Next Steps in Funding Health Equity

I was honored to be asked to speak at the State of Reform conference today on how to take the next steps to go from recognizing #inequity to funding programs that improve #HealthEquity, with my esteemed co-presenters Moira Kenney and Mar Velez.

I wanted to expand on several of the examples I mentioned during the panel during our discussion on how Health Net identifies disparities, responds and the effect of those interventions. 

1. We identified a disparity at a Central Valley clinic serving mostly Salvadorian members – only half of women attended postpartum visits, while a nearby clinic serving a different client population had much higher rates.

• Challenge: Investigation showed that many Salvadorian members followed the tradition of quarantining and covering themselves for 40 days after delivery, which providers did not understand and therefore did not accommodate for.
• Response: To help remedy this, we engaged a community advisory workgroup and developed an initiative to educate providers about these customs, added a question on beliefs (created with member input) to the obstetric history form and created electronic appointment reminders.
• Result: As a result of this initiative, the HEDIS measure on postpartum visits at the targeted clinic increased from 50% to 82% from early 2017 through mid-2019.

2. Health Net offered novel doula services to better serve Black mothers to reduce disparities.

• Challenge: Doula care is not routinely covered by health insurance, but studies show that women who have doulas report lower C-section rates, increased clinical postpartum visits and the feeling of support during pregnancy. We also know that Black mothers have much higher rates of birth complications due to structural racism and that doulas can help mitigate this risk.
• Response: Recognizing this, Health Net became the first Medicaid contracted health plan in California to offer free doula services to its members. This innovative approach supports both African American doulas as well as African American mothers. The program established a consistent pay rate/reimbursement for doulas as well as provided needed support for our members. The program also addressed cultural concordance that helped create trust between the client and doula provider, contributing to the success of the partnership.
• Result: Preliminary data shows C-section births were 50% lower in the group that had doulas as compared to similar women who did not have doulas. The doula program was a collaborative model with other health plans to leverage learnings and spread the work across the state.

3. One final example is our work with local partners to identify gaps in local safety nets and direct funding to fill those gaps. We worked on a collaborative partnership with the Hospital Association of Southern California to increase equity for Black mothers and children.

• Challenge: Research and analysis found disparities in birth outcomes that disproportionately impact the lives of Black women, birthing people and their babies in Antelope Valley, South Los Angeles and the South Bay.
• Response: Health Net awarded a grant to the Hospital Association of Southern California (HASC) to improve maternal patient experience and safety and reduce Black infant deaths through hospital quality improvement system-change solutions across three levels: clinical, institutional and community.
• Result: Cherished Futures for Black Moms & Babies, a joint initiative of Communities Lifting Communities (CLC), the Public Health Alliance of Southern California (Alliance) and HASC, launched a multi-sector collaborative effort that brings together decision-makers from local birthing hospitals, public health departments, health plans and Black women from priority communities to co-design system change solutions. The voices and lived experiences of Black women and birthing people are at the center of Cherished Futures to reduce inequities, inform hospital quality improvement strategies and ensure Black women have a seat at the table as designated Community Advisors.

Our work and research have made it clear that improving health equity will take multi-faceted, collaborative and culturally relevant programs and interventions both statewide and at the local level.