Improving health equity means confronting the systemic, avoidable and unjust outcomes our patients and health plan members may experience. It is meaningful and exciting, yet daunting, work.
Across Presbyterian Healthcare Services and at Presbyterian Health Plan, we have long had the desire to tackle health inequities. But, like health systems nationwide, we struggled with how to scale initiatives and strengthen infrastructure.
Fortunately, after years of work to build a strong foundation, the pieces are in place to make a difference. For us, it starts with data.
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In 2021, we began screening all Presbyterian patients for health-related social needs, such as food insecurity, housing uncertainty, and substance use, and now have data from more than 2 million interactions. Alongside other data sources, including claims, focus groups and community health needs assessments, we now have a more complete picture of the barriers our patients face.
With these insights, we can strategically commit resources and make real programmatic changes.
Why focus on perinatal services?
Two years ago, we began an initiative targeting perinatal health equity. It is an area where we can make a tremendous difference in outcomes. How did we know? We went to the data.
In New Mexico, where Presbyterian is located, March of Dimes data show that 11 of the state’s 33 counties are maternity care deserts. Poor access to services during and immediately following pregnancy is a consistent concern in rural and frontier areas, where many people face transportation issues hindering access to care. In addition, many pregnant patients also have mental health concerns.
Our internal health equity dashboard, which leverages our integrated data to identify relationships between health-related social needs and clinical indicators, has identified geographic and racial inequities in prenatal and postnatal care.
We also listen closely to our patients and members. In 2022, we embarked on listening sessions and created a dynamic survey for patients who submitted negative survey responses after a prenatal, delivery or postpartum visit in a Presbyterian facility. Survey results are reviewed monthly and continue to inform our work.
Based on what we have learned, we are integrating community health workers and peer support specialists into OB-GYN and pediatric care teams. This builds on our peer support specialist program, which already included a peer in the neonatal intensive care unit.
We are also adding behavioral health support into perinatal care. In addition to focusing on screening pregnant patients for mental health issues, we are educating providers on best practices for patients with postpartum depression.
Because access is a concern in our largely rural state, our health plan is enhancing virtual offerings, including remote monitoring, for perinatal members in remote areas. Patients and members tell us they want more culturally appropriate materials, so health plan teams are developing more ways to communicate with them about important resources like birth classes and lactation support.
More than 80% of births in New Mexico are covered by Medicaid. As the largest Medicaid managed care plan in the state, Presbyterian Health Plan serves many pregnant members in collaboration with a statewide provider network. Through our system-wide perinatal initiative, we will continue to track outcomes on measures such as low birth weight and gestational hypertension.
What’s next?
Improving health equity requires an approach that reaches beyond our health system to our many valued community partners.
Last year, we expanded funding for and development of free health equity trainings for staff, providers and the community, collaborating with partners like Black Health New Mexico and Transgender Resource Center of New Mexico. Presbyterian Health Plan is now adding to this work by requiring patient-centered medical home providers to participate in training.
In a state where Native American, Hispanic/Latina and African American women have higher rates of infant and maternal morbidity, we all have a tremendous responsibility and opportunity to improve health equity across the population.
