Nest Health
Nest Health family nurse practitioner Joy Fletcher-Chairs speaks with Nest member Ashley Garces during an at-home visit. Credit: Capture Connect Media

For Nest Health primary care providers, a typical workday is devoid of desks, chairs and cubicles. Living rooms stand in for examining rooms. Children anxiously await their annual vaccines at the kitchen table. 

The at-home medical services startup piloted a program last summer and launched this year to combat poor maternal health outcomes for disadvantaged women and their families. Louisiana has one of the highest rates of maternal mortality in the country and ranks at the bottom of overall child well-being. According to national data, children miss up to 50% of their recommended well-child visits  — and this number is even greater for low-income, uninsured, and Black populations. 

Nest provides free medical services to New Orleanian mothers and children who receive Medicaid, but the company has hopes of expanding throughout Louisiana, and eventually around the country.

Verite spoke with Dr. Janell Wilson, a family medicine physician and medical director of Nest Health, to learn about the company’s at-home model and its commitment to underserved New Orleanians. 

Verite: Nest uses a less commonly practiced at-home model of medical care. I’m curious what drew you to serve as medical director in a company like this?

Nest Health family nurse practitioner Joy Fletcher-Chairs checks the child of Nest member Ashley Garces. Credit: Capture Connect Media

Wilson: I think it’s really exciting because medicine started in the home. Doctors went into the home and took care of patients and were able to get a sense of not only their medical concerns, but also their environment and their psychosocial needs, which we now know plays a huge role in how they take care of their health. And so, in working in this model, with our advanced practitioners, which are nurse practitioners or PAs going into homes, they also have a unique perspective that is not typically available to them. 

In addition to that, they have full autonomy to take care of the patients in a way that they deem fit. And they also typically have shared experiences with the families, because they are from the area, they sometimes live in the community, and the same goes for our family advocates. 

Verite: What might a typical visit look like? 

Wilson: Obviously, they’re in their home. We don’t ask them to clean up. It’s like we’re coming to your space, you be in your natural environment, we’re only here to take care of you and your family. We talk to our family advocates and our nurse practitioners, and that’s the team that goes into the home is two of them, the nurse practitioner being the primary care provider, and then the family advocate doing the medical assistance by taking vitals, but also really helping to understand additional needs of the family as far as like social determinants of health and community organizations that we can partner them with. 

From there, it’s like a basic exam as you would expect in the doctor’s office. We bring all of our equipment with us and we put the baby on the scale, we roll out a mat so that we can assess the baby. We do vaccines. We also take care of Mom, we do all of the recommended screenings, all the anticipatory guidance as recommended by the American Academy of Pediatrics. So everything you would expect in the office, except that the kids are way more comfortable. 

Verite: Who would you say are some of your typical patients?

Wilson: We definitely stick to urban areas, and we work with the Medicaid population. So we’re very dedicated to taking care of communities that typically have issues with access to care. So while we’re not delivering babies, again, we are certainly supporting the moms and understanding what they need to have done so they can stay up to date on whatever, like screenings or tests are required by their OBs, like maybe it’s hard for them to get to their OB because they don’t have a car and the OB needs, you know, like a glucose tolerance test or some random test. We can actually go to the home and get that from the mom on behalf of OBs. So we really want to work with OBs. That’s really, how we support them. 

Verite: Another question we had was about family advocates. I know there are other recent organizations that are including family advocates and doulas and others to complement both prenatal care, but also just physician care. I’m curious about your perspective on how family advocates and doulas and other people can work to complement medical care, especially when there’s a lack of access in Louisiana.

Wilson: Absolutely, I think any organization that can partner and brings more support to moms is an organization that we want to partner with. We don’t have doulas in our organization, but we’re happy to work with them. And our family advocates are kind of a split between a medical assistant and a community health worker. So I know a lot of organizations also use community health workers, like connect with the families, get them connected to community resources. And so our family advocates do that. They do that under the direction of our social workers who also provide targeted therapy. And so they’re doing this dual role of like, we’re in the home, and we’re taking care of the medical needs. But outside the home, we’re reconnecting with families, we’re getting them to the services they need. And we’re also partnering with any other community organizations that support what we’re trying to do, which is take care of children and their families and really focus also on pregnant moms.

Verite: Is there something that stands out to you in relation to the Nest mission from the data [on maternal health care] you’ve seen?

Wilson: I think this goes back to your question about what was surprising. It’s super surprising how many kids don’t have the well visits and vaccinations they need, like, we’ve had families where their kids weren’t in school because they didn’t have the vaccinations. It’s just really hard for moms to get their kids to the doctor. 

A Nest Health nurse practitioner and family advocate at the door of a Nest member’s home. Credit: Capture Connect Media

Verite: What have been the biggest surprises that you’ve encountered?

Wilson: I think the biggest surprise is how much of an impact you can make so quickly, with just putting in the effort to do something different. I mean, being a mom and trying to get three kids to like wellness visits, get them checked out because they don’t feel well, and then you have to take off work and take a bus and they have to get out of school. Making that all super convenient, I think we didn’t expect people to react so positively. We knew that they would appreciate the access and the convenience. But just, again, the impact of them feeling like you know that this is medical care we can trust because we haven’t even touched on the distrust of the health care system that a lot of minorities face. So we are really hoping we can change that narrative and also partner with other health professionals to do that as well.

Verite: Can you speak more about distrust of the medical field in Black and brown communities?

Wilson: I think that is definitely implied by the increased maternal mortality that we see which is disproportionate. Like, the poorest white person has better care than like the richest Black person, I’m just paraphrasing, but there’s reasons for that. And it’s because the health care system isn’t listening to Black and brown people, and so we’re here to listen to them. We’re here to communicate on their behalf if we need to, but also encourage them to be advocates for themselves. So, you know, it’s not an easy problem to solve, and it’s built up over years and years, but I think that we can at least do our part to be available and get what they need.

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Josie Abugov is an undergraduate fellow at Harvard Magazine and the former editor-at-large of The Crimson’s weekly magazine, Fifteen Minutes. Abugov has previously interned for the CNN Documentary Unit...