National Maternal and Infant Health Crisis Spurs 30 Health Systems to Take Action
CHICAGO – September 12, 2019 – In response to the national maternal health epidemic, 30 large health systems are banding together to find and put forward solutions to this crisis in their communities. The United States is the only developed country in the world where maternal mortality rates continue to rise even though more than half of these pregnancy-related deaths are preventable. This endeavor marks the third phase of the Medicaid Transformation Project (MTP), a collaborative effort to transform healthcare and related social needs for the nearly 75 million Americans who rely on Medicaid and other vulnerable populations. To date, 50 new solutions are underway throughout the country across the Project’s first two phases in behavioral health and community-based care.
Inadequate maternal care is a national epidemic disproportionately affecting minority women and the 43% of U.S. births financed by Medicaid:
- Black women and American Indian/Alaskan Native women are three to four times more likely to die of pregnancy-related causes than white women regardless of socioeconomic status
- 50,000 women face severe maternal morbidity every year, a three-fold increase over the past 30 years
- Women with Medicaid are 25% less likely to receive prenatal care and are more likely to have preterm births and low-birthweight infants compared to privately insured women
- 4 in 10 moms with Medicaid coverage will not see a doctor for follow-up after they have a baby
Communities, patients, and care models are ripe for change
The challenges in maternal and infant health are driven by a lack of adequate investment in prenatal and maternal health and the consequences are felt both by mothers and babies. Health systems in the Medicaid Transformation Project aim to shift attention and investment across the full spectrum of maternal and infant care.
“The key to a healthy baby is a healthy mom. Too often, needed healthcare services, including prenatal care, are not accessible. There are ‘maternity deserts’ in this country, which as the name implies, are large areas where little to no proper maternity care exists. The health of the mother must be front and center before, during, and after delivery. The outcomes from absent or poor prenatal and postpartum care are catastrophic for both mother and baby. This is further compounded by cultural biases and barriers to quality care,” says Andy Slavitt, Chair for the Medicaid Transformation Project, former Acting Administrator of CMS, and General Partner at Town Hall Ventures. “There is no more important call to action than getting it right for a new mom and baby at the beginning of life.”
Closing the gaps in care with innovation
The Maternal and Infant Health Initiative kicked off on July 23 with an Action Forum in Philadelphia co-hosted by three Medicaid Transformation Project Members: Jefferson Health, Geisinger, and Christiana Care Health System and led by AVIA. The launch signifies the start of a multi-month effort for participating health systems to identify, select, implement, and scale solutions that improve overall care for moms and infants.
“Health systems are the centerpiece of health in a community, and in our case, a state. Helping a mom deliver a healthy baby is one of the most powerful and positive experiences we can provide a community and one of the best investments we can make as a system,” says Dr. Janice Nevin, President & CEO at Christiana Care Health System, who spoke at the Action Forum.
A central goal of the initiative is improving care coordination throughout the entire pregnancy journey, which is typically very siloed and fragmented. During pregnancy, coordination is missing between OB/GYNs, specialists, and primary care providers who may be treating different aspects of high-risk pregnancies. During postpartum and infancy, coordination is missing between pediatricians and the mother’s clinician. Connecting care teams across a health system can help identify preventable issues earlier and ensure patients don’t fall through the cracks.
At the Action Forum, 70 leaders from 30 health systems took the first steps toward expanding the capabilities necessary to close these gaps in care and address some of the most common challenges that persist around pre-pregnancy, pregnancy, labor and delivery, postpartum, and infancy:
- How do you identify and engage pregnant women in the community early in their pregnancy to ensure adequate first trimester care and beyond?
- How can you use data to identify high-risk patients or comorbidities like diabetes and hypertension more quickly and effectively to intervene with the right care at the right time?
- How do you create flexible care schedules for moms based on individual needs?
- How do you promote racial equity and eliminate disparities in birth outcomes between white women and women of color?
“Our health system has experienced pockets of success in addressing this challenge, as have our peers across the country,” says Dr. Nevin. “The value of being in the Medicaid Transformation Project is that we break down information barriers and learn from each other’s successes – and failures – together. It will take a truly collaborative and innovative effort if we’re going to drastically improve prenatal and postpartum care delivery in our communities and nation – and quickly.”
The Project analyzed more than 70 digital innovations in maternal and infant health to create a shortlist of nine solutions and 15 clinically validated care models, many of which were demonstrated at the Action Forum, including:
- Engagement platforms that can screen for social and clinical needs of mothers, initiate remote monitoring for patients in rural areas or patients with high-risk pregnancies, and collect self-reported outcomes to help monitor the health and well-being of mothers throughout the perinatal journey
- Coordinated care networks that include virtual lactation consultants, clinicians, doulas, and midwives to address workforce shortages and access challenges experienced in urban and rural areas
- Disruptive care models like group prenatal care, which also addresses social needs like mental health, sexual violence, and food security
Leading policy experts Vikki Wachino, former head of the Center for Medicaid and CHIP Services at CMS, and Molly Coye, former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, as well as Slavitt, are lending their guidance to advance this work and are engaged in shaping the next steps of the initiative.
The Project’s rigorous solution selection, methodology, and guidance are empowering health systems to take a more active role in a space that was previously managed by payers and consumers.
Building on Medicaid Transformation Project’s momentum
The Medicaid Transformation Project has initiated 50 new solution adoptions across the U.S. since its launch in August 2018. Members are building off of the learnings from the first two phases of the initiative, focused on community-based care and mental health, and incorporating best practices as they accelerate the third phase around Maternal and Infant Health. Given the growing market for tech-enabled and digital solutions for maternity and infant health, as well as an uptick in policy changes at the state and federal level over the past six months, the Project expects this phase to extend into 2020. Health systems will continue to monitor trends and receive support regarding any new changes and opportunities throughout the year.
“In less than a year we’ve seen just how effective our collaborative model can be, and we’re confident that the promising results from our early work will carry over into our work in maternal and infant health,” says Amy Dirks Stevens, Executive Vice President, Provider Solutions at AVIA. “The barriers to change are significant, but our Member health systems have raised their hands high and are ready to lead the way. This is an exciting and real opportunity to connect the dots for expecting and new moms, and create a more equitable, safe, and supportive pregnancy journey. With so many health systems and healthcare visionaries committed to this mission, we can materially transform maternal and infant health in this country—before, during, and well beyond labor and delivery.”
About the Medicaid Transformation Project
The Medicaid Transformation Project is a national effort to transform healthcare and address related social needs for the most vulnerable. Health systems will implement innovative solutions that address challenges like behavioral health and substance use disorder. This will create long-term systemic impact with the goal of improving the health of 75 million Americans.
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Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. Centers for Disease Control and Prevention. Accessed August 2019. https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w
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