April 2020

Blue University^SM Follow-up: Local Team Puts Chicago on Safer Childbirth Cities Map

By: Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Illinois (BCBSIL)

We’re committed to continuing the conversation after each Blue University event we host. For example, you may have attended our most recent Blue University event on Nov. 22, 2019, titled, Addressing the Maternal and Infant Health Crisis Through a Health Equity Lens. As a follow-up to this event, we published a recap in our January 2020 Blue Review. We also collaborated with Merck for Mothers, a division of Merck & Co, to present a free webinar on March 4, 2020, to discuss the Safer Childbirth Cities Initiative.

Jacquelyn Caglia, director of Merck for Mothers Global Communications and U.S. Programs, opened the presentation on March 4. Merck for Mothers is a $500 million initiative to help “create a world where no woman has to die giving birth.” But, as Ms. Caglia emphasized, there’s no one-size-fits all approach across all populations – rather, the key to success is finding “local solutions to local problems.” One such solution is the Safer Childbirth Cities Initiative, which aims to support implementation of evidence-based interventions and innovative approaches to reverse maternal health trends in the U.S.

Chicago’s Safer Childbirth Cities Initiative project was developed and implemented by two community-based organizations: AllianceChicago and EverThrive Illinois. Together, these organizations are driving the Chicago Collaboration for Maternal Health project.

Lisa Masinter, M.D., MPH, M.S., is the director of research for AllianceChicago, and spoke next on our March 4 webinar. Dr. Masinter described AllianceChicago as a network of 74 health centers across 20 states. This network works together as part of the organization’s mission “to improve personal, community and public health through innovative collaboration.”¹ Dr. Masinter emphasized that collaboration is critical. While there are many initiatives related to maternal health, awareness among parallel initiatives helps create a united front to combat the crisis from multiple angles.
 
In laying the groundwork for the Chicago Collaboration for Maternal Health project, Dr. Masinter noted the importance of using data and maximizing on successes achieved by other organizations and initiatives. She referenced the Illinois Department of Public Health (IDPH) Maternal Mortality Review Committee (MMRC) findings from the 2019 Maternal Morbidity and Mortality Report. It shows that, for pregnancy-related deaths, non-Hispanic black women were six times more likely to die, 72% of deaths were preventable, over 30% occurred postpartum, and most deaths occurred in the Chicago area. Local stats from the Chicago Department of Public Health (CDPH) reflect the IDPH findings overall, with added insights into adequacy of prenatal care, as well as the impact of pre-term delivery and issues related to low birth weights.

With a steering committee that includes IPDH, CDPH and other organizations, together with key advisors, such as the Illinois Perinatal Quality Collaborative (ILPQC), University of Illinois at Chicago, women with lived experiences, and several subcommittees, the Chicago Collaboration for Maternal Health project has three aims that will be rolled out over the course of three years.

• Aim 1: Quality – Develop a quality improvement (QI) collaborative for ambulatory care providers focused on best practices in maternal health for systems and culture change.
• Aim 2: Community – Implement a community engagement effort that informs families and social service providers about maternal morbidity and mortality prevention.
• Aim 3: Policy – Develop, advance, and implement policies that improve maternal health and support the sustainability of provider and community initiatives.

For Aim 1, Dr. Masinter noted that the project team isn’t looking to reinvent the wheel. As a guiding principle, they are leveraging expertise from the ILPQC due to successful programs such as the Severe Maternal Hypertension initiative. Concurrent with this initiative, the severe maternal morbidity rate among women experiencing hypertension at delivery between 2015 and 2017 was reduced by half.² The Chicago Collaboration for Maternal Health project will focus on providing QI support through collaborative learning, rapid response data and evidence-based initiatives so all patients can receive the same quality of care. Among other activities, the project team will develop a toolkit to support its cohort of participants.

Heidi Ortolaza-Alvear, deputy director of strategy and impact for EverThrive Illinois, continued the presentation with a discussion of the second and third aims of the Chicago Collaboration for Maternal Health project. An obstetrician/gynecologist, also trained in public health research, Dr. Ortolaza-Alvear described EverThrive Illinois as an organization that for more than 30 years has worked with women and families to improve health across all phases of life. The organization also offers resources for providers, such as a Perinatal Education Toolkit.³

For Aim 2 of the Chicago Collaboration for Maternal Health project, Dr. Ortolaza-Alvear explained that a community outreach team seek input from area organizations and gather individuals with lived experiences to build a community expert committee. This committee will help shape the initiative with innovative ideas, such as educational baby showers. Aim 3 strategies will focus on creating awareness among key stakeholders and policy makers, building champions – spokespersons who can share their own experiences and lessons learned, and advocating for bold changes that support providers as well as patients.

During a brief question and answer session, webinar participants offered several important topics and ideas for discussion, with an emphasis on potential behavioral health-related gaps in care. While the Chicago Collaboration for Maternal Health project will be targeted, involving specific providers in communities of focus, the presenters emphasized their interest in engaging with all providers to share experiences and increase awareness. They affirmed that behavioral health concerns will certainly be a huge part of their quality initiative, once input from the community and clinical stakeholders is gathered. Following the lead of examples such as the CDPH Family Connects Chicago model,⁴ the goal is to help support implementation of and access to standardized care – such as depression screening and linkage to care postpartum – for all women and their families.

For more information, watch the recording of the March 4, 2020, Safer Childbirth Cities Initiative webinar.

Learn more about Dr. Derek J. Robinson

¹ AllianceChicago, Mission + History + Values. Accessed March 9, 2020, at https://alliancechicago.org/mission-history/.

² ILPQC, Quality Improvement Initiatives, Severe Maternal Hypertension. Accessed March 10, 2020, at https://ilpqc.org/severe-maternal-hypertension/.

³ EverThrive Illinois, Learn About Our Work, Maternal and Infant Mortality. Health Choices, Healthy Futures Perinatal Education Toolkit. Accessed March 9, 2020, at  https://www.everthriveil.org/initiatives/maternal-infant-mortality.

⁴ Healthy Chicago Babies, Family Connects Chicago. Accessed March 10, 2020, at  https://www.healthychicagobabies.org/family-connects/.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medic judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.