By Michael R. Fraser, PhD, CAE, Chief Executive Officer, AMCHP
David Lakey, MD, Commissioner, Texas Department of State Health Services
As an association of state-based maternal and child health leaders, AMCHP is an affiliate of the Association of State and Territorial Health Officials (ASTHO), which represents state health officials nationwide. Together with other partners, AMCHP and ASTHO are working to move forward ASTHO President Dr. David Lakey’s Healthy Babies initiative, which aims to accelerate state efforts to improve birth outcomes over the coming year. Dr. Lakey announced his Healthy Babies Presidential Challenge to all state health officials at last month’s ASTHO Annual Meeting in Portland, OR. At that conference, I had the chance to meet Dr. Lakey and discuss the ASTHO Presidential Challenge with him.
Mike: Dr. Lakey, we are thrilled that you have chosen improving birth outcomes as your Presidential Challenge. What’s the story here – why is this your focus area for the coming year?
David: There are many reasons why improving birth outcomes is my Presidential Challenge this year. In my region, Region VI, and our neighboring region, Region IV, we have some of the biggest challenges with infant mortality and prematurity nationwide. It has been that way for a while, and those rates, as a whole, are not getting any better. The state health officials in Regions IV and VI recently met and all of us identified infant mortality and
prematurity as a priority area. We also have some of the biggest health disparities in the nation, making this a really important issue for our regions. Since our meeting, we have learned about new and existing programmatic and policy interventions that can truly improve birth outcomes. From the national perspective, all of us working together – both within government and outside it – can definitely reduce prematurity reduce disparities, and bring down our infant mortality rates.
With state health officer leadership on this issue, we can explore all the avenues – not just what we have tried in the past but new ideas too, such as statewide policy changes for Medicaid programs and neonatal intensive care units (NICUs). It is very exciting to see my colleagues really connect on this important issue.
Mike: There are a lot of programmatic and policy interventions indeed. What are some of the ways that you have addressed prematurity and infant mortality in Texas?
David: I have been really impressed by work that has been taking place in many states. Specifically, we have looked to Kentucky and their experience with a March of Dimes program called Healthy Babies Are Worth The Wait, and we are utilizing their tools and strategies here in Texas. Following their lead, we convened a statewide expert panel of medical and public health leaders to guide our approach.
In Texas, we can do the same through educational and programmatic work, but also through policy changes – including changing Medicaid policies. During the 2011 legislative session, the Texas Legislature enacted House Bill 1983 and House Bill 2636 to implement Medicaid changes to reduce elective inductions and C-sections before 39-week deliveries and to consider NICU regionalization and standards. As of Oct. 1, 2011, Texas Medicaid will no longer reimburse for non-medically indicated inductions and C-sections before 39 weeks.
Additionally, the state Legislature saw the humanitarian and economic impact that a reduction in prematurity and infant mortality can have for Texas. They invested $4.1 million dollars to fund the Healthy Texas Babies initiative. The bulk of these funds will be distributed to local coalitions who will implement evidence-based interventions in their communities. The goal of the initiative is to decrease preterm births by 8 percent over the next two years, saving lives and saving the state approximately $7.2 million in state and federal Medicaid costs.
Mike: There has been a lot of work in this area for many years, and your Challenge is a great addition to this work. But what’s new here – how is this initiative different from some of the prior work?
David: You are right Mike, there is a lot that states have done in this area and a great deal of that has been Title V led. We have seen some great successes in states – for example, look at South Carolina, Delaware, Maryland and California – they have all reduced their infant mortality rates in the past few years and that’s great. There are also lots of regional and national plans, many of which inform the current Challenge. What I think is important about this initiative and this Challenge is leadership. I know in Regions IV and VI we have committed state health official leadership and we want to extend that nationwide. What’s also important is that we have best practices from states, and from our partners like March of Dimes, that we really can use to inform our work. And we have great alignment of all the players involved – communities, states and the federal agencies – to support this work.
Mike: Dr. Lakey, thank you for taking this on as your challenge. We are really pleased with your leadership in this area and it means so much to state maternal and child health programs, and to our nation’s women, children and families. We look forward to working with you and ASTHO on this work!
David: Thanks Mike, we are going to need everyone’s help to have the impact we are hoping for. We are really glad to have Title V as a foundation for this Challenge and look forward to working with you too.
For more information on the ASTHO Presidential Challenge, click here.