An Interview with Accompany Board Treasurer Katie Shea Barrett

“That’s why I’ve always thought it’s so important to have [doulas’ voices] in policy conversations, because they represent the patient and the patient's voice in a different way. I think that’s super important.”

We recently sat down with Katie Shea Barrett, treasurer of the Accompany Doula Board, to learn more about her work in healthcare delivery system reform and maternal & child health. Most recently, Katie served as Head of Medicaid at Blue Cross & Blue Shield of Rhode Island, where she led the payor's work to enter the Medicaid market in the state.

Katie also previously served as the Founding Executive Director of March for Moms, aligning stakeholders to advocate for mothers’ and families’ health, wellbeing and access to care. Learn more about Katie below!

Can you please tell us a little bit about your background and work experience?

I have worked in the healthcare delivery system reform space, for about 20 years now, ever since I graduated from college. I really was drawn to the space of maternal health through becoming a mom myself. I have two kids. I experienced a postpartum hemorrhage with my second child, but was incredibly well supported by my doula and my midwifery team through both births, [with] different experiences, but the second [birth] being more life changing for me. 

Being a person who works in health policy and health economics, I sort of knew that there were disparities in maternal health, but until I went through that experience myself and really dove in to understanding healthcare inequities for birthing folks, I hadn’t worked deeply in that space. So, going through that experience really drew me to working in that space formally. I took a job as the Founding Executive Director of a nonprofit focused on maternal health advocacy at the federal level called March for Moms. It was an incredible experience. I got to work with a broad coalition of stakeholders to bring reforms such as Medicaid payments for doulas and a number of other federal reforms. That was just such an incredible experience for me. 

Through that experience, I got to meet a lot of the women who were involved in Accompany and founding Accompany. I did not know about Accompany when I was pregnant; otherwise, I would have hired them 100%. Instead, I just hired a yoga teacher friend who was a doula to be my doula. I think what mostly drew me to Accompany was the space of working in value-based care, which is what I did professionally in the Medicaid/ACO/value-based care space, being able to provide these services to families that were on Medicaid and certified Medicaid health plans, and really thinking about how that could work in the future.

When I started working with Accompany about five years ago, they were really ahead of their time. Now, we have Medicaid payment for doulas and a lot of these incredible reforms and initiatives that Accompany has been a big part of pushing. That’s what drew me to the organization, given my background in health economics. That’s the role I fill on the Board, really thinking about our payments and our contracts with ACOs and payors, and how to scale the work that we’re doing. It’s really different than a public health construct in which you’re getting a grant, or something like that. Those are sustainable payments, like health care payments. But how do you do that in the context of a community organization? We’re not billing for services, we’re not a medical institution or organization. 

What led you to pursue a career in public health, health policy, and health systems?

I didn’t know too much about public health when I was in college. I was pre-med. When I graduated, I grappled with the decision of whether I wanted to go to medical school or do something else. I managed to find this incredible job in health care policy at a think tank in New York City out of college, and was like, “Wow, there are a lot of different ways to work in health care than just to be a clinician.” That’s how I discovered public health and all of the different careers that one could have in public health. I went to graduate school at night while working full-time in New York, because otherwise, you can’t afford to live in New York if you don’t work and go to grad school at the same time! 

I wanted to be a doctor because I wanted to serve families. I wanted to be a pediatrician. I wanted to serve families. Then, I quickly realized that there are a lot of other ways to serve families by being an administrator, by being a regulator at the state level, and all of the different roles that I’ve had throughout my 20-year career. I’m sure that there’s more that I don’t even know about now. But that’s really what drew me to it, being able to fix a system that works really poorly for moms and kids. 

In your opinion, what are some of the most significant challenges facing maternal health in Massachusetts?

To me, because I always think about things from a policy angle, it’s really coming together. I think one of the challenges we have in Massachusetts and nationally from doing federal advocacy work is that there are a lot of different people advocating for a lot of different things. There’s not a lot of air space in health care more broadly and very specifically for maternal health inequities. I think the biggest challenge is how do we come together as a community and really focus our advocacy efforts. It was doula payments, then it was a lot of the recommendations that came out of the Maternal Health Inequity Commission. Then, how do we do that coalition building so that we can actually get movement? As long as every single one of us is going to our policymakers and asking for different things, you’re never going to get them.

The biggest challenge in maternal health is there’s so much to fix, and everyone is trying to advocate for different parts of it at the same time. I’ve always said, “Hey guys, I’m a person who works in politics. We’re never going to get all those different things unless we come together and figure out how to align.” What is the most important thing? It might not be your niche issue. It might not be my niche issue. Then, we all have a personal relationship with these issues. Whatever the issue is, it’s being able to come together. That’s what I hope to see throughout my career and what I’ve always tried to. How do we have these really hard conversations to focus our efforts and incrementally move things ahead? 

Your work must involve significant engagement with different stakeholders across healthcare organizations, payers, community groups, advocacy groups, individuals, and more. How do you engage and collaborate with such a range of perspectives to address maternal health needs in your work? 

I think all those voices are important, right? It can’t ever be just the payer’s perspective or the provider’s perspective or even the patient’s perspective – although that’s probably the prevailing perspective. I really do think you need to have all those different perspectives. One of the reasons I was drawn to policy work is because, that’s it, how do you get all these different perspectives and do something that makes a difference and changes things? That’s also what’s really hard. It’s really hard because people have such different takes, whether it’s financial on the (health)plan side or burnout on the clinician side or inequities on the patient side. You know they’re all critically important issues, but you need to really be able to listen to each other and come together. I think that’s a really wonderful role Accompany can play, is you know, it’s plain, but it’s “doula-ing the reform.” Right? How do you come in and support everybody to have those hard conversations and find a place where we all can work together?

How do you think doulas can play a role in improving maternal health outcomes? 

I think doulas are such incredible advocates, period. They are advocates to their clients. They are advocates to their families. They are advocates for the type of work that they do and advocates for their wage and policy issues like Medicaid payment. I think it’s really just continuing to raise that voice and center those voices, because sometimes it’s really hard for patients to speak about their experiences. Doulas are literally trained to translate a patient’s needs to an institutional system like a hospital. That’s literally what they are trained to do. 

So, that’s why I’ve always thought it’s so important to have their voice in policy conversations, because they represent the patient and the patient's voice in a different way. I think that’s super important. I love being able to bring doulas to the state house and different places to advocate and I hope they all continue to be advocates. 

How did you hear about Accompany Doula Care? Why did you decide to get involved as a Board Member?

I got to meet Christina Gebel in my work with March for Moms at the federal level. She was at March of Dimes at the time and was co-founding Accompany with the other co-founders. She was explaining the idea of taking payments from an ACO and having such a broad array of doulas that represent different languages and cultures and figuring out how to make that a sustainable model. So I met her, then I heard about the idea, and I met some of the other doulas that she’s been working with. I just kind of fell in love with all of them. So, when they were trying to formalize a Board and going through the organizational transition, they asked me to join the board, and of course, I said yes.

What does advocacy mean to you?

I think it means speaking out, in a policy context, for what you think needs to change. That’s advocacy to me as a policy maker and a person who works for that space. It’s also just speaking for what you need as a human, as a birthing person. That’s why I think doulas are so uniquely positioned here, but without advocacy, we can’t change anything. Doulas can speak for what the needs of moms and birthing folks are and help think about that in the context of what needs to change. So many of these conversations are about mortality and morbidity, but how do we advocate with a frame of what needs to be different to not have this be the case any longer?

What is your hope and vision for the future of maternal & child health in New England? How can we make that vision a reality? 

I think pretty plainly, my wish is that every birthing family has a supportive doula that they trust and can support them throughout the prenatal period and up to a year postpartum. Really thinking about the vulnerability of families during that time period and having everybody have doulas that they trust, that are affordable and accessible to them, would be my hope and my dream. 

I think more wonky, my dream would be that groups like Accompany can continue to thrive and have a sustainable funding model and not be constantly trying to cobble together grants and payments from different people who want to give a payment and really operating under the terms of the institution, as opposed to operating under the terms that we want to operate under. That would be my dream.