IPHA 2011-2012 Annual Report - Illinois Public Health Association

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Maternal and Child HealthStrong Start6www.ipha.comIPHA’s Maternal and Child Health (MCH) Sectionworked with many state and local agencies and organizationsto develop a proposal to the federal Centerfor Medicare and Medicaid Services for a Strong Startfor Mothers and Newborns cooperative agreement.The proposal requested $20.5 million for a four-yearproject to test the effectiveness of two models of“enhanced” prenatal care, Centering Pregnancyand Maternity Care Homes, in reducing the rate ofpre-term birth among Medicaid-eligible women.A core group of Maternal and Child Health expertsled the development of the proposal, includingKaren Ayala, chairperson of the Maternal and ChildHealth Section; Janine Lewis, Executive Director ofthe Illinois Maternal and Child Health Coalition; Drs.Arden Handler and Deborah Rosenberg of the UICSchool of Public Health; Dr. Susan Vonderheid ofthe UIC College of Nursing; Glendean Sisk and JoAnne Durkee of the Illinois Department of HumanServices; Mike Jones, Linda Wheal, Julie Doetsch,Gwen Smith, and Alicia Hawkins of the IllinoisDepartment of Healthcare and Family Services;Mary Driscoll of the Illinois Department of PublicHealth; and Amy Sagen and Jennifer McGowan ofthe Governor’s Office. This group met on a weeklybasis from February through June to lead thedevelopment of Illinois’ proposal.The leadership team organized three work groups:one for Centering Pregnancy, led by Dr. Vonderheid;one for MCH, led by Ms. Lewis, and one onData, Evaluation and Information Technology ledby IPHA and Dr. Rosenberg. The work groups metfrom March through May. The Governor’s Officeof Health Information Technology also providedinvaluable support in the design of the datacollection system. The local agencies that will beimplementing each model for Strong Start wereactive participants in their respective groups.The participating service providers are: AccessCommunity Health Network, Advocate Illinois MasonicMedical Center, Aunt Martha’s Youth Service Center,Chicago Family Health Center, Circle Family Health-Care Network, Cook County Health and HospitalsSystem, DuPage County Health Department, ErieFamily Health Center, Greater Elgin Family CareCenter, Lawndale Christian Health Center, McLeanCounty Health Department, PCC CommunityWellness Center, Rockford Health Physicians, St.Clair County Health Department, SangamonCounty Department of Public Health, Southern IllinoisHealthcare Foundation, Stephenson County HealthDepartment, Swedish Covenant Medical Group,Tazewell County Health Department, VNA Health, andWinnebago County Health Department.Altogether, 95 people representing 48 organizationsparticipated in at least one conference call. All ofthese partners comprise Illinois’ Strong Start Coalition.Illinois averages about 177,500 live births annually.Just over 89,000, or half, of those births are financedby Illinois’ Medicaid program. “Non-normal deliveries”(low or very low birth weight infants, fetal deathsand other conditions) accounted for 39% of birthsto Medicaid-eligible women and 98% of Medicaidexpenditures for prenatal care and delivery in StateFiscal Year 2009. In particular, very-low birth weightinfants represent 1.3% of births to Medicaid-eligiblewomen and 59% of Medicaid expenditures forprenatal care and delivery. (i) Reducing the rate ofpreterm birth is imperative for improving infant healthand reducing Medicaid spending.Centering Pregnancy (CP) is an innovativeevidence-based model of group prenatal care thathas been implemented in over 300 sites nationwide.CP provides health assessment, educationand support in a group facilitated by a credentialedprenatal care provider (physician or advancedpractice nurse) and a co-facilitator, usually a nurseor health educator. After an initial individual prenatalvisit including risk assessment, a group of 8-12pregnant women with similar expected deliverydates meet for 10 group visits. During the first 30minutes, women have a brief individual assessmentwith the care provider, participate in self-careactivities, complete a Self-Assessment Sheet onthat session’s topic to facilitate later discussion,enjoy refreshments, and socialize. When the group“circles up” together for the remaining 90 minutes,there is facilitated discussion about health topicsand the exchange of wisdom on shared healthexperiences. Each session has an overall planwith “core” health promotion content geared to thestage of pregnancy of each visit, including issuessuch as smoking, substance use and depression.Any concerns women express are also discussed.Groups are lively, interactive, and patient-centered.Multiple learning formats include discussion,activities (e.g., games, word puzzles), and invitedresource persons (e.g., nutritionist) who share theirexpertise. The group context, including substantiallyincreased time for health promotion, self-care,a collaborative client-provider relationship andincreased social support from the facilitators andthe group, is CP’s unique approach. We plan toserve 7,000 women through this model.(i) Illinois Department of Healthcare and Family Services. 2012. Report to the General Assembly(for) Public Act 93-0536. Springfield, Illinois: Author. Pages 15 – 20 and Chart 34 on page 43.
The Transforming Maternity Care Partnership (ii)identifies four key elements of a Maternity CareHome: continuity of care from a primary clinicianwho accepts responsibility for providingand/or coordinating all health care and relatedsocial services during a woman’s pregnancy,childbirth, and postpartum period; commitment tocontinuous quality improvement, patient safety, andevidence-based practice; commitment to womancenterednessand a positive experience of care;and timely access to appropriate care and information.These elements have been put into practicein Illinois for many years, though not always in onesetting. The Illinois Department of Healthcare andFamily Services’ designation of a “Maternal andChild Health Provider” is identical with many of theclinical characteristics of the Maternity Care Home.Community-based care coordination is a commonfeature of Illinois’ Family Case Management,Targeted Intensive Prenatal Case Managementand Healthy Start programs. Illinois’ proposal willbring these elements together by placing a carecoordinator within a prenatal care practice thatmeets the requirements for a “Maternal and ChildHealth Provider.” The care coordinator will functionas a member of the health care team and facilitatecommunication among patients and communityservice providers. The functions performed by thecare coordinator will include enrollment in StrongStart and in Medicaid or CHIP; assessment ofservice needs; development of an individualizedplan of care with the patient and family members;referral of patients for additional health careservices and community health and social services(especially WIC, smoking cessation, substanceabuse treatment, behavioral health care and oralhealth care); follow-up with patients to ensure(ii) Romano, A. What Is a Maternity Care Home? Transforming Maternity Care. http://transform.childbirthconnection.org/2012/03/what-is-a-maternity-care-home/. Accessed August 29, 2012.that they have been able to access services andassistance in “navigating” the health and humanservices system; coaching patients and advocatingfor them with health care and human service providers;providing health education in a culturally andlinguistically competent manner; providing psychosocialsupport to patients; preparing patients forappointments; anticipating and discussing patients’needs with other members of the health care team;building relationships with community serviceproviders; and collecting data to document carecoordination activities. We plan to serve 13,700women through this model.The data collection and analysis system developedby the partners is one of the strengths of Illinois’proposal. Data on program participants will be fedto a central database created by Medical ResearchAnalytics and Informatics Alliance at StrogerHospital, a CDC-funded Prevention EpiCenter andhost of Illinois’ “public health node.” Data will bedrawn from the Illinois Department of Healthcareand Family Services’ Medicaid Enterprise DataWarehouse, which includes matched Medicaid,vital records and hospital discharge data; the IllinoisDepartment of Human Services’ Cornerstonesystem; local clinics’ electronic medical recordssystems and specialized program data collection.We used a unique approach to financing proposaldevelopment. Funds were provided by IPHA, theIllinois Maternal and Child Health Coalition, TheChicago Community Trust, The Lloyd A. Fry Foundationand The Polk Brothers Foundation. The proposalwas written by Ralph Schubert, owner of TakeIt For Granted LLC, through a contract with IPHA.Interested parties may obtain a copy of the Coalition’sproposal by contacting IPHA at (217) 522-5687.2011-2012 IPHA Annual Report 7Programs & Partnerships
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IPHA 2011-2012 Annual Report - Illinois Public Health Association

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