What If Communities Were the Key to Better Birth Outcomes?

[00:00:00] Before we start, I want to invite you to Rosetta Fest 2026 in Nashville. This is where employers, unions, and clinicians who are cutting healthcare costs 20-50% while improving care and outcomes share exactly how they did it. Operators learning from operators with patients at the table. Learn more and register at rosettafest.org. Now let's get into today's conversation.

[00:00:26] The current maternity system is failing, and it's failing by design. So there was just this big gap in between what women need and what the system was willing to pay for. Who pays for healthcare gets to define how it's delivered. And that's something that I think that we all have to recognize. We have 70% of women who report that they've suffered a life-altering morbidity during their pregnancy. 70%. The number one thing on that list is...

[00:01:12] Welcome to Relocalizing Health. I'm Dave Chase. Every episode, we're talking with people who are taking back healthcare from corporate extraction and rebuilding around our own communities and their own communities. Today's guest works at the very beginning of life. Allison Duncan is the founder of ANU, and she's the architect of a paradigm that's very different than what you typically see, certainly in the States, but really around the world.

[00:01:42] And she's someone who's mapped the best approach in the world that actually works and is working on how communities like the one she lives in, hopefully the one I live in, and all you live in, build their own model. So she's mapped out one of the best maternity hospitals and maternal journey on the planet. And she's now helping build a model in Pickens County, South Carolina, where birth is treated as a jewel it should be. Allison, welcome.

[00:02:09] Thank you, Dave. I'm so happy to be here with you. And just want to say how much I admire what you're doing at Health Rosetta. And I'm just happy to be a part of the movement with you.

[00:02:19] Yeah, no, it's so fun because there's people coming out from so many different important parts coming together and we all realize we need each other. But I want to get into, you know, your work is really kind of an architectural work that, of course, spans the maternal journey, as I mentioned. Tell me a little bit about what that means and how did birth become the thing that you really built your organization around?

[00:02:45] What it actually means in terms of architecturally speaking is that the current maternity system is failing. And it's failing by design. And I think that that was something that I didn't realize when I actually started to work in this area. I was invited to work in this area by a man named Todd Park, who is a good friend of mine. He actually is a founder of a health insurance, Medicare Advantage insurance company called Devoted.

[00:03:15] But prior to Devoted, he was a co-founder of Athena. And a lot of people don't know that Athena actually started by trying to scale up birth centers. So actually in maternity in San Diego. And one of the reasons why that beginning model didn't work is because they couldn't figure out how to get paid for delivering the quality of services that they knew that women needed.

[00:03:37] And so there was just this big gap in between what women need and what the system was willing to pay for. And that gap has persisted for decades, more than 30 years now. And so after working in a very large ultra-poverty initiative where we scaled a ultra-poverty solution that was evidence-based out of Bangladesh into many other countries around the world,

[00:04:04] I was sitting down talking with Todd about how important this kind of intervention, which we're going to talk about a little bit later, how important this kind of intervention would be for women in the United States. And he was just, you know, expressing his concern and his frustration that the maternity care system has continued to be intractable. And so he invited me onto a journey with him to explore why is that?

[00:04:32] Why is the maternity care system intractable? And why do we consistently produce the worst outcomes of any developed country? And now over a decade or more, we've been ranked 55th in terms of maternal and infant mortality. And so it really started as a curiosity of trying to understand, you know, obviously I have a love for life. All of the companies, I've been in philanthropy, impact investing, and social movements for 25 years.

[00:05:02] All of the companies and projects that I've had a chance to be focused on are all about unleashing human potential and flourishing. And so this was just the next step for me. And as we got into it, I think as you've expressed in a lot of the things that you've done, as we got into it, we just saw the system is designed to not respond, actually, to the actual needs that drive the outcomes. And so that was a conundrum.

[00:05:30] And so I started to search and look to find who does this well. And so that was at the very beginning of this process was just a big question of who does maternity care well? And what does that even look like? It's a great segue because I want you to take me to Brazil, although I just want to comment that, like we could do a whole series of episodes on your past work and the alter poverty alleviation work is just stunningly impressive.

[00:05:59] But we're going to stay focused on the maternal journey right now. So take me to Brazil. As I understand it, you went in and sort of did an asset mapping of this maternal hospital. And, you know, what did you find that maybe you didn't expect? I mean, probably had heard they'd done a good job, but I'm curious about that whole experience. Well, I mean, I think one thing that I want to talk about is what even got me to go there. Right. So, again, I was looking all over.

[00:06:27] I was doing a global scan for high performing maternity care systems, whether that be birth centers or hospital systems or whether it be a payment model. Like where did where was there a high performing maternity care system that actually works? And there are a number out there.

[00:06:45] But in particular, I was in the Amazon visiting a community that I had been involved with and was working on a food relief program and so on and so forth. And I was curious because I was doing this birth project. I was very curious about what was happening for the indigenous people in Acre in Brazil, what was happening for moms for them.

[00:07:11] Now, this particular community that I was visiting, they sustain deep, intractable hunger, actually. The children and the community suffers from hunger. And we were working on that front. But I was invited to go and attend a birth while I was in the community, by the community. And while I was there, that birth actually turned into a catastrophic situation.

[00:07:34] The mother had to seek care outside of her village and very far away, several hours away into a hospital. She didn't end up having a C-section. She did end up living and everything turned out OK. But it was very close call. And so after that, I was meeting with the midwives and they were saying that their community was facing very unusual and increasingly difficult complications in birth.

[00:08:02] And so even to be able to manage a traditional home birth inside the community was something that they were struggling to be able to do. And they felt very unsafe and insecure about accessing the standard Brazilian health care system for their care. Right. There's language barriers, cultural barriers. There's all types of medical and obstetrical violence that occurs there.

[00:08:26] While I was involved in this program, in this research project, I went on a journey to find an organization that was sensitive to indigenous needs and indigenous rights that would be able to help me bring technical assistance and support to the midwives of the indigenous community that I was working in.

[00:08:47] So I think that's a first clue is that I found this organization by asking many, many contacts that were helping me in the strategy process. I found them because they had a reputation for actually training traditional indigenous midwives on sonography, using technical equipment, working with hospitals, talking with obstetricians so that they were actually engaged already in community outreach and community based work.

[00:09:17] Humanize birth, keep birth localized and make home birth possible. OK, just think about that. A hospital was actively in outreach to keep birth localized and make home birth possible. I don't know if that sounds like Greek to you, but that is not something that you're going to find in the U.S. maternity care system as far as I can, as far as I know. Right.

[00:09:44] That is just not a behavior that is typical of hospital systems at this point in time. And so I went by reputation to meet with the founders and the leaders of this hospital in Brazil.

[00:09:55] And while researching them, talking to people who were actually in the Brazilian government making policy around health care, being over and over again, being told that they were on the forefront of a hospital-based maternity care approach that was humanizing. And in Brazil, the C-section rate is around 75 to 80 percent, depending on which region that you're actually looking at.

[00:10:24] And when I visited Hospital Sofia Feldman in Brazil, their C-section rate at that time, and this was during COVID, their C-section rate was 21 percent. So you can imagine in a context where it was culturally normal to have a C-section almost as a default, there was this hospital that was 100 percent philanthropy. It was 100 percent Medicaid equivalent called Seuss. So 100 percent focused on Seuss populations.

[00:10:53] And it had the lowest C-section rate in the country, lower than most C-section rates within the United States. And it was outreaching to indigenous communities to help build capacity for traditional midwifery. So I knew that I was in a very special place and that I had a lot to learn just by making that relationship. So that's how I got there. And that's a little bit about what I found when I arrived.

[00:11:18] Now, they are a high-risk reference hospital, which means that across their state, which is Minas Gerais, it's a 22 million geographic fence, that they are referred to them are the highest risk pregnancy cases within that state. Okay, so they get the highest risk cases and they have the lowest mortality in the country and also mostly around the world, right? I haven't done a comparative analysis of everything, so I can't say that completely.

[00:11:45] But they have a very, very low mortality infant and maternal mortality rate. Yeah. Wow, that's amazing. Now, you know, bringing it back to this country, you know, my words, I believe, you know, once I've learned about the outcomes we have around maternal journey, I don't think you can call it anything but a national embarrassment, you mentioned one data point. Maybe expand on that a little bit, right?

[00:12:12] How bad are the outcomes in this country and how should people feel about that in light of the different dimensions that you've shared with me in some prior conversations? I think that it is a national disaster, actually. And I think that it's probably one of the most important things that we turn around as quickly as possible. A lot of people have heard that the fertility rate is dropping, okay? And so our American mothers are actually having babies, less babies, and they're having them later.

[00:12:41] But one of the things that's also happening is that our disease burden inside the pregnancy is increasing drastically. So every year we have a higher number of high-risk pregnancies across all geographies. And so how does that actually manifest? That manifests in maternal mortality and infant mortality, those numbers. But it also comes forward in morbidity numbers, like postpartum anxiety and depression,

[00:13:07] or women who report a life-altering morbidity or trauma during their pregnancy or during their postpartum period. So currently today, we have 70% of women who report that they've suffered a life-altering morbidity during their pregnancy. 70%. The cost of untreated postpartum anxiety and depression is extremely high. This is growing.

[00:13:31] And across all categories, socioeconomic and racial lines, birth is happening earlier and earlier. So the preterm birth numbers are increasing. Early birth and preterm birth numbers are increasing also across almost all geographies. So we have hot spots in the U.S. where this is very, very intense. But we can actually see that it is a national challenge.

[00:13:54] And it has a lot to do with the way in which our health care system is structured and paid for. So who pays for maternity care gets to define how it's delivered. Who pays for health care gets to define how it's delivered. And that's something that I think that we all have to recognize. And right now, the payers of the maternity care system in the United States are defining a delivery model that's responsive to escalating complications rather than preemptive.

[00:14:24] Focused on preventing things that are known to exacerbate complications in pregnancy that are easily preventable. So we have high degree of preterm birth. In some regions, it can be as high as 20, 25 percent. The national preterm birth rate is above 12 percent at this time. Preterm birth actually decreases life expectancy for baby, mother and father.

[00:14:50] And also it's a highly catastrophic event for quality of life for the family, in particular the baby. And, you know, you hit on a point in terms of, you know, who's controlling the dollars. And at the end of the day, right, it's I haven't heard any, you know, Australians or Italians volunteering to pay for the U.S. health care. So it's our dollars. And particularly in the employer union area where we've done a lot of focus, it's even more so.

[00:15:15] And I look at it as, you know, really reclaiming sovereignty, you know, over that and such a critical part of the process, of course. And, you know, when people think about maternal death, they think about, you know, things like hemorrhaging and whatnot.

[00:15:32] But give us a little idea of the fuller picture once you look at the whole journey before, during and after birth and, you know, the distinction between pregnancy associated deaths and so on. And I think that will illuminate the situation even more for folks. If you've been listening and thinking, I wish there were more places where people share what actually works.

[00:16:01] That's exactly why we created Rosetta Fest. Join us in Nashville at the end of July. It's where employers, unions, and clinicians who've built thousands of health plan successes share how they improve the caregiver and patient experience that leads to the best health and financial outcomes. The only people on stage at Rosetta Fest have created sustained success and happily share their secrets. Details and tickets at rosettafest.org. All right. Back to the episode.

[00:16:32] Yes. Well, when you look at the maternal mortality numbers, let's talk about those for a minute. Maternal mortality review committees that count those numbers, they count pregnancy-related conditions that lead to death, right? And so those pregnancy-related conditions are clinical conditions. And so that can be hemorrhage. There is also mental health conditions, which can be often, you know, suicide or related to overdose.

[00:16:59] But, you know, stroke, heart attack, preeclampsia, eclampsia, these are in the top of the pregnancy-related deaths. There's been data that has come out regarding pregnancy-associated death. And pregnancy-associated death is death from all causes that occur either while a woman is pregnant or within 12 months after giving birth.

[00:17:20] And so the fact that we call it pregnancy-associated means that we're not necessarily sure in the data whether or not this mom died due to the pregnancy, right? However, when you look at those numbers, they are 10 times more than the numbers that are counted in the pregnancy-related numbers. So that means we're 55th only by counting the pregnancy-related numbers.

[00:17:50] But there are all-cause mortality that is happening to moms within one year of giving birth. Pregnancy-associated death that is 10 times more. Can you imagine if we were to look at those and we were to understand some of those things that are on that list? Like the number one thing on that list is accidental overdose, okay? Number two thing on that list is homicide cause. Number two, pregnancy-associated.

[00:18:15] So when you look at that and you think about why are women being killed during and, you know, during their pregnancy or after their pregnancy, we can see that really what is and also what is causing preterm labor starts, which has a lot to do with stress conditions, we can see that actually there's some clues in there as to how we might want to change maternity care

[00:18:41] and what we might need to address to support women while they're pregnant and after they've given birth, right? If they're suffering from death on causes that cannot be clinically related to the pregnancy, but are socially related to the pregnancy, obviously, then that would lead us to a conclusion. And if it's 10 times more, that would lead us to a conclusion that perhaps maternal social care is something that we really need to look at as the primary intervention

[00:19:11] for how we could change the system and ultimately change these outcomes. Yeah, no, I think that's so critical to understand. And, you know, as I've, you know, shared with some of the folks around Rosetta Fest and having you speak at the event and what you're doing, you know, I'll convey that, right? Just how in there are some good models in the U.S., but really at the best, they're a really good clinical model with a little bit of social care.

[00:19:39] But certainly what I heard from you was really flip that on its head. The social care is really the foundation. Obviously, the clinical matters a ton too. And so, you know, that's a good segue into talking about that first thousand days from pregnancy confirmation, you know, through, you know, obviously the first couple years of life. And you described as the best investment in all of health.

[00:20:05] Make that case for a civic leader like a mayor who's never thought about it that way. Well, one of the things in terms of investment is just to follow the money. Now, in the United States, approximately 50% of pregnancies, sometimes 48%, sometimes 51%, are paid for by Medicaid, okay? And so a lot of people would think, well, what does this really have to do with cost savings for us in our own community, right?

[00:20:32] Well, when you look at the payment rates for Medicaid, Medicare, and commercial insurance and other insurance models, you'll see that Medicaid doesn't pay for full cost. So if we just, in terms of there's the human side of why this is the best investment in all of health care, and then there's also the financial side of why this is the best investment. So just continuing on the financial side.

[00:20:59] So when we have a high level of preterm birth, which is absolutely the most expensive type of pregnancy outcome that you can have, right? If you look at, think about it in terms of a preterm birth and the minimal charge rate for a day of NICU stay, neonative intensive care unit stay, minimum would be $12,000 to $20,000 a day.

[00:21:26] So if you're talking about an infant needing to stay in the NICU for weeks for that type of procedural care, and that being entirely preventable, we can talk about why that's preventable, but the fact that that could be a preventable pregnancy outcome. You can see that even I was speaking with one of the leaders of the Blues, and I was told that the million-dollar baby is a thing of the past.

[00:21:53] Like we're talking that $8 million babies, $20 million babies, right? In terms of very preterm babies. The line of viability in terms of life is earlier now because we have better technology. And so that's more expensive, but it's available. And I'm grateful and thank God that it is available. And so I'm very grateful that we have the kind of preterm birth, early life services that we do have.

[00:22:18] I just think that we're utilizing them far more than we need to, far more than we need to. Okay. So if you're talking about a Medicaid preterm birth, the cost that's not covered by Medicaid is actually going to have to shift to the employers and to the local fully insured buyers in that hospital system. And so I think that it's very rare that people really understand that when you have very big

[00:22:45] ticket Medicaid items that are not paid for, the hospital has to recover those in other ways. And I've done some deep dive studies in what's happening in my community as well as what's happening in your county as well on this. And so the cost shifting is profound. And if you look at that, you'll see that in our two communities, our hospital systems are, you know, employers are paying 250 to 350 times Medicare rates.

[00:23:10] And that has to do with having high cost shifting, which if you look at what the biggest ticket item is in these places, it is Medicaid preterm birth cost for mom and baby. So if you want to just say like, what is from a financial perspective, what is the one thing that we could focus on? That if we got that right, that we would actually be able to bring down the most pressure for everyone in the community.

[00:23:37] It would be to reconstruct the maternal journey and it would be to reduce preterm birth in our communities. Hands down. That's just on the financial side. The other interesting thing about that is when you look at the kind of infrastructure and what you would need to do to actually be able to support, adequately support a pregnancy to drastically reduce preterm birth occurrence. All of that, those services can be utilized and extended to other members of the community

[00:24:06] and other health verticals. Right? So it's actually because of the type of service, social service that it would be, it is actually highly extendable. To be able to get that right, you can extend it to others. So that's just the financial cost. That's also the scalability and the extendability of the services and the infrastructure for the investment. And then you have the human cost. Right? Because as we have catastrophic labor and delivery outcomes, when we have a mother who's suffering

[00:24:33] from postpartum anxiety and depression, or she suffers from even a clinical outcome of like of pregnancy, gestational diabetes, that increases her likelihood of getting diabetes within two years of giving birth, having full-blown type 2 diabetes within giving birth. Also preterm birth, those babies have more complications. They have more diagnoses in the first thousand days of their life than children who are born full

[00:25:02] term and who are born from a mother who's strong and who's been adequately supported and she's in a healthy environment. So in general, it's one of these things that kind of geometrically compounds for a community. And so there is no situation that reducing the maternal mortality and morbidity rates in a community do not provide geometrical cost savings and the improvement of the quality of life for the whole community. Yeah. Yeah. No, it's amazing.

[00:25:31] You know, I just had Kenneth Aldridge from, you know, Rosen Hotels, the Rosen Care model. And, you know, when I did my TED Talk about them, you know, a decade ago, I think it was 56% of their pregnancies were categorized high risk. And when I just spoke to them recently, it's, you know, this year it's been between 60 and 70%. And yet they've done a really nice job. And I'm sure, you know, with the insights you have, I'm sure they can do an even better job going forward.

[00:26:01] So maybe let's take us to your hometown in Pickens County. Yes. And what's going on there? What are you actually building at the Dream Center? And I'll confess, I had the great privilege of visiting the Dream Center recently and it was amazing, but I won't do justice to it. So I want you to describe that. Well, so it's really interesting because, you know, I went to Brazil to learn from Hospital Sophia Feldman around how a hospital could manage the pregnancy journey.

[00:26:30] And in that particular learning, one of the things that they knew and that they were talking about was we have to reinvent the social care wrapper around our patients and our clients. Right. So they knew that intuitively and they knew that that was absolutely the next step. And having been involved with the Ultra Poverty Graduation Program, it was odd that these things kind of started to come together.

[00:26:56] Because when we look at what happens in a pregnancy that needs social care, it is often with a woman who has extreme vulnerabilities in her environment. Right. So it's relationship vulnerabilities. It can be intergenerational, intractable poverty, homelessness, hunger, substance use. And so I was looking for a partner that could help us at ANEW design this maternal social care

[00:27:26] wraparound that we could extend into Hospital Sophia Feldman and that we could extend into our clinical partners that we have. And so I was looking for that and it just so happened. And Dave, you know that I believe in Providence for sure. So it just so happened that the best organization that I could find for that to be able, that design partner was in my hometown. So I'd lived away for 25 years and then I'd moved back to Pickens County and the Dream Center

[00:27:55] had been working for 14 years and they had focused on working with women who were experiencing homelessness, single women and women with children. And they have a tiny house village and they have a yearlong program that was very similar to the ultra poverty graduation program, but it was a residential program. And what that program did is it invited women who were ready to actually go on a transformational journey for their lives.

[00:28:20] It invited them in to live at the Dream Center and to be able to go through a structured phased program. The first phase is core and that's where they're able to relax and heal and receive love and go to the gym and change their diet and be surrounded by people who care about them and do a lot of work to actually dream a new dream for their life, right? And to get the chaos down and the stability in.

[00:28:49] And then the second phase of their Opportunity Village program is around discovering opportunity. And so that's where they go into a journey of discovering what they can do to increase their economic independence. And the goal of the program is actually to be able to get completely economically dependent and off of government support services, right? And so the goal of the program is to invest in them at the women who are living there at

[00:29:17] a level that they can achieve economic sovereignty themselves at the household level for them and their children without having to make the compromises that sometimes women feel that they have to do, which is to maintain or go back to relationships that are dangerous for them and are unsupported, right? And so to replace that type of domestic violence situation with a stable community support structure

[00:29:43] of friends and mentors and peers who are on this transformational journey. And so what we discovered about maternity care is that when you're looking at some of the things that are leading to preterm labor starts, and you look at those causes of maternal mortality and morbidity, you can see that it has a lot to do with economics. So women are making compromises often in their lives, or they're engaging in coping mechanisms

[00:30:13] that are dangerous for them and their children because they are unable to provide for themselves and their children in this economic environment, and they don't see the way to do that. And so we went on a journey with the Dream Center to design a program called Strong Mamas, Strong Babies. And that program is designed to be a thousand-day journey, and we recruit women to come in and take classes with us. They are—and I can talk more about what's inside Strong Mamas, Strong Babies, but I'll

[00:30:42] just say that the Dream Center is a community-based organization. It takes no government funds. It is sustained by a community agreement. This needs to happen, that recovery in our community is something that we want to support and provide an option for recovery. So it's funded by 70% of self-generated through resale stores, and then donors and an extraordinary number of volunteers.

[00:31:08] I mean, I think there are more than 2,000 volunteers per year that help to sustain and make the Dream Center happen. And so this became the platform for us, and had everything that we need to be able to recruit and build a program, Strong Mamas, Strong Babies, and offer it and then measure the outcomes. And so we're in the middle of that. And it is—as we are trying to build a new paradigm in maternity care, we're looking at

[00:31:32] everything that we would need to build to be able to, one, replicate this model, and two, create an evidence base to demonstrate that it is far superior to invest in maternal social care with a clinical partnership, rather than a primary focus of investment as maternal clinical care that has a social addendum. Yeah. Yeah, no, it's amazing.

[00:31:59] And you were here about a month ago, and something I haven't had a chance to share was, you know, they did a post-event survey. And Allison came here, and I presented as well, about, you know, what's possible if we reclaim health sovereignty and relocalize health. And one of the definite recurring pieces of feedback was like, okay, we need to get our Dream Center here. We want, you know, some variation on that.

[00:32:26] And there's a lot to the Dream Center, and they have a great website, so people should check it out. But, you know, for me, there was definitely a couple takeaways at the highest level. One that's consistent with what I find, whether it's Rosen or the NUCCA model folks, this is just a group that's like no excuses. Like, they have as big a challenge as anybody, but they just kind of apply, you know, radical

[00:32:53] common sense and, you know, care and love at the end of the day. And when you bring those things together, it's really remarkable, you know, what happens. And, you know, just success breeds success. And the fact that they're, you know, so open to sharing it, you're open to sharing it, I think it's really amazing. And, you know, as you think about that, what do you think makes a community in general, you

[00:33:18] know, community like Dream Center, Opportunity Village, but more broadly, like the Sophia Feldman and what's happened there? What do you think makes a community a beacon and what leads the success in one community to travel to the next? Like, what do you think are some of the key success factors there? Well, I've had a chance to see that, you know, several times in many places around the world.

[00:33:42] And I'll say that that no excuses leadership, I'll never forget when we were in Hospital Sophia Feldman. And I asked Dr. Jaubatiste and Dr. Eva, you know, what causes this organization to exist? And he said, it's the love in our hearts and the will to act because we are convinced that it is a human right to be able to give birth and to have a birth that's sensitive and humanized, right?

[00:34:10] And so I think that it's a love for humanity in the leaders and a will to act in the face of structural impediments. I mean, I've seen that. I mentioned several times the Ultra Poverty Graduation Program. It's the largest scientifically proven program. It came out of Bangladesh. And Sir Abed, it was just five friends and the will to act after a major, major tsunami, you know, where there was devastation and there was a love for their community. And I see that in Sophia Feldman.

[00:34:39] I see that at the Dream Center. And frankly, I see that with your friends and colleagues in your community as well. I mean, there was an extreme will to act. And then I think that from that perspective, it's not that we're actually doing this because the payment model is already structured to be able to do it. We're doing it because this is common sense and what actually has to be the tip of the spear to lead us to redesign the payment models to serve us.

[00:35:07] And that's to serve us in terms of reducing our cost and improving our health care outcomes, right? You know, we can look at why the system is kind of fossilized or at a standoff. And it has a lot to do with financial engineering and contracting, a lot to do with that. And so one of the things that it doesn't sound very, you know, sexy in a way, but one of the things that we know we have to do to make this model scalable is that we have to make it

[00:35:36] contractable. So that means that we have to make it clear and transparent and we have to make it repeatable. So for us, we're looking for support in terms of not just delivering it in our community, but creating an open source, scalable platform for to be able to be extended around the country and ultimately around the world. That's what we're trying to build. And I think it's vision and it's love and will. That's great.

[00:36:03] Well, as we're wrapping up, it's time for some marching orders. And one is, you know, I want to invite everybody to come to Rosetta Fest to hear more about what Allison's doing, you know, meet her. There's going to be a breakout. We're going to do some interviews there. And so that's certainly a great opportunity. But time for you. I'd love to have you kind of give people, whether they're an employer or they're a civic leader, like a mayor, they're a clinician or a community leader.

[00:36:32] What would be your marching orders to kind of start down this, you know, process? It's going to take some time, but is so important, as you've pointed out throughout our conversation. Well, so first of all, I just want to say that at Rosetta Fest, I will be showing the complete Strong Moms, Strong Babies program and how the life path transformation, the ingredients. So if people come and they want to come to the breakout, I will be detailing all of it there. OK.

[00:36:59] And so maybe that would be a first great thing to do is actually to get level set on what's in the stack and what does it take to actually build a replication and become a sister. That's what we're inviting your county to do is to be a sister county to us in Pickens County, South Carolina. So there's a direct invitation for that and to host a dialogue around how we go on a journey as sisters, sister friends.

[00:37:26] Those who are in the maternity sector understand that reference, but it's very important. A sister friend to someone who's pregnant is a big difference maker. And so that's one. I guess that's two. And then, but the main thing is we have to just get honest with ourselves. Maternity care is broken. And anyone who thinks that can be incrementally tuned to get better hasn't studied the problem adequately. I just want to be very direct about that. This is not an incremental shift.

[00:37:55] And it's broken far, far more. It's fractured far more than we've had the time to go into in terms of the cause and effects and actually how women get dropped and left and how complications are exacerbated and even complications are induced. And so our maternity care system is broken. And so a civic leader, a employer needs to come to terms with that and then needs to have a very specific project.

[00:38:25] If it's not being a sister with us, the numbers are too bad. So everybody needs to have a project to revolutionize maternity care in America. And so I would love to see drastic and high level competition to be able to have the best ideas to get this done because the future of our society, our country, our creativity depends on us winning this and turning it around. Yeah. Well, yeah, that's great.

[00:38:51] I think a point I'd really emphasize from our conversations over the last, you know, couple years, particularly the last few months is just how, of course, the maternal journey in and of itself is incredibly important. But it is this lever for bigger change. Oh, yes. It really shines a light on the many dysfunctions in our payment model and just how we, you know,

[00:39:18] wait for stuff to get just complete seven alarm fire, you know, when we could have, you know, tamped out any fire risk much earlier in the process. So I want to thank you for joining me, Allison. And for everybody who's listening, as I mentioned, you can see Allison, meet her at Rosetta Fest in Nashville at the end of July. She's going to be anchoring the maternal conversation, the women's health track with Dr. Artie Thangadu.

[00:39:45] And we're going to grab her also for Rosetta Fest Live, which is like our ESPN game day. So if today moved you, that's a point, you know, come build with us. The Calvary is not coming from D.C. to fix it. It's on us. And look forward to seeing you all in Nashville, we hope. Thank you. Thank you so much, Dave.