2/21/23: Innovations in Health Equity-Focused Maternity Care Delivery: A Deep Dive into Providence Swedish Health Services

Thank you for participating in this month’s Maternal Health Hub Learning Community session on Innovations in Health Equity-Focused Maternity Care Delivery: A Deep Dive into Providence Swedish Health Services, featuring Whitney Haggerson, Vice President of Health Equity and Medicaid at Providence Health and Dr. Nwando Anyaoku, Chief Health Equity Officer at Swedish Health Services.

View the slides here and recording here.

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Whitney Haggerson of Providence Health began by sharing an overview of Providence’s work to address health equity. In 2020, the organization committed $50 million to health equity work, which includes investments to build out the infrastructure needed to implement and execute health equity programs and policies across several conditions and patient populations. So far, the funds have impacted over 650,000 lives through COVID programs, vaccine distribution, and other work streams, as well as enabled partnerships with over 1,701 community partner organizations. To support improvements in health equity, Providence Health also runs health equity learning collaboratives that leverage data to identify inequities, implement programs to address the inequities, and integrate, scale, and sustain successful programs. In these collaboratives, data stratification identified four main areas for the collaboratives to target: cancer screening, hypertension, diabetes, and mental health.

Dr. Anyaoku shared details about the “JUST Birth Network,” (with JUST standing for justice, unity, support, and trust) a recent initiative developed by Swedish Health Services using the funds from Providence. In analyzing maternal morbidity and mortality data, Swedish Health Services found significant inequities in outcomes for Black and Indigenous birthing individuals. Knowing the benefits of doulas, Swedish Health Services developed the JUST Birth Network to train, implement and sustain a network of Black and Indigenous doulas. The program includes birth and postpartum doulas, bereavement doulas for those that experience a pregnancy loss, and both childbirth educators and cultural navigators. The program uses outreach and recruitment to pair pregnant individuals early on in their journey with a doula; it also pairs them with one later in pregnancy even at the point of labor and birth. Every Black and Indigenous birthing individual is also provided the option to use a cultural navigator to help navigate their pregnancy journey.

The program launched in May of 2022 and by the end of the year included 28 Black doulas in its network. Swedish Health Services also contracts with a network of Indigenous doulas through an FQHC that has an existing network. Originally, the Swedish Health Services team assumed they would see 10-15 people per month using these services but from November 2022-January 2023, Swedish Health Services saw 148 patients using the doula services. Swedish Health Services has also received very positive feedback from both the doulas and individuals served about the benefits of this program.

Throughout the presentation, Ms. Haggerson and Dr. Anyaoku emphasized the importance of engaging with the communities served. In program development, Swedish Health Services focused on speaking with community members to determine the community’s needs so it could develop initiatives that reflected the communities served. The team further elaborated on this subject when a participant asked about how Providence and Swedish Health Services developed trusting relationships with community-based organizations. They shared that this was not a quick process. When originally reaching out to a CBO, the team encountered a response of “we have been in your area for 25 years, why are you just now reaching out.” The team had to practice humility and start from the beginning by leveraging existing relationships to build out other relationships with organizations.

To conclude the presentation, Ms. Haggerson shared two additional, related Providence initiatives: SDOH screening and identifying and addressing inequities in acute care. The first stream looks to screen members better and to ensure there is follow up with members to see if they are receiving the proper services. In the second stream, Providence is starting the work by focusing on restraint utilization in the ED, goals of care conversations, NTSV c-section rates, and sepsis mortality.

At the end of the presentation, Learning Community members engaged in a discussion with the presenters. The following serves as a summary of this discussion:

• A participant asked where Providence and Swedish Health Services were in adopting the Smooth Transitions Best Practices to receive birthing individuals referred/transferred from the midwife and birth center community.
  • Saleiha Akangbe, Program Manager for the initiative, shared that a critical aspect of the program’s success is due to the fact that Swedish prioritizes educating the care team about the history of midwifes and birth in this country. They also leverage the cultural navigators whenever a patient is transferred from a birth center or home birth to deliver in a hospital, to provide support during the transition. She shared that there is often guilt (on the part of the birthing person) and potential bias on the part of hospital staff who may feel that any negative consequences of initiating birth at a birth center or at home are the fault of the birthing person.
  • Another participant asked a follow up question about the training OB/GYNs and other hospital staff and clinicians receive to undue existing implicit bias.
    • Anyaoku shared that they partner with an organization that facilitates simulation training exercises which have been extremely effective at helping clinicians understand birthing experiences with which they were previously unfamiliar. While the training is not mandatory, they find that providers are heavily influenced by their peers to participate. The training is available for doctors, nurses, doulas, medical students, and other members of the interdisciplinary teams. Providence also runs a town hall meeting every other month that allows the teams to meet and discuss issues such as obstetric violence, implicit bias, and more.
  • Another participant asked for clarification regarding Medicaid coverage of doulas in Washington state.
    • Saleiha shared that there is a strong advocacy effort to pass Medicaid doula coverage, supported by the community-based doula community. She also noted that prior to the JUST Birth Network, there was a doula network established that cross-subsidized doula services for Medicaid beneficiaries with a portion of the payment from those who could pay fully out-of-pocket. There is hope that the state will pass legislation to support Medicaid reimbursement for doulas.
  • One individual asked about the use of the HITECH act to support data sharing between midwifes, OB/GYNs, and birth centers. Dr. Anyaoku shared that while Providence uses EPIC, not all of their partners do. Thus data needs to be shared in a variety of ways and Providence as a whole is participating in advocacy efforts to advance HITECH.
  • A participant asked about the use of value-based arrangements with Medicaid MCOs to further this work.
    • Anyaoku shared that these conversations are underway, but nothing is in place yet.

The Maternal Health Hub staff shared several updates with the group:

1. As a follow-up to a convening of maternity care subject matter experts and CMS leadership, the Hub released a resource “Lessons Learned from a Multi-Stakeholder Roundtable on Medicaid Maternity Strategies.” The brief discusses the key challenge in today’s maternity care environment and shares potential solutions and opportunities to leverage existing policy levers. We encourage you to share this resource widely with your networks! Social media language can be found here.
2. Save the Date! The National Partnership for Women & Families is hosting a launch event on March 22, 2023 for the Raising the Bar for Excellence and Equity in Maternal Health The launch event will be held in-person in DC, with a virtual component. Register here to attend: https://act.nationalpartnership.org/a/raisingthebar.
3. Reminder: As we begin planning for the future of the Hub’s work, we ask all Learning Community members to fill out this survey which asks for feedback on the Learning Community and what would be most helpful going forward. Thank you for your feedback in advance!