Summary

Launched
2022
Estimated duration
4 Years
Estimated total value
$50,000,000.00
Regions
Northern America
Locations
United States
Partners
Bedford-Stuyvesant Family Health Center, Brooklyn Coalition for Health Equity for Women and Families, Brooklyn Perinatal Network, Caribbean Women's Health Association, EmblemHealth, Metroplan, New York City Health & Hospitals, New York City Midwives, One Brooklyn Health (OBH) , State University of New York Downstate Medical Center, The Childbearing Year

New York City Health Department Chief Medical Officer Birth Equity Initiative

Summary

The New York City Department of Mental Hygiene and Health Chief Medical Officer (CMO) Birth Equity Initiative is a new and innovative umbrella effort for streamlining, expanding resources and improving the impact of all maternal health programs. Through a collective impact approach, the CMO Birth Equity Initiative committed to working with diverse organizations, including insurance companies, community-based organizations, advocates and activists, hospitals and federally qualified health centers to reduce birth inequities for Black pregnant persons and women in Brooklyn.

Approach

The goal of this initiative is to substantially expand resources for Black pregnant persons and women in Brooklyn, due to the highest number of births occurring in this borough in comparison to others and existing maternal health programs led by the NYC Health department.

A data-driven, anti-racists and place-based approach will serve as a guiding framework for all components of the CMO birth equity initiative.

The three components to the CMO Birth Equity Initiative include: 1) Multi-disciplinary working group. Convene a diverse group of stakeholders to identify a collective impact goal around reducing birth inequities that is achievable within 4 years. Stakeholders include community members and birth justice advocates, doulas, hospital leaders, impacted persons, insurers as well as representatives from the American College of Obstetricians and Gynecologists and the NYC Department of Homeless Services. 2) Advance a Medicaid maternal home payment bundle model. Establish a payer- and provider-agnostic Maternal Home payment bundle modeled on H+H’s maternal home model. 3) Support primary care integration with Birth Equity. Identify a specific scope of primary care services for pre-conception people who are in marginalized groups and establish connections and coordination with other primary care programming.

Morbidity and mortality tied to the working group vision will be consistently tracked and monitored as they execute efforts together to confirm interventions within the first year

Action Plan

For the first 2 years of the initiative, the multidisciplinary workgroup will identify approximately 6-8 measures associated with maternal morbidity and mortality that are tied to the vision that will be consistently tracked and monitored as they execute efforts together. Within this first year, the working group will confirm interventions and identify commitments from implementing stakeholders.

Potential areas of focus within the 4 year initiative include but not limited to:

Maternity l Hospital Quality Improvement Network (MHQIN) : To demonstrate uptake and achievement of MHQIN metrics (including quality improvement using severe maternal morbidity data, implementing, and sustaining respectful maternity care, training, and education on becoming anti-racist, implicit bias, and trauma informed care) across participating hospitalsi

Maternal Home: To establish a payer and provider agnostic Brooklyn Maternal Home that can provide standardized evidence-based enhanced services to high-risk women who are pregnant or TTC in a way that allows them to choose from multiple options of participating outpatient and hospital providers.

Comprehensive women’s health: Identify specific scope of services for pre-conception women who are high risk

Citywide doula expansion: specific expansion targets to be determined

Working group convened by CMO: engagement targets to be determined

Improve demographic data collection: 80% of completed race, ethnicity, and gender identity

Background

The New York City Department of Health and Mental Hygiene (DOHMH) invests an estimated $50 million per year on advancing birth justice and eliminating maternal health inequities in the borough of Brooklyn and the city of New York. For more than a decade, these investments have focused on several programs including Nurse Family Partnerships, New Family Home Visiting, City Wide Doula Initiative, Family Wellness Suites, Creating Breastfeeding Friendly Communities and Healthy Start Brooklyn. These efforts address periods of preconception, pregnancy, labor and birth, and postpartum.

Despite these substantial investments, preventable pregnancy related deaths remain high at 78% in 2018. Black mothers make up 1/5 of births, but account for 1/2 of pregnancy-related deaths. Furthermore persistent racial disparities in access to quality birthing facilities remain prevalent with data showing 65% of White deliveries and only 23% of Black deliveries occurring in NYC-based hospitals that recorded lowest morbidity.

The Chief Medical Officer (CMO) Birth Equity Initiative is a new and innovative umbrella effort for streamlining, expanding resources and improving the impact of all DOHMH programs, while cultivating a collective impact approach with diverse organizations, including insurance companies, community-based organizations, advocates and activists, hospitals and federally qualified health centers to reduce birth inequities for Black pregnant persons and women in Brooklyn.

Addressing the birth equity crisis requires mobilization of healthcare payment resources and investments prioritizing populations most impacted, from communities particularly disinvested in.

Progress Update

Significant process has been made in each of the three components of the CMO Birth Equity Initiative. The multi-disciplinary working group meets bimonthly (6 meetings total between June 2022-June 2023) and has adopted a vision statement. The group is in the process of adopting specific metrics to track and identify a collective action or intervention to take in the coming year. The Maternal Home payment model continues in its planning stages, ensuring that the chronic disease and behavioral needs of pregnant and postpartum birthing people are met while building on existing municipal, health care, and community infrastructure. This work also continues exploring ways to leverage philanthropic dollars, Medicaid dollars and potential expansion through the Medicaid waiver. Primary care integration efforts are also ongoing. We trained field team staff in providing technical assistance to address perinatal mental health within primary care. We are conducting a program mapping exercise to better understand the landscape of maternal health services provided at our community health center partners. We are also applying for funding to pilot a maternal medical home at 7 FQHCs across the city.

Partnership Opportunities

This initiative aims to significantly impact maternal health in the borough of Brooklyn, as a pilot example of what is feasible across New York City and the country. Financial resources are needed to (a) kick-off and sustain the 4-year effort, (b) conduct analysis that informs the selected policy and practice solutions, (c) execute the selected policy and practice solutions over a multi-year period, (4) market, disseminate and scale-up in other relevant US settings. The CMO Birth Equity Initiative anticipates these and other efforts totaling $130 million, with the largest investment in the execution of selected policy and practice solutions aimed at reducing maternal health inequities across New York City and for at least 20 years to make a lasting, sustainable impact

NYC Health Department will provide a space for external working group members to share their experience and best practices for addressing the Black maternal health crisis in NYC. NYC Health Department will also provide the data needed to support this work. but not limited to doulas, clinicians, community members, community-based organizations, insurers, federally qualified health centers, hospitals, professional associations, and city agency representatives. Each working group meeting is an opportunity for relationship building across sectors including health care, payers, healers, and community members.

NOTE: This Clinton Global Initiative (CGI) Commitment to Action is made, implemented, and tracked by the partners listed. CGI is a program dedicated forging new partnerships, providing technical support, and elevating compelling models with potential to scale. CGI does not directly fund or implement these projects.