Racial disparities provider presentation

Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

“There is no quality improvement without equity.”

Joia Adele Crear-Perry, MD, FACOGFounder & President of the National Birth Equity Collaborative

Health equity

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Equality vs. equity

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Social determinants of health

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Food

HousingTransportation

Interpersonal Safety

Social Determinants

of Health

Reducing disparities in severe maternal morbidity and mortality

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Implicit bias, explicit bias and racism

• Implicit bias◦ The attitudes or stereotypes that affect our understanding, actions and

decisions in an unconscious manner. • Explicit bias◦ The attitudes and beliefs we have about an individual or group on a

conscious level; much of the time these biases and their expression arise as the direct result of a perceived threat.

• Racism◦ Prejudice, discrimination or antagonism directed against someone of a

different race based on the belief that one's own race is superior.

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https://implicit.harvard.edu/implicit/takeatest.html

Goal

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Maternal mortality rates

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Pregnancy-related deaths in the United States

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0%6%6%

7%

8%

9%

11%11%

12%

14%

16%

Anesthesia Complications

Amniotic Fluid Embolism

Unkown

Hypertensive disorder 6.9%

Cerebrovascular accidents

Thrombotic pulmonary or otherembolismCardiomyopathy

Hemorrhage

Infection or sepsis

Other non-cardiovascular medicalconditionsOther cardiovascular conditions

Pregnancy-related deaths in the United States during 2011 to 2016

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Leading causes of death differ throughout pregnancy and after.

Heart disease and stroke cause most deaths overall. Obstetric emergencies such as severe bleeding and amniotic fluid embolism cause most deaths at delivery.

In the week after delivery, severe bleeding, high blood pressure and infection are most common.

Cardiomyopathy (weakened heart muscle) is the leading cause of deaths one week to one year after delivery.

Racial/ethnic disparities in pregnancy-related mortality

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Black Non-Hispanic

AmericanIndian/Alaskan

Native Non-Hispanic

Asian/PacificIslander Non-

Hispanic

White Non-Hispanic Hispanic

Deaths per 100,000 live births 42.4 30.4 14.2 13 11.3

0

5

10

15

20

25

30

35

40

45

Deaths per 100,000 live births

Deaths per 100,000 live births

Irving family’s story

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• The Story of the Irving Family• https://youtu.be/YptST8FHAK4

H.R. 1318 Preventing Maternal Deaths ActVirginia legislation

• On December 21, 2018, the Preventing Maternal Deaths Act (H.R. 1318) was signed into law. This legislation sets up a federal infrastructure and allocates resources to collect and analyze data on every maternal death in every state in the nation.

• In June 2019, Virginia Governor Ralph Northam announced his commitment to reduce racial disparities in maternal mortality by 2025.

• In July 2019, to meet Governor Northam’s goals to support health equity, the Department of Medical Assistance Services (DMAS) announced the Healthy Birthday Virginia initiative to ensure mothers and babies celebrate the first birthday together.

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Maternal mortality and morbidity review committee

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The Virginia Neonatal and Perinatal Collaborative (VNPC) was formed in 2017 with the following goals:• To provide assistance to hospitals and obstetric providers in performing quality

improvement initiatives designed to improve pregnancy outcomes including decreasing the preterm birth rate to Healthy People 2030 goals, and to decrease maternal mortality by 50%

• To enhance the quality of state-wide perinatal data, and to provide hospital-specific data back to participating hospitals promptly to accomplish quality improvement goals

• To provide assistance to hospitals and newborn care providers in performing quality improvement initiatives designed to improve neonatal outcomes including decreasing morbidity and mortality as well as decreasing length of stay

• To inform and involve the community including health care providers, nurses, ancillary medical staff, payers, hospital administrators and, most importantly, patients in efforts to make Virginia the safest state to deliver babies

• To narrow racial and ethnic disparities with the achievement of health equity in pregnancy and neonatal outcomes

Happy Birthday Virginia Initiative recommendations

• Strengthen accountability for prenatal and postpartum managed care services.

• Increase access to treatment for expecting mothers with substance use disorder.

• Streamline enrollment to eliminate delays in access to care.• Continuity of coverage will enable women to automatically transition

between Medicaid eligibility categories.• Begin targeted outreach campaign this fall to educate women about the

new Medicaid eligibility rules and the importance of prenatal and postpartum care.

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Happy Birthday Virginia Initiative recommendations (cont.)

• Performance measure: New requirements include performance measures for prenatal and postpartum care and reductions in tobacco use among pregnant women.

• Transparency: DMAS will develop online dashboards that will be publicly available on the agency website to document progress on maternal and infant health goals.

• DMAS is partnering with Virginia Department of Health (VDH) on maternal interventions to decrease tobacco use in pregnant women.

• Data-sharing: DMAS is partnering with the (VDH) and the Department of Social Services (DSS) to share data in order to better drive and evaluate health outcomes, including those for mothers and infants.

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References

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• H.R.1318 - Preventing Maternal Deaths Act of 2018• 115th Congress (2017-2018)• https://www.dmas.virginia.gov/files/links/3961/Press%20Release%20for%

20Healthy%20Birthday%20Virginia%20(07.01.2019).pdf• https://virginianpc.org/• ACOG Partners with Black Mamas Matter • CDC - Infant Mortality • CDC - Pregnancy-related Deaths

https://mediproviders.anthem.com/vaHealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Commonwealth Coordinated Care Plus (CCC Plus) benefits to enrollees. AVAPEC-2686-20 August 2020