Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Addressing Racial Disparities in Maternal Health: Access to Midwifery in Florida, Lecture notes of Law

This document investigates the challenges in accessing midwifery services for Medicaid beneficiaries in Miami-Dade County, Florida, and the impact on maternal health outcomes, particularly for Black individuals. The document highlights the importance of midwives in reducing primary cesarean section rates and improving perinatal and postpartum outcomes.

Typology: Lecture notes

2021/2022

Uploaded on 09/12/2022

rechel--
rechel-- 🇬🇧

4.6

(10)

229 documents

1 / 12

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Inadequate Access to
Midwifery Services: Results of
a Secret Shopper Survey
Alison Yager, Deputy Executive Director
Catherine Osorio, Law Intern September 2020
Atinuke Lardner, Student Intern
pf3
pf4
pf5
pf8
pf9
pfa

Partial preview of the text

Download Addressing Racial Disparities in Maternal Health: Access to Midwifery in Florida and more Lecture notes Law in PDF only on Docsity!

Inadequate Access to

Midwifery Services: Results of

a Secret Shopper Survey

Alison Yager, Deputy Executive Director

Catherine Osorio, Law Intern September 2020

Atinuke Lardner, Student Intern

Background: The Maternal Health Crisis in Florida and Miami-Dade County Maternal health indicators reveal that the risk of poor outcomes for pregnant and birthing people, particularly Black people, is steadily rising in Florida and nationwide. Nationwide, the maternal mortality rate has increased more than twofold since 1987.^1 The United States has the highest maternal mortality rate of any developed nation and is currently the only industrialized nation where maternal mortality rates are rising.^2 The state’s overall maternal mortality rate hovers close to the national average at 28. deaths per 100,000 live births.^3 Having been shown to improve maternal health outcomes, midwives are an invaluable component of any effort to address this ongoing crisis.^4 The current maternal health crisis is indelibly marked by stark racial disparities. Birthing people of color bear the disproportionate impact of the crisis, facing poorer outcomes across a variety of measures. In 2016, 41.4% of Floridians who died due to pregnancy related complications were Black, despite Black people comprising only 16.9% of the state’s population.5,6^ More recent data is further reflective of the stark inequalities, with Black Floridians in 2019 experiencing a maternal mortality rate of 47.8 per 100,000 live births compared to a rate of 23.1 per 100,000 live births among White residents.^7 In 2019, the maternal mortality rate in Miami-Dade county was 28.6 for every 100,000 live births.^8 A closer look at the data reveals that Black residents were nearly three times as likely to die from pregnancy-related complications, with Black individuals experiencing a rate of 36.3 mortalities per 100,000 live births, in comparison to a rate of 12.7 among White residents.^9 Similar disparities can be found in the county’s infant mortality rate data. In Miami-Dade County, the mortality rate among Black infants is 6.2 for every 1,000 live births compared with a rate of 2.5 among White infants.^10 In addition to facing a greater risk of death due to pregnancy related causes, parents and infants of color face an increased risk of serious complications. According to a study conducted by the American Diabetes Association, Black people are more than twice as likely to experience a severe maternal morbidity event (SMM) at the time of delivery.^11 Infants of color are also at an increased risk: 13.8% of Black infants and 11.8% of American Indian infants are born preterm as compared to 9.1% among White newborns.^12 Similarly, 13.7% of Black infants are born underweight compared to 7% of White infants.^13 Both preterm birth and low birthweight are associated with a variety of neonatal health conditions such as respiratory distress syndrome, brain bleeding, and intestinal disorders, as well as with higher rates of chronic health conditions like vision loss, cerebral palsy, and learning and behavioral difficulties^14. Risk factors such as poverty, lack of education, and preexisting health conditions fall short of fully explaining the alarming discrepancies in maternal and neonatal health outcomes.^15 Research suggests that Black individuals face unique risks, even when controlling for variables such as income level and maternal age.^16 With this in mind, many researchers cite institutional and individual bias as factors that exacerbate racial disparities. In addition to receiving lower quality healthcare in general, a recent investigation conducted by NPR and ProPublica found that Black mothers often felt devalued and disrespected by their healthcare providers.^17 In other words, for Black parents, the combined impact of inadequate access to quality healthcare and limited interactions with biased or inattentive healthcare professionals can prove to be fatal.

ACCESS TO MIDWIFERY SERVICES

MEDICAID MANAGED CARE, MIAMI-DADE/REGION 11

SECRET SHOPPER SURVEY RESULTS

Goals & Purpose Data was collected to determine the network accuracy and adequacy of the Medicaid Managed Care Assistance Program (MMA) serving pregnant women seeking midwife care in the Miami-Dade/Region 11 area. We were spurred to undertake this research after hearing from midwives about their challenges in meeting the needs of expectant mothers covered by Medicaid. We understand that access issues, and related reimbursement challenges, have been long standing. We believe that these access issues, which exacerbate racial health disparities, exist state-wide. However we focused on Miami-Dade County (MDC) for a variety of reasons, including the fact that the 2019 maternal mortality rate among Black residents was nearly three times that of its White residents. As described above, midwives play an important role in reversing these disparities. Scope, Methodology, & Limitations of the Data This data was collected from September 2019 to January 2020. The data collected was limited to entities who offer midwife services to the area’s population enrolled in Medicaid. The midwives called consisted of those listed on each of the nine managed care plan provider directories serving Miami-Dade/Region 11; a total of 46 midwives and 6 facilities. From the nine online MMA directories, a “master call list” was compiled of midwives and facilities that offer midwife services and their phone numbers and addresses, noting which number and address came from which MMA’s directory. Many providers were listed in more than one MMA’s directory, and many were also associated with a provider network or facility/hospital system. The results are strictly based upon the provider directory lists, as updated and accurate directories are elemental to the network adequacy tested here. Thus, if a midwife was not listed on a provider directory but did accept the provider policy, that midwife would not be included here. If a provider directory only provides a facility name and address, the facility was contacted. We made three attempts to reach each provider listed. When a provider could not be reached, subsequent attempts were generally made on a different day, and at a different time of day. When telephonic contact was made, the following questions were asked in order: (1) Is the midwife located at the number called? (2) If yes, does the midwife accept the MMA insurance? (3) If yes, when is the next available appointment? Findings General Accuracy of Miami-Dade/Region 11 Medicaid MMA Physician Directories Myriad challenges were encountered in reaching the listed midwives, and then in making an appointment. These obstacles are grouped thematically below.

  • Directories listing inaccurate or unreachable phone numbers: We attempted to reach each listed provider three times, generally on different days and at different times. Of the 46 midwives and 6 facilities called, seven midwives/facilities could not be reached. Barriers to contact included: failure to return a voice message on voicemail or taken by a receptionist, wrong number, dropped call, no answer and full voicemail, or no call-back.
  • Directories list numbers for provider networks and larger healthcare entities: Many midwives were listed as part of a provider organization/system, which posed several challenges to accessing services. First, calls to systems generally resulted in longer hold times. Many calls began with a hold of several minutes and resulted in either being transferred and put on hold again or a dropped call. Many of the calls to larger organizations were fruitless; many calls never made it to the desired receptionist, and very few listed institutions had providers who were indeed in-network and available. Further, some midwives listed at larger healthcare entities provided only reproductive healthcare, and not prenatal care.
  • Directories list numbers for providers who are not covered, not working at the listed addresses/numbers, and/or not midwives: Inaccuracies in network provider directories posed the most significant problem. Of 52 providers listed for midwife services, seven (13%) were not listed accurately. Problems with accuracy included: the provider directory was outdated; the listed midwife was not in fact part of the MMA network; the midwife was not with the listed practice; the midwife had left Region 11; and individual was incorrectly listed as a midwife.
  • Midwives are Part of an OB Practice Group; Midwife coverage of birth is not guaranteed In some instances, the midwife was part of an OB practice group. Due to the nature of the practice and their coverage arrangements, care or delivery by the midwife could not be guaranteed.
  • Midwives are not taking new member patients Of the 45 midwives/facilities that we reached, nearly a third (14 midwives) were not accepting new member patients.
  • Directories were difficult to navigate Many provider directories were difficult to find and difficult to navigate. Issues experienced included but were not limited to: (1) the visual layout of directories made information gathering challenging; and (2) the provider directory listed midwives under multiple provider categories. Individual Network Adequacy (including wait times) of Miami-Dade/Region 11 MMA plan midwives The percentage of listed midwives accepting new member patients in each of the Medicaid MMA plans in Miami-Dade/Region 11 ranged widely, though for all but one MCO, 50% or fewer of the listed midwives were accepting new member patients. Only for Molina, which lists just one facility, were

(^1) “Pregnancy Mortality Surveillance System,” February 4, 2020. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance- system.htm. (^2) Ibid. (^3) “Maternal Mortality ,” 2020. https://www.americashealthrankings.org/explore/health-of-women-and- children/measure/maternal_mortality_a/state/ALL. (^4) Midwife-led continuity models of care compared with other models of care for women during pregnancy, birth and early parenting. Accessed August 31, 2020. https://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other- models-care-women-during-pregnancy-birth-and-early. (^5) Hernandez, Leticia, and Angela Thompson. Issue brief. Florida’s Pregnancy-Associated Mortality Review 2016 Update , May 2018. http://www.floridahealth.gov/statistics-and-data/PAMR/_documents/pamr- 2016 - update.pdf. (^6) “U.S. Census Bureau QuickFacts: Florida.” Census Bureau QuickFacts. Accessed August 31, 2020. https://www.census.gov/quickfacts/fact/table/FL/RHI225219. (^7) “Maternal Deaths .” FLHealthCHARTS Data Viewer. Accessed August 31, 2020. http://www.flhealthcharts.com/charts/DataViewer/InfantDeathViewer/InfantDeathViewer.aspx?indNu mber=0392. (^8) Ibid. (^9) Ibid. (^10) “Neonatal Infant Deaths.” FLHealthCHARTS Data Viewer. Accessed August 31, 2020. http://www.flhealthcharts.com/charts/DataViewer/InfantDeathViewer/InfantDeathViewer.aspx?indNu mber=0392. (^11) “Racial Disparities Persist in Maternal Morbidity, Mortality and Infant Health.” AJMC. Accessed August 31, 2020. https://www.ajmc.com/view/racial-disparities-persist-in-maternal-morbidity-mortality-and- infant-health. (^12) “Preterm Birth,” n.d. https://www.americashealthrankings.org/explore/health-of-women-and- children/measure/pretermbirth_MCH/state/ALL. (^13) “Low Birthweight,” n.d. https://www.americashealthrankings.org/explore/annual/measure/birthweight/state/ALL. (^14) Ibid. (^15) Taylor, Cristina Novoa and Jamila. “Exploring African Americans' High Maternal and Infant Death Rates.” Center for American Progress. Accessed August 31, 2020. https://www.americanprogress.org/issues/early-childhood/reports/2018/02/01/445576/exploring- african-americans-high-maternal-infant-death-rates/. (^16) Ibid. (^17) Ibid. (^18) Heubeck, Elizabeth. “Midwives Could Be Key To Reversing Maternal Mortality Trends.” Connecticut Health Investigative Team, October 31, 2018. http://c-hit.org/2018/10/30/midwives-could-be-key-to- reversing-maternal-mortality-trends/. (^19) Sehhatie, Fahimeh, Maryam Najjarzadeh, Vahid Zamanzadeh, and Alehe Seyyedrasooli. “The Effect of Midwifery Continuing Care on Childbirth Outcomes.” U.S. National Library of Medicine. Medknow Publications & Media Pvt Ltd, May 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061621/. (^20) Ibid. (^21) “Midwifery Integration State Scoring (MISS) System Report Card: Washington.” Birth Place Lab, https://www.birthplacelab.org/wp-content/uploads/2018/02/Washington.pdf.

(^22) Ibid. (^23) Vedam, Saraswathi, Kathrin Stoll, Marian Macdorman, Eugene Declercq, Renee Cramer, Melissa Cheyney, Timothy Fisher, Emma Butt, Y. Tony Yang, and Holly Powell Kennedy. “Mapping Integration of Midwives across the United States: Impact on Access, Equity, and Outcomes.” Plos One 13, no. 2 (2018). https://doi.org/10.1371/journal.pone.0192523. (^24) “C-Section.” Mayo Clinic. Mayo Foundation for Medical Education and Research, June 12, 2020. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655. (^25) Vedam, Saraswathi, Kathrin Stoll, Marian Macdorman, Eugene Declercq, Renee Cramer, Melissa Cheyney, Timothy Fisher, Emma Butt, Y. Tony Yang, and Holly Powell Kennedy. “Mapping Integration of Midwives across the United States: Impact on Access, Equity, and Outcomes.” Plos One 13, no. 2 (2018). https://doi.org/10.1371/journal.pone.0192523. (^26) Ibid. (^27) Ibid. (^28) “Midwifery Integration State Scoring (MISS) System Report Card: Florida.” Birth Place Lab, https://www.birthplacelab.org/wp-content/uploads/2019/03/Florida.pdf. (^29) “Births Covered by Medicaid .” FLHealthCHARTS Data Viewer. Accessed August 31, 2020. http://www.flhealthcharts.com/charts/DataViewer/BirthViewer/BirthViewer.aspx?cid=595. (^30) “Maternal Deaths .” FLHealthCHARTS Data Viewer. Accessed August 31, 2020. http://www.flhealthcharts.com/charts/DataViewer/InfantDeathViewer/InfantDeathViewer.aspx?indNu mber=0392.

Sunshine Health Comp

Simply Healthcare Comp

Molina 1 1 1 1 100% Staywell Comp 3 1 0 0 0% AVERAGE (all plans)

Addendum 2 Online Directories for each Medicaid MMA serving the Miami-Dade/Region 11 Area

  • Aetna Better Health Comp https://www.aetnabetterhealth.com/florida/assets/pdf/member/36.01.069.202001.FL.MMA.Re gion-11.pdf
  • Humana Medical Comp https://www.humana.com/finder/medical/results?pageId=0beb6f5fff054f8fab9bc41fe29090a
  • Miami Children MMA https://www.miamichildrenshealthplan.com/MCHP/media/pdf/Miami-physician-directory-for- region- 11 - 02012020_2.pdf
  • United Healthcare MMA https://www.uhccommunityplan.com/content/dam/uhccp/plandocuments/providerdirectory/F L_MMA_Provider_Directory_Region_11.pdf
  • Prestige MMA https://www.prestigehealthchoice.com/pdf/provider/self-service-tools/printable-provider- directory-region-11.pdf
  • Sunshine Health Comp https://providersearch.sunshinehealth.com/search-results
  • Simply Healthcare Comp http://simplyhealthcareplans.prismisp.com/SearchResults
  • Molina https://www.molinahealthcare.com/members/fl/en-US/PDF/Medicaid/provider-directory- region-11.pdf
  • Staywell Comp https://www.wellcare.com/florida/members/medicaid-plans/staywell