HEALTH EQUITY

Black Maternal Health Week

The country is reckoning with the many largely structural and systemic factors that contribute to poor maternal outcomes for women and birthing people, especially those of color. However, with the ever increasing threat of COVID-19, most do not understand how this also exacerbates the intersecting oppressions and brutal hardships Black women face. The truth is in the facts and they are grave: Black women are three times more likely to experience a pregnancy-related death than white women.

The Department of Human Services and Pennsylvania Department of Health are working to ensure that all women have the rights, respect, and resources for a healthy pregnancy and births. We are joining with Black Mamas Matter to observe Black Maternal Health Week (#BMHW2021) and support their mission of improving outcomes for black mothers and their babies. 

Black Maternal Health Statistics

•  The U.S. has an infant mortality rate of 5.8 per 1000 live births in 2017, with an infant mortality rate among  Black infants of 10.8 deaths per 1,000 live births in 2018, almost twice as high.
• Black mothers are more likely to suffer from PMADs (Perinatal Mood and Anxiety Disorders) like postpartum depression, in silence and without clinical help. 
• Only about 66% of Black infants are breastfed compared to more than 82% of white and Latinx moms.
• Hospitals in areas with higher percentages of Black residents were less likely to provide adequate breastfeeding information and support to new mothers.
• Black women disproportionately lack necessary reproductive health care—including contraception, abortion, STI screenings, and reproductive cancer screenings. This leaves them vulnerable to many risk factors around pregnancy. Recent improvements in maternal and infant health across the 20th century are due, in part, to expanded contraceptive access and use.
• Research indicates that 22% of Black women receive lower quality of care than white women and are subject to discrimination in the healthcare field.
• People from some racial and ethnic minority groups are more likely to be uninsured than non-Hispanic whites.

Wolf Administration's Health Reform Plan

1. Interagency Health Reform Council (IHRC) The council will be composed of commonwealth agencies involved in health and the governor’s office. The initial goal will be to develop recommendations by December 30 to find efficiencies in the health care system by thinking about how to align programs where feasible, including the joint purchasing of medications, aligning value-based purchasing models, and using data across state agencies to promote evidence-based decisions.
2. Regional Accountable Health Councils (RAHCs) RAHCs will be required to collectively develop regional transformation plans – built on community needs assessments – to reduce disparities, address social determinants of health, and align value-based purchasing arrangements.
3. Health Value Commission The Health Value Commission would be established through legislation, and would be charged with keeping all payors and providers accountable for health care cost growth, to provide the long-term affordability and sustainability of our health care system, and to promote whole-person care. 

DHS Health Equity Initiatives

Health equity is the attainment of the highest level of health for all people. Studies in Pennsylvania have shown that there is more than ten percent difference in access to well child visits between black infants and white infants. Furthermore, the life expectancy of a baby born in Pennsylvania is strongly tied to zip code. A newborn in certain census tracts of North Philadelphia has a life expectancy of 63 years, when just a couple miles to the south newborns are expected to live to 86. In the U.S., it has been estimated that the combined cost of health disparities and subsequent deaths due to inequitable care is $1.24 trillion dollars. Health shouldn't be predetermined by the color of your skin, the language that you speak, the country that you were born in, the zip code that you live in, the religion that you practice, or your sexual orientation, gender, or gender identity. As such, DHS has:

• Created the new Equity Incentive Program, starting in 2020, which incentivizes Physical Health Managed Care Organizations (MCOs) to achieve national benchmarks for Black members. The total eligible pool of incentives was $26 million in 2020. The Equity Incentive contained two quality measures in 2020, Timeliness of Prenatal Care (HEDIS®) and Well Child Visits (HEDIS®) and will grow to include measures for racial disparities in chronic condition management in 2021. 
• Required Physical Health, Behavioral Health, and Community Health Choices MCOs to achieve or be working towards the National Committee for Quality Assurance (NCQA) Distinction in Multicultural Health Care. The first MCO in the country to achieve the distinction is from Pennsylvania, and almost all Physical Health MCOs have now achieved the distinction. 
• Created a new Maternity Care Bundled Payment (a type of value-based purchasing), that will reward providers that reduce racial inequities and achieve national benchmarks in physical health, behavioral health, social determinants of health, and health equity. This bundled payment aims to close racial disparities that lead to a 3:1 maternal mortality inequity between Black and White women. 
• Launched the Regional Accountable Health Councils (RAHCs). RAHCs—comprised of payors, providers, and community-based organizations— will address health equity as a top priority and will use a collaborative regional approach to focus on communities with a high burden of disease called Health Equity Zones (HEZs). The RAHCs will work to identify the root causes of such disparities and will establish policies and interventions to reduce these disparities. View the RAHCs regions and membership.