Perinatal Care Coordination


The state of California had mandated counties coordinate care for underprivileged pregnant people, who are insured with Medi-Cal. San Francisco needed to assess the variety of services available for perinatal care, covering a woman during her pregnancy and in the months after the baby is born—not limited to care in a clinical setting, but all the services a woman might need. While many services are offered, they often don’t work together, and the women often get overwhelmed at trying to navigate the system.


Malini Nijagal, MD, MPH, a professor of obstetrics and gynecology at UCSF and a clinician at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). She is part of the San Francisco Respect Initiative, which is supported by the UCSF Department of Obstetrics & Gynecology, and which aims to improve pregnancy care access, experience and outcomes for communities that face the most barriers.

Heather Briscoe, MD, a UCSF professor of pediatrics, and Marcy Spaulding, MS, RN, a public health nurse with the San Francisco Human Services Agency, who together run the city’s Plan of Safe Care Collaborative.

Melanie Thomas, MD, MS, a UCSF assistant professor of psychiatry and part of the Solid Start Initiative at ZSFG, which seeks to “encircle all pregnant people, children and families with integrated, evidence-based resources and care.”

Family Child Services, part of the San Francisco Human Service Agency (in turn, part of the San Francisco Department of Public Health) provided funding for the project.


The project focused on women who receive Medi-Cal benefits—health insurance for low-income Californians. Many of those women are seen at ZSFG, where all of the doctors at ZSFG are UCSF faculty. The doctors brought in SOM Tech to serve as consultants on the project.

SOM Tech was a natural consultant for the project. The SOM Tech team has experience in convening large groups for what Beth Berrean, Deputy Director for Design and Discovery, called “participatory design,” in which it gathers input from a wide variety of stakeholders in seeking a solution to a given problem.

“We also have some experience doing design with vulnerable populations and underserved populations,” Berrean said. SOM Tech has deep contacts in community-based organizations, who play a key role in San Francisco’s perinatal care ecosystem. “That makes us a good choice to do it, as opposed to other external agencies, who may have more of a consumer focus.”

SOM Tech, on the other hand, is accustomed to partnering with community members and groups.

“Because we complement that with the ability to think through technical feasibility, as well as highlight the operational, financial and sustainability concerns about implementing new tools and technology, we're frequently chosen to do that kind of exploratory work,” Berrean said.


SOM Tech started by conducting two participatory design workshops with a large number of community-based organizations and other people who were providing support to women and infants.

SOM Tech also conducted two-part interviews with patients and then with their extended care teams.  “This was a fun, a fun thing to do,” Berrean said.

“We first interviewed the patient about their experience, and we then talked with all of the folks who were responsible for that coordinated care piece of it,” Berrean said. Because SOM Tech has a diverse team, it moved one of its senior software developers, Dayana Daniel Hernández, onto the project to conduct Spanish language interviews.

The interviews were enlightening. “It was definitely interesting to find out how the lack of a care coordination system puts the burden on the patient to be that coordinator.”

The interviews also helped SOM Tech identify opportunities for improvements. “Being pregnant is a transitional point,” Berrean said. “It's an opportunity to transition women to a better housing situation, or to transition them to a substance treatment plan,” or to other services they might need.

Because much of the work took place during the pandemic, many of the women were not receiving help in person. “That highlighted the need for a technical solution,” Berrean said. “In the past, a case manager could be more present.”

Technology would not be a stumbling block, Berrean said, partly because young women of all income levels are very comfortable in the digital world. “The patient population that tends to get pregnant were all pretty technically savvy,” she said, whether or not they speak English. SOM Tech recommended that any care coordination system that’s created should make use of technology, so that “folks could actually use it.”

But SOM Tech did not build the system. “This was purely a design and discovery exercise,” Berrean said. “We really looked at what could be possible. And then we did research on what other counties have actually done to solve this.” SOM Tech reached out to Alameda, Marin, Los Angeles and San Diego counties for ideas.

Berrean said SOM Tech helped the DPH and other key members in the perinatal care network realize that they had an existing relationship with some of these community-based organizations (called CBOs for short), but they weren't sure how best to leverage their insights. “We were able to lead a process that really helped highlight what the CBOs were seeing and doing and needing,” she said.


SOM Tech’s main recommendation sounds simple, but often gets lost in the clutter of bureaucracy and technology: Put the patients first.

“Solutions that are purely based on the electronic health record aren't really about solving for the needs of the patient. They're solving for the need of the Department of Public Health, essentially,” Berrean said. “We said, ‘You need to think about what the patient or the family needs, and not what the department needs.”

For instance, according to report produced at the project’s end, SOM Tech found that Compass Rose, which integrates with the Epic software that manages electronic health records, provides excellent case management, but would be “suboptimal” because it would require intensive use of time, money and human effort without meeting patient needs.

“A system that was only focused on the Department of Public Health was never going to be successful,” Berrean said.

SOM Tech also produced a PowerPoint presentation that Dr. Nijagal disseminated widely in the perinatal care community. The presentation declared: “A key problem experienced by patients, health care providers and CBOs in perinatal care is fragmentation and lack of care coordination.”

“Providing well-coordinated and person-centered support for vulnerable pregnant people and newborns in SF will require a technology solution that enables communication between pregnant people and their care team members, and that is easily accessible, user-friendly and valuable to all team members alike.”

Marin and Alameda counties, for instance, use community health records, which are essentially platforms that allow all people helping women with their care to share information easily and digitally. That information sharing is essential to ensure effective collaboration, keeping the patient at the center of everyone’s efforts.

Written by Dan Fost for SOM Tech (2022)