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

There are three components to the CMO Birth Equity Initiative:

Multi-disciplinary working group.? Convened diverse stakeholders to identify a collective impact goal around reducing birth inequities that is achievable within 4 years. The inaugural meeting included 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. Our next meeting will be on August 29th.??

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.??

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.??

The initial work will begin with the working group. Working group meetings will convene every other month for 90 minutes beginning June 21st, 2022, for at least two years. Various stakeholders will collaboratively work to improve birth equity across NYC with a focus on Brooklyn. Meeting agendas will be set by DOHMH facilitators, and the first meeting will be focused on setting a shared goal towards the reduction of severe maternal morbidity. We are inviting individuals and those with institutional knowledge that can inform new ways of addressing birth equity. Teamwork and consensus-building will be central to the working group. In partnership with hospitals, FQHCs, clinicians, insurers, community members, and New York State entities, we aim to improve health and well-being for all birthing people and their families.

Background

Building off the New York City Health Department’s decades of work within the Divisions of Family and Child Health, Center for Health Equity and Community Wellness, and Epidemiology, the initiative uses a collective impact approach to convene stakeholders around an identified goal of reducing birth inequities. The initiative is first being implemented in Brooklyn based on it having the largest number of births. The NYC Health Department will serve as the backbone organization and facilitate the stakeholders’ efforts to set metrics and work in alignment. Moreover, NYC Health Department will leverage our agency-wide expertise in technical assistance, policy, and data analytics capacity, together with our Neighborhood Health infrastructure and our health plan, provider, and F/CBO relationships.

The Chief Medical Officer (CMO) birth equity initiative will take a data-driven, anti-racist, and place-based approach to this work. In 2018,?78% of pregnancy-related deaths?in New York State were categorized as?preventable. Those that were 100% preventable included hemorrhage, mental health conditions, and?cardiovascular conditions. 75% of pregnancy-associated deaths?in Black mothers are?preventable, compared to?43% in white mothers?. Pregnancy-related deaths have declined in NYC, but inequities remain. On average,?Black mothers were?9.4 times more likely?to die of a pregnancy-related?death?compared to?white mothers. Black mothers make up?1/5?of births, but account for?1/2?of pregnancy-related?deaths.

Progress Update

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. We anticipate 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.