisory board. Partnerships with local organizations provide housing or housing support, nutrition, health education, and other resources. Finally, participants retained access to the platform for at least 6 months postpartum, consistent with managed care coverage. In practice, many continued using the app beyond this period for pediatric appointments and health education, reflecting organic uptake of postpartum support and sustained engagement with the platform.

Guiding principles and equity framework

The development of InovCares was guided by equity-centered design principles to ensure inclusivity, cultural relevance, and digital accessibility. Health equity was conceptualized as an ongoing, iterative practice that centers marginalized communities in intervention design, delivery, and evaluation. Guided by a Digital Health Equity Framework, ¹⁸ InovCares addressed digital determinants of health such as technology access, literacy, and algorithmic bias through intentional design and community engagement. Co-development with patients, providers, and community stakeholders ensured that platform features and educational content reflected diverse lived experiences. To support inclusive design, the platform underwent independent user testing, heuristic evaluation, and needs assessments with birthing people and other stakeholders across varied racial, ethnic, and gender identities and abilities. Usability was evaluated based on heuristic dimensions such as learnability, efficiency, memorability, and accessibility to identify and mitigate barriers that could disproportionately affect users. ²²

The model was co-developed with input from patients, providers, and community stakeholders, ensuring that platform features, educational content, and services reflected diverse lived experiences. To support inclusive design, the platform underwent independent user testing, heuristic evaluation, needs assessments, and interviews involving birthing people across varied racial, ethnic, and gender identities and abilities. Usability was assessed across key dimensions (e.g., learnability, efficiency, memorability, error management, satisfaction, and accessibility) to identify and address barriers that could disproportionately affect users. ²² Design decisions aligned with five equity principles outlined by Khoong and colleagues ²³ : auditing who benefits, aligning institutional incentives, elevating frontline and patient perspectives, sustaining long-term community engagement, and protecting patient data. To operationalize these principles, the platform incorporated several strategies. First, user-centered design was prioritized through extensive testing to address digital literacy and self-efficacy among diverse birthing populations. Second, institutional alignment was achieved through partnerships with payers to support value-based reimbursement and infrastructure investments in FQHCs. Third, community integration was strengthened by collaborating with doula collectives, food banks, and other community-based organizations to embed digital services within broader support systems. Finally, technology safeguards were implemented through equity-informed AI tools and closed-loop referral systems, incorporating privacy protections and bias mitigation measures such as using racially representative training data and corrected BMI metrics. Together, these strategies ensured that the platform advanced equity at individual, institutional, and community levels.

Partnership formation and site selection

InovCares was supported by funding from Blue Cross Blue Shield of Texas (BCBSTX), which played a key role in enabling the launch and implementation in Texas. This payer partnership helped facilitate outreach to potential clinical and community partners and provided the financial infrastructure needed for technology integration, staff training, and service delivery. BCBSTX’s involvement also lent additional credibility to the initiative during early conversations with FQHCs and other key stakeholders.

Partnership formation was led by the InovCares founder, who emphasized a relationship-driven approach centered on direct, one-on-one engagement. Initial outreach typically began with phone calls and emails, followed by in-person meetings that were crucial for building trust, understanding clinical needs, and securing buy-in. In several cases, face-to-face visits, especially those involving payer partners, proved instrumental in advancing partnership discussions. InovCare’s founder’s professional background in patient-centered medical homes further supported his ability to navigate the operational realities of FQHCs and communicate effectively with both clinical and administrative teams. Sustaining partnerships required ongoing communication, responsiveness to site-specific challenges, and a clear understanding of each organization’s capacity. Not all clinics were positioned to adopt InovCares, and technological and operational readiness varied widely.

Following outreach to approximately 45 FQHCs and other clinics across Texas, two sites were selected for the pilot intervention based on several criteria. Each site needed to offer a comprehensive pregnancy care model that integrated obstetric, behavioral health, and social support services. Clinics served high-need populations, particularly Medicaid-enrolled individuals facing barriers to care, and demonstrated a clear organizational structure supported by multidisciplinary teams. Basic technology infrastructure, including an electronic health record system compatible with the InovCares platform, was also required. Equally important was each site’s willingness to engage in collaborative implementation efforts, including staff training and workflow integration. Geographic location and patient demographics were considered, with priority given to clinics serving racially and economically diverse communities. Strong commitment from clinical leadership and departmental stakeholders was essential to ensure successful adoption and sustainability of the model.

In addition to clinical sites, community-based organizations were identified using the same relationship-based approach. Environmental scans and informal networking helped surface potential partners. For example, a maternity home for pregnant and parenting young people was identified through a search for local housing resources. InovCares initiated contact directly and visited the organization in person to establish trust and learn about its operations. This engagement evolved into a sustained partnership that yielded mutual benefits: The nonprofit received financial support through philanthropic connections facilitated by InovCares, while its clients gained access to the InovCares digital platform and virtual care services.

Implementation process

In 2024, the initial rollout followed a structured three-phase implementation process at one FQHC in Dallas, Texas, ²⁴ and another FQHC in Brownsville, Texas, ²⁵ both serving predominantly Black and Latino populations. These centers were equipped with multidisciplinary teams, including obstetricians/gynecologists, nurses, nurse midwives, behavioral health specialists, case managers, and dieticians. Together, they provided consistent care throughout the prenatal and postpartum periods. The FQHCs also offered a wide array of onsite services: pharmacy, laboratory, pediatrics, dental care, eye clinic, podiatry, radiology, rheumatology, immunizations, and adult medicine/primary care. The first phase focused on technical setup, including collaboration with Information Technology (IT) staff to integrate the platform with existing electronic health record systems. The second phase involved credentialing and training clinical team members to use the platform effectively. The third phase included patient recruitment and onboarding. Patients were identified during prenatal visits via electronic health record notifications.

Participant eligibility and enrollment

Clinic staff used electronic health records to identify and invite eligible patients to participate in the intervention if they were at least 20 weeks pregnant and had one or more clinical indicators such as hypertension, diabetes, obesity, or a history of a high-risk pregnancy. Consenting participants received training in English or Spanish and a maternal health kit with a Bluetooth-enabled blood pressure monitor, prenatal vitamins, and setup instructions. Patients who declined participation continued to receive their standard prenatal care. During the intervention, patients engaged with core components of the InovCares mobile platform.

Between January 2024 and January 2025, 605 pregnant people were enrolled in the InovCares intervention across the two FHQCs, and 69.2% continued participation after delivery and enrolled their child in pediatric care at the sample facility. The majority of intervention participants self-identified as Hispanic, followed by NH Black or African American, NH White, and other racial identities such as Asian American and American Indian/Alaska Native. Also, most intervention participants were insured by Medicaid or self-pay (no insurance). While specific patient engagement and service delivery data are reported in a separate article currently under journal review, general insights from the implementation period offer valuable context for understanding the reach and impact of the InovCares model. Across both participating FQHCs, patients demonstrated consistent and meaningful engagement with the digital platform, integrating its features into their routine care experiences. The platform facilitated timely communication between patients and care teams, supported closed-loop referrals, and enabled access to virtual services that addressed both clinical and social needs. Staff and community partners observed improvements in care coordination, patient retention, and responsiveness to health-related challenges, particularly among Medicaid-enrolled populations. Moreover, the program’s emphasis on early risk identification and personalized care planning contributed to reductions in acute care utilization and supported more favorable maternal health outcomes compared to state-level benchmarks. These trends underscore the potential of the InovCares model to advance equity and efficiency in maternal health service delivery, especially within value-based care frameworks.

Evaluation framework

Although this article does not report evaluation data, the pilot was implemented with a structured evaluation framework to assess feasibility, engagement, and preliminary implementation outcomes. Process and performance indicators included patient enrollment, app usage, satisfaction ratings, and service utilization; and clinical outcome data such as blood pressure, glucose levels, and pregnancy outcomes were tracked via electronic health records (Table 1). Data sources included the InovCares platform, clinic reporting systems, and qualitative feedback from patients and providers. All evaluation data will be disaggregated by demographic characteristics such as race and ethnicity to examine equity-related patterns. Validated equity measures were not applied in this pilot; equity was operationalized conceptually through design principles and contextual analysis rather than standardized metrics. These activities will inform a forthcoming comparative effectiveness study focused on long-term clinical and equity-related outcomes.

Table 1.

Process, Performance, and Outcome Measures for the InovCares Pilot Intervention

Process/performance measures

Outcome measures

Number of patients enrolled Amount of time spent using mobile app Mobile app log-in frequency Patient satisfaction with mobile app Patient turnover at clinic Number of prenatal and postnatal patient encounters Number of messages in Health Tribe Number of telehealth consultations Number of nutrition consultations Number of wellness goals set/achieved Number of patient risk assessments made Number of closed-loop referrals made (transportation, food, and housing assistance) Number of patients using doula services outside of clinic hours

Blood glucose levels Insulin levels High blood pressure Gestational diabetes Gestational hypertension Mode of delivery (cesarean or vaginal births) Pregnancy term (preterm vs. term deliveries) Cost-effectiveness and savings (through avoided emergency department visits)

Lessons learned and implications for health equity

These lessons learned were drawn from meeting notes, preliminary patient and clinician survey data, and informal feedback from partner FQHCs. Interpreted through a digital health equity framework,^18,23 these insights underscore the importance of design and contextual factors for sustainability. Future research will employ rigorous mixed-methods approaches to enhance reproducibility and theoretical integration. The pilot implementation of the InovCares model revealed critical insights across three domains—patient engagement, provider adoption, and institutional partnerships—highlighting both the promise and complexity of advancing digital equity–oriented maternal health interventions in under-resourced settings.

Patient and clinician engagement

InovCares has the potential to demonstrate how integrating culturally responsive, AI-assisted digital tools with in-person care can help address longstanding barriers such as transportation, food insecurity, and behavioral health needs. Unlike many digital interventions that stop at screening, InovCares facilitated closed-loop referrals and direct service delivery, improving continuity and coordination of care. The inclusion of bilingual interfaces, culturally concordant providers, and peer-to-peer “Health Tribe” support features fostered trust and belonging among Medicaid-enrolled and immigrant birthing people—populations often excluded from early digital health innovations.^17,18 One patient expressed in the app-based survey,

“It’s my first pregnancy and I have got immense support from InovCares. InovCares provided us with a digital blood pressure machine which has been a great device throughout my pregnancy. I could also schedule a session with my doula and I am learning essentials about labor and delivery now. It’s been a great experience with InovCares for us.”

Preliminary data indicated that 80% of patient users reported using the app once per week. This high patient engagement was facilitated by bilingual interfaces, culturally concordant providers, and gamified wellness tools aligning with evidence that positive reinforcement supports sustained engagement.^26,27 These features illustrate how adaptability and cultural tailoring has the potential to mitigate digital exclusion, a key digital determinant. By addressing language and literacy barriers early on, the platform enhanced usability for Medicaid-enrolled and immigrant populations often excluded from early digital health innovations.

Clinician engagement proved equally essential. Co-designing workflows and integrating the platform with electronic health record systems minimized disruption and encouraged adoption—factors identified in implementation science as critical for sustainability. ¹⁹ Providers reported that real-time access to patient-reported data supported earlier intervention for high-risk conditions such as gestational diabetes and preeclampsia, while embedding doulas and maternity care navigators strengthened care coordination. As one clinician reflected to the InovCares team during a debrief meeting,

“As a provider being immersed in the InovCares experience, I can attest to its remarkable impact on our clients. InovCares enhances provider accessibility and removes barriers to care, including insurance gaps. It provides vital services like prenatal vitamins, essential medications, and transportation for those with accessibility issues. This program has significantly improved our patients’ access to care, resulting in fewer negative outcomes.”

Institutional and payer partnerships

Institutional commitment from FQHC leadership and partnership with managed care organizations were central to the program’s success. Collaboration with BCBSTX enabled electronic health record integration, staff training, and reimbursement for nonclinical services which addressed a persistent barrier to sustaining equity-focused interventions.^8,15 While electronic health record integration required significant time and financial investment, participating clinics viewed the long-term benefits, such as improved patient retention, enhanced service offerings, and value-based revenue streams, as outweighing initial costs. Variability in site readiness and infrastructure, however, influenced implementation pace. Some clinics lacked adequate technology or staff capacity to sustain the platform beyond initial funding. These challenges underscore the need to assess organizational readiness early, provide technical assistance, and establish transparent sustainability plans that align payer incentives, staffing models, and reimbursement pathways for technology-enabled care.

Institutional commitment and payer alignment were critical for implementation, reflecting structural determinants of digital health equity. ¹⁸ Partnerships enabled reimbursement for nonclinical services such as doula care and transportation, addressing financial barriers that often limit access to technology-enabled maternal care in safety-net settings. This underscores the importance of organizational readiness and incentive alignment for sustaining equity-driven digital models.

Sustainability strategies for long-term viability

Models like InovCares align with value-based care frameworks, which can support sustainability beyond initial philanthropic and payer funding. Potential strategies for maintaining viability include, for example, (1) integrating services in Medicaid and managed care contracts that reimburse telehealth and nonclinical supports such as doula care and maternal care navigation or (2) exploring shared savings agreements tied to reductions in emergency visits and preterm births. Evidence from similar initiatives suggests these approaches may help offset technology and staffing costs when scaled, ¹⁵ but their long-term effectiveness for maternal health interventions requires further evaluation. These possibilities highlight pathways for transitioning equity-focused digital interventions from grant-supported pilots toward more sustainable models.

Technology, AI integration, and equity considerations

AI-assisted risk assessments improved care coordination but also raised concerns about algorithmic bias. InovCares incorporated safeguards, such as racially representative training data and corrected BMI metrics, ²⁸ operationalizing principles from digital health equity literature. InovCares’ Chief Technology Officer also monitored algorithmic performance. We envision how intentional design can reduce harm for marginalized populations, although ongoing monitoring remains essential to prevent inequities in predictive analytics. From an implementation perspective, these adaptations reflect an emphasis on intervention complexity and adaptability, highlighting the need for continuous refinement in response to contextual challenges. Despite these advances, AI and electronic health record integration can pose operational and financial challenges that reflect systemic inequities in digital infrastructure across safety-net settings. Sustained policy and payer support are needed to ensure that under-resourced clinics can maintain these technologies without exacerbating disparities.

Cross-cutting lessons for health equity

Collectively, these lessons demonstrate that advancing maternal health equity through digital innovation requires more than the introduction of new technologies—it demands equity-centered design, sustained partnerships, and adaptive implementation strategies. The InovCares experience illustrates that success depends on culturally grounded and accessible design, the integration of social risk navigation into clinical workflows, and strong payer-clinic partnerships that ensure financial viability. Equally important is the ongoing monitoring needed to identify and mitigate algorithmic bias. By embedding equity within both the structure and delivery of care, InovCares demonstrates how technology, clinical practice, and community partnership can be aligned to operationalize maternal health equity. These lessons provide a practical roadmap for scaling similar interventions across diverse, resource-constrained health systems.

These lessons also show that advancing maternal health equity through digital innovation requires more than technology deployment. It demands intentional design to address digital determinants of health and structural alignment with payer incentives and safeguards against algorithmic bias, while also considering factors such as organizational readiness and process adaptability. ²⁹ Applying these concepts clarifies how equity and implementation factors can interact and offers guidance for scaling interventions without exacerbating disparities. Future research should employ rigorous mixed-methods approaches to examine how these principles influence outcomes across diverse settings.

Conclusion

The maternal health crisis in the United States demands bold, equity-driven solutions. The InovCares model represents a scalable, technology-enabled approach that integrates digital innovation, culturally responsive care, and cross-sector collaboration within under-resourced settings. Its mobile-first, AI-assisted platform facilitates real-time care coordination, embeds equity-informed design principles, and operationalizes social determinants of health screening and response within clinical workflows.

Partnerships with managed care organizations were critical to implementation (and will be to sustainability), enabling reimbursement for nonclinical services and extending reach to high-risk populations. By centering the lived experiences of birthing people and aligning technology with community and payer infrastructure, InovCares demonstrates how equity can be systematically embedded into maternal health service delivery. Lessons and insights from this model and work establish a foundation for future comparative effectiveness research and inform the broader implementation of digital maternal health models that advance structural equity in care in the United States. Lessons from this pilot establish a foundation for future comparative effectiveness research and inform broader implementation of digital maternal health models that advance structural equity.

Availability of Data and Material

Inquiries about data availability can be made to the corresponding author.

Consent to Participate

All participants consented to participate in this study.

Authors’ Contributions

M.K.: Conceptualization, methodology, software, formal analysis, resources, data curation, writing—original draft, visualization, supervision, project administration, and funding acquisition. J.T.: Data curation, visualization, writing—original draft. C.C.: Writing—original draft. TE: Writing—review and editing. H.I.: Writing—review and editing. K.K.B.: Writing—original draft.