Women’s and Infant Health Team: Building Capacity to Promote Maternal and Infant Health

By The AMCHP Women's and Infant Health Team
(Andria Cornell, Brittany Argotsinger, Erin Bonzon, Piia Hanson and Megan Phillippi)

The Women's and Infant Health (WIH) program is committed to improving maternal and child health (MCH) programs and enhancing the delivery of MCH services at the national, state and local levels. The program goals are to improve the health of women and infants through increased capacity of Title V MCH programs and coordination between stakeholders. The WIH team collaborates with numerous partners to implement projects that span diverse topics such as home visiting, infant mortality, health reform and health system redesign, maternal mortality, chronic disease, and preconception health. As we look back on our efforts from 2014 and gear up for an exciting 2015, we would like to highlight a few of our key projects.

Looking Back on Women's Health
In 2014, AMCHP saw an increase in urgency on improving women's health across the life span, as partners mobilized in response to troubling national trends in maternal morbidity and mortality. The call to "Put the M back in MCH" and to "Put the W in MCH" is becoming ubiquitous, and women's wellness is a focus not just as a means to improve infant health outcomes but to invigorate families and communities and support the health of women as individuals and through their many roles and transformations.

Through our Every Mother Initiative funded by Merck for Mothers, AMCHP partners with 12 states to strengthen their state-based maternal mortality review process and implement data-informed and effective population-based strategies to prevent maternal death. The first cohort of the initiative (August 2013 – October 2014) included Colorado, Delaware, Georgia, New York, North Carolina and Ohio. Their work will be published in 2015. The second cohort (October 2014 – December 2015) includes Florida, Illinois, Louisiana, Missouri, Oklahoma and Utah. Throughout the initiative, AMCHP sought to align state efforts with significant strides in the maternal safety landscape. The National Partnership for Maternal Safety, an initiative of the Council on Patient Safety in Women's Health Care, has worked to develop patient safety bundles for birth facilities, as well as complementary materials to support the identification of patients requiring urgent bedside evaluation and the review of severe maternal morbidity cases at the facility level.

Looking Ahead on Women's Health
2015 holds great promise for advancing comprehensive initiatives in women's health. The proposed revisions to the Title V Block Grant include a focus on women's health, with National Performance Measures (NPMs) focusing on the well-woman visit, primary cesarean delivery, prenatal dental visits and smoking during pregnancy. National Outcome Measures (NOMs) capture key maternal health outcomes around prenatal care, severe maternal morbidity, and maternal mortality. AMCHP looks forward to working with states to develop Evidence-Based and Evidence-Informed Strategy Measures to measure successes in key women's health activities that create movement in the NPMs and NOMs.

During 2015, in addition to continuing to support the Every Mother Initiative, AMCHP will focus on comprehensive initiatives in maternal health, and the postpartum period, specifically. In December 2014, AMCHP hosted a Postpartum Think Tank Meeting with more than 40 partners and collaborators to review the current state of research, need for, and utilization of postpartum care and develop a systems-based, equity-infused approach to enhanced postpartum care. AMCHP and partners recently compiled a draft meeting summary for publication, and will work throughout 2015 to implement a programmatic and policy agenda to support its recommendations. Also in 2015, AMCHP will release a new and exciting maternal health resource. It will offer a synthesis of guidelines and recommendations from more than 50 state and national reports, plans, peer-reviewed literature, and blueprints for change to facilitate a comprehensive state approach to moving maternal health data into action, align health planning efforts with clinical and non-health sector partners, and address persistent disparities in maternal well-being.

Improving Infant Health - Looking Back
In 2014, WIH team members participated in multiple committees, coalitions, meetings, and conferences to provide input on issues related to improving health of women and infants. One such initiative, the Collaborative Innovation and Improvement Network (CoIIN) to reduce Infant Mortality, is a multiyear, national movement engaging federal, state and local leaders, public and private agencies, professionals and communities to employ quality improvement, innovation and collaborative learning to reduce infant mortality and improve birth outcomes. The CoIIN focuses on the following six strategy areas: 1) SIDS/SUID/safe sleep, 2) smoking cessation, 3) preconception/interconception health, 4) social determinants of health, 5) prevention of preterm and early term births, and 6) risk-appropriate perinatal care. AMCHP staff serve as technical advisors for CoIIN learning networks and collaborate with national partners to provide strategic oversight for the CoIIN.

Last summer, AMCHP helped National Institute for Children's Health Quality to host Infant Mortality Summits for Health Resources and Services Administration (HRSA) Regions I-III, VII-X and the Pacific Basin jurisdictions. During the summits, AMCHP staff guided states and jurisdictions through developing an action plan to reduce infant mortality and provided guidance on evidence-based practices (EBPs) to reduce infant mortality. Following the 2014 summits, AMCHP worked with national partners to synthesize the documents to develop strategies for the national rollout of the CoIIN.

Looking Ahead
AMCHP has received funding from the Robert Wood Johnson Foundation (RWJF) to establish the Birth Outcomes Collaborative: Building a Culture of Quality to Demonstrate Value and Improve Equity. This initiative builds on the CoIIN successes in Regions IV and VI and will help states sustain their journey toward building a culture of QI in MCH work and facilitate continued progress toward equity in birth outcomes. The principle objectives of the AMCHP collaborative are to facilitate the spread of evidence based practices and innovations to improve birth outcomes and reduce infant mortality; increase the use and application of QI methods to address birth outcomes, reduce disparities and improve health equity; and demonstrate the value of investments in MCH interventions to improve birth outcomes.

AMCHP will offer TA funds and other resources to help states further develop their QI skills and leverage the work of CoIIN to address their identified priority strategies, with a focus on health equity, early childhood systems, and timeliness and transparency of data. We look forward to engaging AMCHP members and partners in a variety of activities that will build capacity at the regional, state, local and community levels to transfer knowledge, skills, and practical approaches to QI and reduce infant mortality for families in high need communities.

Health Reform Connections: Women's and Infant Health under the ACA
We know that AMCHP members are looking for ways to leverage opportunities under the new health reform law. Here are a few options to address women's and infant health work on the horizon:

Health plans are required to cover women's preventive services with an A or B rating from the U.S. Preventive Services Task Force. There is no cost sharing for these services.
Low risk cesarean delivery (first-time, term, singleton baby in a vertex position) is part of the Core Set of Children's Health Care Quality Measures for Medicaid and CHIP (Child Core Set).
Maternity benefits, as well as breastfeeding support, counseling and equipment, are covered without cost sharing as an essential health benefit (EHB) in marketplace plans. Safe sleep promotion is among Bright Futures preventive services also covered without cost sharing.
Among other tools, the Prevention and Public Health Fund established under ACA will give states additional flexibility to support the health of women and infants in the coming year.