State officials along with insurance and healthcare providers in New Jersey are joining forces to address the glaring racial disparities in the state’s maternal and infant care. They are part of a unique seven-state coalition focused on reducing various health inequities.
Facilitating those partnerships, the New Jersey-based Robert Wood Johnson Foundation will invest $3.4 million in the Advancing Health Equity Learning Collaborative, a multi-year initiative to unite public and private-sector healthcare entities around Medicaid reforms designed to plug gaps in care related to race, poverty and other factors.
“This is the first attempt that we know of to bring together these three stakeholder groups to identify common goals for advancing health equity and then work together to implement them. We are excited about the potential of this project,” said Andrea Ducas, RWJF senior program officer. (The foundation also financially supports NJ Spotlight.)
The multi-state project will be overseen by staff at Advancing Health Equity, a University of Chicago center the foundation launched in 2005, with additional expertise provided by the Institute for Medicaid Innovation, a nonprofit in Washington, D.C, and the Center for Health Care Strategies, a national policy group located in Hamilton, N.J.
The funding will also cover travel costs for the seven state teams and outside technical assistance, if needed; in addition to New Jersey, partnerships have been established in Delaware, Illinois, Maine, Pennsylvania, Tennessee, and Washington State. Their work — built to address local priorities and informed by Medicaid members and patients impacted by health disparities — will begin in early October and continue for two years, project leaders said.
Medicaid members will have a say
Medicaid members “will have valuable input and critical information about why the inequalities are happening and how they can be fixed,” said Scott Cook, the Chicago center’s co-director. The teams will also examine how social determinants of health, things like housing and education, play a role in these disparities.
New Jersey’s coalition includes the state Department of Human Services, which oversees Medicaid; Horizon Blue Cross Blue Shield, the largest Medicaid managed care insurer; and RWJBarnabas Health, one of the state’s largest healthcare systems.
According to the 2018 edition of America’s Health Rankings, an annual report card from the United Health Foundation, New Jersey’s maternal mortality rate was more than 38 deaths per 100,000 births — nearly twice the national figure — and had increased almost two points since 2016. That put the Garden State at 45th nationwide, with among the highest rates in the country. (New Jersey scores well on infant mortality, however, with 4.5 deaths per 1,000 live births, the fourth-lowest rate nationwide.)
The racial disparities in the data also paint an alarming picture. AHR found that, in 2018, maternal mortality among white moms in New Jersey was 29.8 — versus 18.1 nationwide for this racial group. But for black mothers here the death rate was 102.3, over three times higher than for white women and more than double the national average for black women of 47.2. (State data shows black infants also die at more than three times the rate of white babies in New Jersey; the DOH uses different parameters in its assessments so the mortality rates it reports appear lower.)
First Lady Tammy Murphy, who has made maternal and infant healthcare a policy priority, called these disparities “abhorrent” and joined DHS Commissioner Carole Johnson in describing the current outcomes as “unacceptable.” They pledged to continue their work to reduce these disparities and welcomed the new help from the Chicago center.
“Today’s announcement gives us one more tool in this fight by giving us the platform and support to work together with other payers and health care providers to innovate to improve outcomes. We look forward to the collaboration,” Johnson said when the program was announced Monday.
New Jersey legislation
Earlier this year, Murphy launched the Nurture NJ campaign to increase public awareness of these issues. DHS has expanded Medicaid coverage for doula services and is working to add group prenatal classes to the benefit portfolio. Earlier this year, Gov. Phil Murphy signed into law a package of legislation designed to standardize clinical birthing practices, create more culturally appropriate care, and empower women in the process.
The latest announcement of the collaborative initiative also drew praise from Jennifer Velez, the executive vice president for community and behavioral health at RWJ Barnabas, who said the network is “extremely pleased” to be included in the partnership. Its work will focus on hospitals it runs in Newark and Jersey City, she said.
“With the collective resources, reach and commitment we bring to this effort, our team is uniquely qualified to develop innovative solutions that make New Jersey a model state for improving maternal health and making sure all children get the healthy start in life they deserve,” added Mark Barnard, executive vice president for government programs and operations at Horizon, which insures 3.8 million New Jerseyans.
In general, the seven national partnerships are tasked with designing new methods to deliver and pay for healthcare in ways that address outcome disparities. The work will involve two phases, according to Cook, with the center coordinating the project.
What’s fueling the disparities?
First, teams will explore what is fueling unequal outcomes for certain groups — like individuals who are homeless or returning home from prison — and devise ways to reduce these gaps through Medicaid reforms, he said. Secondly, they will design an insurance payment model to incentivize more equitable outcomes, so that reducing disparities makes business sense for those paying the bills.
The project is framed by a national shift away from the fee-for-service model, in which doctors and other providers are rewarded based on the volume of care they provide, Cook explained. Instead, solutions could involve more value-based systems, he said, in which caregivers are reimbursed based on outcomes, or other methods. “It’s really wide open to how (the partnerships) want to do that and structure that,” he said.
The teams might benefit from some of AHE’s previous work with dozens of hospital systems and a limited, three-site pilot project the center completed a few years ago which also involved insurance companies, Cook said. But this time around the conversation will also include state Medicaid officials, and members, in an effort to devise more comprehensive, effective models.
“No one has done this before,” Cook added. While solutions are often highly specific, he said, the goal is to create models that could be beneficial to others around the country.