Collaborative Care Plans for Better Patient Outcomes
Let us be your partner in providing comprehensive care to your patients with severe morning sickness and hyperemesis gravidarum (HG).
Harmonia Healthcare is an ally in your care plan for patients suffering from severe morning sickness and HG. Our dedicated team is ready to provide compassionate medical treatment, including:
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IV fluids
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Vitamin infusions
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Antiemetics
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Electrolyte replacement
We can also order labs, address electrolyte imbalances, and prescribe nausea meds for home use.
For Your Practice
Fewer appointments for morning sickness
Fewer med refills
Fewer late night calls from worried spouses
Non-competitive, collaborative relationship
Zero impact on global reimbursements
For Your Patients
Proven approach and care model
Alternative to the hospital
Improved patient outcomes
In-person and telehealth options
How we work with you to improve patient outcomes
Your patient continues to see you for their entire pregnancy! We support you, by offering your patients hydration, IV antiemetics and vitamins. We manage their at-home nausea prescriptions, so you receive fewer weekend calls for vomiting and fewer med refill requests.
We will fax you all our records for your patients and keep you updated on their treatment and progress. We are NOT affiliated with any hospital or obstetrics clinic. You can feel secure in your business sending your patients to us.
Many insurance carriers are starting to cut reimbursement for physicians if too many empaneled patients go to the ER and are not admitted. The second most common cause of ER visits in the first 20 weeks is HG. Our care plans are able to keep severe HG patients out of the ER, hospital and even off of home health! Our protocols are based on ACOG and HER Foundation treatment protocols.
We are actively working towards being in network with major commercial insurance carriers and Medicaid in the state of New Jersey. We are currently operating under a cash pay concierge model.
You can fax us referrals to 732-468-7970 or simply send your patient to our website. Patients can call or text us at 732-538-5149. If you have an urgent patient, send us a text and we will expedite their care.
Initially, we are operating on a cash pay model. Once in network with major carriers, our care is billed outside of the global reimbursement for a birth.
What is HG?
Hyperemesis Gravidarum (HG) is not morning sickness. HG is defined as a potentially life-threatening pregnancy disease that may cause weight loss, malnutrition, dehydration, and debility due to severe nausea and/or vomiting, and may cause long-term health issues for mother and baby(ies). Signs, symptoms, and treatments for HG are explained on this page.
Why HG Matters So Much to Us
HG is an area of high unmet need where treatment expertise is scarce
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A lack of disease awareness means it's severely under diagnosed
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The emergency room is the primary treatment center for many HG patients
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Poor disease management significantly impacts the health of both mother and baby
The Occurrence of HG is Underestimated
The criteria used to diagnose HG often varies among health professionals and researchers. It's vastly underdiagnosed and not really a rare disorder. Patients who are very severe are typically hospitalized. One study by Zhang, found a 10-14% incidence of severe vomiting, and another study found 16% of pregnant patients using antiemetics (anti-nausea medications). There are hundreds, if not thousands, of additional people who terminate their pregnancy out of desperation when given inadequate treatment, despite experiencing such severe symptoms and disruption to their lives.
We want to change that with proactive treatment plans which we will develop working closely with your current healthcare provider.
Criteria for HG
It depends on which criteria you use to define! The most recent definition, The Windsor Criteria for HG, defines HG as:
Severe nausea and/or vomiting that starts in the first 16 weeks of pregnancy
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Significant changes in daily life and the inability to eat and/or drink normally
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Older definitions required certain lab findings such as ketones in the urine or low potassium levels, as well as patients losing 5% of their body weight.
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However, many patients can lose significant weight without having ketones in the urine, or they can have ketones in the urine without losing significant weight.
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“A large majority (82.8%) reported that HG caused negative psychosocial changes, consisting of (1) socioeconomic changes, for example, job loss or difficulties, (2) attitude changes including fear regarding future pregnancies and (3) psychiatric sequelae, for example, feelings of depression and anxiety, which for some continued postpartum. Patients who reported that their health-care provider was uncaring or unaware of the severity of their symptoms were nearly twice as likely to report these psychiatric sequelae.”
The Impact of HG
Research finds that the greater the severity and duration of symptoms, the greater the effect on both mom and baby.
Nausea and vomiting during pregnancy (NVP) can be mild (morning sickness) or more severe (hyperemesis gravidarum). NVP impacts every aspect of a woman's life.
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76.0% reported changes in their plans for future childbearing.
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19.4% developed a fear of pregnancy, and some specifically developed a fear of having sex.
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34.8% changed their mind regarding or considered limiting the number of children they planned to conceive.
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28.7% of patients reported that their health-care providers were either uncaring or did not understand.
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Several used adoption or surrogacy to reach their family goals or increased the spacing of their pregnancies.
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15.2% voluntarily terminated at least one pregnancy because of HG.
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6.7% reported serious psychological sequelae from their HG experience.
Source: Journal of Perinatology (2008) 28, 176–181.
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Risks and Outcomes for HG Patients
Beyond the fetal loss rate of 34%, children and mothers are at risk for complications from HG, especially if the symptoms are severe, prolonged or inadequately treated. The greatest risk appears to be in patients who have more weight loss, severe symptoms, and/or who fail to gain weight for two consecutive trimesters.
The adverse health consequences for mother and child, as well as the costs of healthcare and lost productivity, affect families, the community, and the nation. These patients and their children deserve excellent care and a chance at a healthy future.
Kimber MacGibbon, RN
HER Foundation Co-Founder and Director
Proper management of HG reduces severity and symptom progression.
Research shows that effective and timely care is crucial. Prescription medications and infusions can disrupt the course of HG and reduce ER visits & hospitalizations by 95%.
One challenge with HG is weighing the risks of potential complications and misery with possible risks of anti-vomiting (antiemetic) therapies. There are a number of medications deemed safe with a long history of use. Yet, newer drugs often prove more effective, and do not significantly increase malformation rates.
At our pilot HG clinic in Alabama, OBGYNs and midwives from 3 major hospital systems refer patients to the outpatient HG clinic for treatment of nausea and vomiting. Local OBGYNs report that their patients are happier, healthier! Many of the local OBGYN’s have their front desk triage send any new pregnant patient inquiries involving nausea and vomiting directly to the HG clinic.
At your first appointment at Harmonia healthcare, our physician will present the most up-to-date research and data on HG and safe medications for your pregnancy. The physician will discuss all risks and benefits to different treatment options so that you can feel confident that you are doing what is best for yourself and your baby. Medications available in the clinic include nausea medications, vitamin infusions (thiamine and multivitamin infusions), and electrolyte replacement.
You can find the HER Foundation treatment protocols here. ACOG guidelines for nausea and vomiting recommend treating patients with IV fluids and medications when patients start to feel dehydrated. Dehydration symptoms include dry lips, dark or decreased production of urine, lightheadedness, and generalized weakness. The most up to date literature shows that many nausea medications are extremely safe for pregnancy. A combination of IV fluids to restore hydration and medications at home can relieve the suffering of HG patients.
Early intervention for HG patients helps to manage symptoms and minimize nutritional deficiencies.
Minimizing symptoms leads to minimizing deficiencies, which leads to a happier, healthier pregnancy! In combination with our treatment plans, our goal is for patients to keep down at a minimum 2 meals a day and 4-6 cups of fluids. Over 600 patients undergoing treatment in a pilot HG clinic reported significantly reduced nausea and vomiting, reduced depression, reduced social isolation, and reduced suicidal ideations. Once on treatment plans, the majority of patients were able to resume most elements of daily life - work, parenting and social outings.
Conservative estimations suggest HG costs nearly $500 million annually just for inpatient hospitalization.
There are also over 375,000 outpatient visits to emergency rooms for treatment of HG at an estimated cost of $2.5 billion, plus home health care, pharmaceuticals, outpatient infusion care, diagnostics, and frequent obstetrical visits. The costs for HG treatment exceed $3 billion for HG each year in the US, and many patients get inadequate care. The long-term effects of HG and its complications multiply these costs over time, but there is not current data estimating these additional costs.
Understanding the Economic Burden on System and Patients
Harmonia Healthcare is Leading in HG Research
Marlena Fezjo, Chief Scientific Officer at Harmonia Healthcare and Research Director for the HER Foundation discovered that the cause of HG is related to the nausea and vomiting hormone GDF15. HG is genetic, and is not psychological and is not caused by hCG. Additionally, causes may vary between patients depending on biological make-up (genetics), body chemistry, fetal gender, and overall health.
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