Author: LBodnarchuk

Rethinking Behavioral Health and SDOH

Written by LBodnarchuk on . Posted in Insights.

May is Mental Health Awareness Month – a reminder to all of us that checking in on your mental health is just as important as your physical health. Nationwide mental health trends reveal an increasing concern. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that one in five adults in the United States have a mental health or substance abuse disorder1. Nationwide trends in rates of mental illness reveal a rapid increase of instance over the past decade, as illustrated in Figure 1.

Graph Displaying Percent of People with Mental Health Illnesses in the Past Year

The American Medical Association defines behavioral health as encompassing the following conditions: mental health disorders, substance use disorders, life stressors and crises and stress-related physical symptoms2. For health plans and patients alike, often the first solution that comes to mind when addressing behavioral health issues is to focus on psychiatric interventions. Despite this assumption, mental and physical health are often intrinsically related and influenced by similar environmental factors. As a result, programs that utilize comprehensive Social Determinants of Health (SDOH) data to address behavioral health are often overlooked.

Behavioral Health and Social Determinants of Health

Social determinants, or drivers, are a useful indicator to identify factors which contribute to poor mental health in communities and individuals. Addressing health equity in all forms, including behavioral health, and SDOH factors are intrinsically related. Poor mental health can cause poor SDOH outcomes or vice versa. The National Library of Medicine3 notes that these outcomes are largely tied to food scarcity, inadequate housing, lower socioeconomic status and trauma among additional factors.

Social Determinants of Health that Cause Poor Mental Health

Expanding access to quality behavioral health services is a necessary component of efforts to address behavioral health and SDOH outcomes. The following indicators are associated with limited access to behavioral health services and present an opportunity for intervention:

  • Health Care, including insurance coverage and provider availability
  • Stable Housing – a significant contributor to mental stress
  • Education, especially from an early age
  • Income and Employment
  • Social Support

Clinical systems are still assessing ways to measure SDOH factors to inform behavioral health policies as there are still shortfalls in assessing these metrics4. Ideally, health plans, providers and communities can partner to address these issues.

Approaches to Target Behavioral Health through SDOH

Understanding and targeting the causal factors of mental health related to SDOH is critical in enabling mental health equity. The importance of various social determinants and their continuous evidence of impact on mental health is a call to action for improved whole-person care. Housing and food access highlight the whole-person impact of SDOH on health:

Stable Housing

Inadequate and unaffordable housing can result in poor mental health5. Increased access to affordable housing and adequate living conditions present examples of interventions focused on SDOH that would directly impact mental health. Poor living conditions such as mold, lack of heating and dampness can impact both mental and physical health. Overall, a lack of affordable housing within a community causes increased rates of homelessness which can lead to even greater mental health issues and physical health risks. An intervention to offer housing programs to those with mental health illness or housing vouchers to access affordable housing are examples of efforts to drive change.

Food Security and Healthy Diet

Access to food and a healthy diet are intrinsically tied to physical health and wellness; however, evidence suggests that unhealthy eating is also a contributor to poor mental health. Having a whole-person approach to care presents a potential intervention. Individuals with illnesses such as diabetes are more likely to have depression, highlighting the correlations between mental and physical health6. Increasing food security by delivering healthy food to farmers markets, community gardens, corner stores or through home delivery offers alternative opportunities for individuals struggling with poor nutrition due to lack of access.

Evidence of successful programs continues to arise as health plans, providers and communities’ partner to address social determinants of health. Pyx Health’s Loneliness Assessment is an example of a successful intervention.

Pyx Health Loneliness Assessment

Providers can also look to interventions which work in conjunction with health plans to address behavioral health and SDOH outcomes. Pyx Health, based in Arizona, is a healthcare company which works with Medicaid and Medicare plans to support individuals experiencing loneliness. Their process involves identifying vulnerable members through SDOH screening tools and offering vulnerable members 24/7 support7. Members use the app to express their needs and are subsequently connected with resources within their health plan and community. The approach improves behavioral health outcomes and reduces stress on clinical health resources. Given the limited amount of multi-dimensional approaches which specifically address behavioral health utilizing social determinants of health, this approach serves as inspiration for similar interventions.

How ProspHire Can Help

Through ProspHire’s Addressing Health Disparities service offering, we strive to support our neighbors and clients to achieve more equitable whole-person care. Through population health assessments, targeted Social Determinant of Health interventions and innovative solutions to support behavioral health needs, we hope to enable positive change for your customers and our communities.

1 https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases

2 https://www.ama-assn.org/delivering-care/public-health/what-behavioral-health

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863696/

4 https://www.healthaffairs.org/do/10.1377/forefront.20210610.928520

5 The impact of persistent poor housing conditions on mental health: A longitudinal population-based study – PubMed (nih.gov)

6  Diabetes and Mental Health | CDC

7 https://www.pyxhealth.com/

ProspHire Recognized as one of the Best Places to Work in Healthcare Four Years in a Row

Written by LBodnarchuk on . Posted in News.

PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, has been selected by Modern Healthcare as one of the 2023 Best Places to Work in Healthcare. The award program identifies and recognizes outstanding employers in the healthcare industry nationwide. Modern Healthcare partners with Workforce Research Group on the assessment process, which includes an extensive employee survey.

“Thank you to all of our dedicated employees who recognize ProspHire as an outstanding employer in the healthcare industry,” said Lauren Miladinovich, Co-founder, Managing Principal and CEO. “Be it an uncertain economy, staffing shortages or increasing demands of flexibility and remote work opportunities, our leadership team constantly strives to understand what our employees need and want in today’s business environment.”

“We are incredibly proud of our fourth consecutive win of the healthcare industry’s most prestigious award. This remarkable achievement is a testament to the unwavering dedication of our team, whose collective spirit and commitment to excellence have made ProspHire a Best Place to Work. We are grateful for this recognition and will continue to foster a thriving, inclusive and empowering environment for our people to innovate, grow and make a meaningful impact in healthcare,” said Chris Miladinovich, Co-founder, Principal and COO. “Next year is one for the thumb.”

ProspHire will find out the ranking on the Best Places list on September 28.

About ProspHire
ProspHire is a national management consulting firm focused on healthcare advisory, project delivery and strategic resourcing. Founded on the core value of relationships, with the goal to “prosper together,” ProspHire partners with clients to identify and solve their most significant people, process and technology challenges. The woman-owned and rapidly growing Pittsburgh-based firm has nearly 100 practitioners and consultants who deliver exceptional service to each one of our clients across the U.S. Visit www.prosphire.com.

ProspHire Ranks Among the Highest Scoring Businesses on INC. Magazine’s Annual List of Best Workplaces for 2023

Written by LBodnarchuk on . Posted in News.

PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, has been named to Inc. magazine’s annual Best Workplaces List for 2023. The list is the result of a comprehensive measurement of U.S. companies that have excelled in creating exceptional workplaces and company culture, either operating in a physical or virtual facility.

Inc. selected 591 honorees this year. Each company participated in an employee survey, conducted by Quantum Workplace, which included topics such as management effectiveness, fostering employee growth and overall company culture. Organization benefits were also audited to determine overall score and ranking.

“Being named to Inc. Magazine’s Best Workplaces is an honor,” said Lauren Miladinovich, Co-founder, Managing Principal and CEO. “Proving to the world that you are a magnet for talent and have a culture that keeps teams engaged, productive and proud to come to work is truly a remarkable achievement.”

The List of Best Workplaces will be featured in the May/June 2023 issue of Inc. Magazine and prominently featured on inc.com.

About ProspHire

ProspHire is a national management consulting firm focused on healthcare advisory, project delivery and strategic resourcing. Founded on the core value of relationships, with the goal to “prosper together,” ProspHire partners with clients to identify and solve their most significant people, process and technology challenges. The woman-owned and rapidly growing Pittsburgh-based firm has nearly 100 practitioners and consultants who deliver exceptional service to each one of our clients across the U.S. Visit www.prosphire.com.

Women’s Health Week

Written by LBodnarchuk on . Posted in Blog, Clinical Services Optimization.

Did you know? May 14-20 is Women’s Health Week!

Women’s Health Week is aimed to raise awareness about the manageable steps women can take to improve their health and lifestyle. Incorporating simple preventative and positive health behaviors into their everyday lives is important. One’s lifestyle organically impacts day-to-day behaviors that can lead to downstream impacts both positively and negatively. Women’s Health Week provides an avenue for others to share their experiences and enhance exposure to learning opportunities that may have not been realized. During this time of the year, women are encouraged to maintain their preventive screenings, healthy life choices and rejuvenate. ProspHire encourages women to consider the factors that influence their mental health, such as managing stress and talking about anxiety and depression. 

CDC recommendations to improve physical and mental health

To improve physical and mental health, the CDC recommends that women:

  • Get regular checkups, including a yearly well-woman exam. Talk to a healthcare provider about any health concerns you have.
  • Get active.
  • Eat a healthy and balanced diet.
  • Prioritize your mental health and learn how to cope with stress.
  • Practice healthy behaviors. Daily decisions influence your overall health.

Why is Women’s Health Week important?

Women’s health plays an important role within the Healthcare industry that is driven by quality. It brings added awareness and accountability by way of preventative based HEDIS measures which are monitored by providers, health systems, health plans and members themselves. HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA), which allows direct, objective comparison of quality across a multitude of value-based care programs designed to improve the quality of care to members regardless of age, gender, finance and other social determinants.

HEDIS measures dedicated to women's health with a focus on prevention

There are specific measures within HEDIS dedicated to women’s health that focus on prevention:

Breast Cancer Screening (BCS) Women who had one or more mammograms to screen for breast cancer during the measurement year or the two years prior.

Cervical Cancer Screening (CCS) Women who were screened for cervical cancer within the eligible time frame.

Chlamydia Screening (CHL) Women who were identified as sexually active and who had at least one chlamydia test in the measurement year.

Prenatal and Postpartum Care (PPC) The percentage of deliveries that received a prenatal care visit and or postpartum visits within the eligible timeframe.

Within HEDIS performance it is expected that better outcomes lead to more enrollees, visits and overall engagement compared to competitors. Physician-specific scores are being used as evidence of preventive care from primary care office practices. These measures are also the basis for physician incentive programs such as ‘pay for performance’ and ‘quality bonus funds’.

How can ProspHire Help

How Can ProspHire Help?

At ProspHire, we have dedicated subject matter experts with experience supporting health plans, provider groups and health systems to yield positive quality outcomes that trickle down to enhanced patient and member experience, improved quality of care and reduced costs. Connect with one of our health care experts today.

© 2023 ProspHire, LLC. All Rights Reserved

What You Need to Know for Star Year 2025 Planning

Written by LBodnarchuk on . Posted in Insights.

It’s that time again for a new Star Year (SY). We are currently four full months into measurement year 2023 (SY2025), and in the final months of closing out the performance for SY2024. During this time, health plans must have a keen eye on two Star Years at once to maximize interventions and try to increase performance. With the pending changes coming into effect that will have a negative impact on plans, such as Tukey Outlier Deletion (SY2024), it is imperative that as we begin SY2025 we have the right plan in place from the beginning.

CY 2022 - 2025 & SY2024-25 Critical Strategies to Success

ProspHire’s Stars experts provided critical strategies to success as we are within SY2025 planning /execution:

SY2024 Expectation Setting: Tukey Outlier Deletion Impacts

As your health plan continues to map out initiatives for SY2025, Tukey expectation setting and education are important to communicate early with leadership and shared services to understand possible impacts to your organizations Star rating in SY2024 and SY2025. With the implementation of Tukey Outlier Deletion and the reality of a potential drop in overall Star rating, plans must understand the implications of Tukey for their plan. It is important to communicate with leadership early and often to allow for future planning efforts to take place. Plans must continue to educate shared services on these impacts to drive new innovative solutions to continue to boost performance with this barrier.

Overall Tukey-Driven Start Year 2023 Rating Differences by Actual Rating

*These results were calculated in partnership with Hyperlift and use methodology that excludes CAI and Reward Factor. QI Measures were applied

Goal Setting Sessions

Within the plan it’s critical to analyze your goals early and often within the performance year and select targets that consider the potential Quality Improvement measures and promote significant improvement. Doing measure-by-measure goal setting allows for prioritization of targeted measures that the plan can design specific interventions to promote improvement. It is also important to consider potential Tukey Outlier Deletion impacts for SY2025 projected cut points to allow for more aggressive planning and execution throughout the year.

Stars Strategic Plan

Once targets are established for the performance year, it’s imperative to develop a plan by domain that includes targeted interventions and strategies for member outreach and provider partnerships. It is critical that Stars is made a priority throughout the entire organization and measure-level owners are clearly defined to strongly execute defined strategies throughout the year.

Intervention Key Performance Indicator (KPI) Tracking

After you establish a strategic plan for Stars, it is critical to establish ongoing assessments of intervention effectiveness. Ensuring that the plan has regular access to these KPIs will allow for the proactive monitoring of performance and help inform where strategies may be falling short and additional interventions are needed. These should be set for internal interventions and vendor partners driving measure improvement strategies. Access to data is critical to inform planning and performance success.

Additional key themes to consider throughout SY2025:

  • Ongoing Training and Education of Stars
  • Transparency By All Parties Within Shared Services
  • Understand Organizational and Industry Changes
  • Ongoing Measure Analysis

At ProspHire, we continue to partner with health plans to offer insights, analysis and execution strategies that improve Star ratings.

© 2023 ProspHire, LLC. All Rights Reserved

ProspHire Founders Named Entrepreneur of the Year® East Central Finalists

Written by LBodnarchuk on . Posted in News.

PITTSBURGH, PA – ProspHire’s founders, Lauren Miladinovich and Chris Miladinovich have been named finalists for Ernst & Young’s (EY US) Entrepreneur of the Year® 2023 East Central Award. The program celebrates entrepreneurs from Western Pennsylvania, West Virginia, Northeast and Central Ohio and Kentucky.

Unstoppable, serial, entrepreneurial creators and disruptors, Lauren and Chris started ProspHire as an idea on a napkin in the basement of their Western Pennsylvania suburb. Eight years later, despite the unprecedented challenges of a global pandemic, talent shortage, data security issues and economic instability, they took this first of multiple ventures, a healthcare consulting Firm, from $0 to $20m. They have built and sustained a resilient culture focused on healthcare advisory, project delivery and strategic resourcing for each of their clients across the U.S.

“The list of finalists is impressive and we are humbled to be recognized among them,” said Lauren Miladinovich, Co-founder, Managing Principal and CEO.

“We are honored to be named finalists for the EY Entrepreneur of the Year award. This recognition is a testament to the hard work and dedication of our team, who have helped us bring our vision to life. As entrepreneurs, we are committed to creating solutions that make a positive impact on society and being a finalist for this prestigious award is a validation of that mission. We look forward to the opportunity to connect with other like-minded entrepreneurs and share our experiences of driving positive change in the world,” said Chris Miladinovich, Co-founder, Principal and COO. “With a commitment to continued innovation, we aim to deliver on our vision to be a leader in healthcare strategy and execution for our clients.”

To Lauren and Chris, being entrepreneurial is as simple as thinking outside the box and expecting the unexpected. What they don’t say is what their employees and staff see every day… the constant hunger to make things better and enabling those around them to be flexible, adaptable and see opportunities.

28 entrepreneurs were selected as finalists by an independent panel of judges. The candidates were evaluated based on their demonstration of building long-term value through entrepreneurial spirit, purpose, growth and impact, among other core contributions and attributes. Now in its 37th year, Entrepreneur of the Year is one of the preeminent competitive business awards for transformative entrepreneurs and leaders of high-growth companies who are building a more equitable, sustainable and prosperous world for all.

Regional award winners will be announced on June 14, 2023, during a special celebration. The Entrepreneur of The Year program has recognized more than 11,000 entrepreneurs throughout the US since its inception in 1986, and it has grown to recognize business leaders across 145 cities in over 60 countries around the world.

About ProspHire
ProspHire is a national management consulting firm focused on healthcare advisory, project delivery and strategic resourcing. Founded on the core value of relationships, with the goal to “prosper together,” ProspHire partners with clients to identify and solve their most significant people, process and technology challenges. The woman-owned and rapidly growing Pittsburgh-based firm has nearly 100 practitioners and consultants who deliver exceptional service to each one of our clients across the U.S. Visit www.prosphire.com.

Monthly Health Awarenss Initiative: Mental Health Awareness May 2023

Mental Health Awareness Month

Written by LBodnarchuk on . Posted in Blog.

Did you know? May is Mental Health Awareness Month. ​

In a given year, 1 in 5 Americans will experience a mental illness and more than 50% of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime1.

To improve access to mental health services, the Mental Health Parity and Addiction Equity Act (MHPAEA) was implemented in 2008 to instate health plan requirements to provide equal treatment of mental health conditions and substance use disorders as would be provided for medical or surgical benefits. What does this mean?

Mental Health Parity and Addiction Equity Act

MHPAEA was established, and has evolved over time, to subject requirements on large group plans, individual and small group plans, to provide the same limitations or allowances for physical and behavioral health care. An example of the law in action is that a co-pay to see a behavioral health provider cannot be higher than that to see a general practitioner. Ultimately, if a health plan offers a mental health or substance abuse benefit, they must provide a benefit that is at least equal to the physical health benefit.

How does MHPAEA Affect Mental Health Equity?

MHPAEA made it illegal for plans to discriminate or offer less generous benefits to people with behavioral health conditions. However, with consideration to equity, the enforcement of the law is managed at the discretion of each individual state leading to some national inequities in coverage. Although there are safeguards in place with the federal law being the minimum requirement, there are several advocates nationally pushing for increased mental health coverage and enforcement.

The need for access to and equitable mental health care goes beyond law and calls for change across the healthcare industry. Data shows that individuals from racial and ethnic minority groups face obstacles in accessing needed care2. There are several obstacles that may contribute to the disparity in outcomes, but racism and racial trauma are known factors that negatively impact mental health3. To learn about ways we as individuals, public health organizations, healthcare systems, states and communities can work together to promote health equity, visit the Centers for Disease Control and Prevention’s publication on Prioritizing Minority Mental Health.  

How Can ProspHire Help?

At ProspHire, we continuously strive to improve access to care and address health disparities. While supporting health plans remain compliant with federal and state regulations, we identify opportunities to leverage regulatory programs and initiatives to drive further change to impact your members and our communities.

For more on our Clinical Practice and Addressing Health Disparities visit: prosphire.com.

988 Suicide & Crisis Lifeline
  1. About Mental Health (cdc.gov)
  2. Prioritizing Minority Mental Health | Health Equity Features | CDC
  3. Racial Trauma – PTSD: National Center for PTSD (va.gov)

ProspHire Expands Executive Leadership Team with VP of Operations

Written by LBodnarchuk on . Posted in News.

PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, is pleased to announce the appointment of Francis Roman as Vice President of Operations. In this new role, he is responsible for overseeing many of the Firm’s operational business units, including Finance, IT and Administrative Operations.

“I’m very honored to take on this role and passionate about providing our people with the best tools, support and training to ensure new technology and operational innovations continually improve ProspHire’s operations,” said Roman.

Francis brings 15 years of experience leading large-scale, complex business transformation projects in both client and consulting environments for healthcare and insurance companies. He previously served in a Managing Director role at ProspHire, where he led the Business Growth and Expansion service offering. He also supported the Firm’s technology infrastructure and command center. Francis is a Deloitte alum and graduated from The Penn State University with a B.S. in Information Sciences and Technology.

“I’m excited to add another key position as part of our growth strategy,” said Chris Miladinovich, ProspHire’s Co-founder, Principal and Chief Operating Officer. “Fran’s breadth and depth of experience in leading transformation projects will serve him well as he assumes this operations leadership role and helps our Firm drive revenue and accelerate as we embark on our next chapter.”

“We are grateful for Fran’s extensive project leadership over the last 6 years,” said Lauren Miladinovich, ProspHire’s Co-founder, Managing Principal and Chief Executive Officer. “His oversight and experience were critical to our growth and he is well-suited to take on this new role and lead the crucial aspects of our business operations.”

Is your Health Plan Equipped to Implement your Value-Based Insurance Design (VBID) in 2024?

Written by LBodnarchuk on . Posted in Insights.

Medicare Advantage Value-Based Insurance Design Model

On April 5th, 2023, CMS announced the extension of the Value-Based Insurance Design (VBID) Model. ​

The VBID Model aims to increase use of high value services, while increasing flexibility of participating Medicare Advantage organizations to provide targeted supplemental benefits to meet the needs of their enrolled population. ​

Starting in calendar year (CY) 2024, the VBID Model will be testing several model components, some new and some existing. Participating health plans will be required to engage in the Wellness and Health Care Planning component of the VBID Model in CY2024 in addition to testing one or more of the other interventions in CY2024. These model components include:​

  • Wellness and Health Care Planning (WHP)​
  • VBID Flexibilities (Model PBPs’ select enrollees targeted by condition, socioeconomic status or a combination of both)​
  • Part C and Part D Rewards and Incentives (RI) Programs​
  • Hospice Benefit Component
VBID Statistics by the Numbers

VBID 101: What You Need to Know About VBID

Key VBID Facts:

  • Members must earn or redeem rewards and/or incentives within the contract year in which the program has been implemented. Gift cards can be considered an acceptable form of reward or incentive so long as they are not redeemable for cash by the member.​
  • Medicare Advantage Organizations may include information about the VBID program in marketing materials, so long as those materials are provided equitably to all current and prospective enrollees without discrimination.​
  • The VBID program cannot be used to specifically target populations as potential enrollees.​

Reporting

Participating organizations must report supplemental benefit utilization to CMS twice annually. Included in this reporting requirement under the Flexibilities component are supplemental benefits for food and nutritional insecurity, transportation barriers and living supports.

Reporting Requirements: (From CMS MA Reporting Technical Manual)

  • 15.1 Do you have a Rewards and Incentives Program(s)? (“Yes” or “no” only)
  • 15.2 What health related services and/or activities are included in the program?
  • 15.3 What reward(s) may enrollees earn for participation?
  • 15.4 How do you calculate the value of the reward?
  • 15.5 How do you track enrollee participation in the program?
  • 15.6 How many enrollees are currently enrolled in the program?
  • 15.7 How many rewards have been awarded so far?

Core Program Elements

The core elements of the VBID Model cover health care planning, supplemental benefit provision, rewards and incentives and extra hospice support. Health plans can apply to tailor the optional elements based on CMS provisions to best meet member needs.

Mandatory and Optional Elements of the VBID Model

Health Equity Plan A New VBID Element in 2024

Starting with the 2024 VBID Model, each plan is required to submit a VBID Health Equity Plan. This contains the health plan’s strategy to advance health equity through participation in the VBID Model.

Key Elements:

  • Health plans must identify priority populations and screening tools that will be used to capture disparities and health-related social needs.
  • Health plans must define the actions that they will take to address the identified disparities, overcome potential barriers and refer members to appropriate support services.
  • Health plans must present information on metrics and monitoring approach for the strategies presented in the Health Equity Plan.
  • Finally, health plans must explain their education and engagement strategies for members as well as providers, caregivers and broader communities.

Preparing for Success

Participating health plans should expect to receive provisional approval on their CY2024 Medicare Advantage VBID applications in Mid-May.

Is your plan equipped to implement your VBID model in 2024? Medicare Advantage Organizations must consider their supplemental benefit vendor readiness, strengthening their quality and population health programs and ensuring medical management preparation for the new VBID program year.

ProspHire’s Medicare experts are prepared to support your organization in planning for VBID success.

Addressing Shortfalls In Maternal Health Equity: How Health Plans Can Partner with Community-Based Organizations

Written by LBodnarchuk on . Posted in Insights.

Among developed countries, the United States falls behind in maternal health outcomes. According to the Commonwealth Fund, in 2020 the United States maternal mortality rate was 24 deaths per 100,000 live births which is more than three times higher than the majority of other high-income countries. ProspHire’s home state of Pennsylvania is no exception. Disaggregating health data within the United States by race reveals a significant difference in outcomes. According to Penn Medicine, black women are three times more likely to die from pregnancy-related complications than white women in the United States. These disparities are further evident in Pittsburgh, the location of ProspHire’s headquarters, which was identified as having the highest maternal mortality rate for black women amongst all United States cities (Pittsburgh NPR).  

Pregnancy-Associated Mortality Ratio (PAMR), by Demographic, Pennsylvania 2018
Source: Pennsylvania Maternal Mortality Review 2021 Repo

For health plans and providers seeking to address these shortcomings in maternal health equity, what can be done? 

The Role of SDOH in Addressing Health Inequities  

Healthcare industry experts have identified social determinants of health (SDOH) as useful indicators that provide insight into patients’ quality of life and health. SDOH variables include patients’ socioeconomic conditions, and the extent to which they have a disparate impact on health outcomes. Health plans can identify at-risk members within a given population by utilizing available data which provides a broad consensus on the role of SDOH in maternal health inequities. One resource underutilized by health plans is community-based organizations (CBOs), broadly defined as NGOs, nonprofits and community healthcare facilities.  The Affordable Care Act (ACA) provides incentives for partnerships between health plans and CBOs which have proved helpful in addressing social determinants of health.

Rethinking Addressing Maternal Health Inequities

Health Plan-CBO Partnerships and Addressing Maternal Health Equity 

Health plan-CBO partnerships are especially promising in addressing maternal health equity because they are directly familiarized with addressing community and family-level drivers of inequality1. Once criteria have been determined, such a partnership can work together to take the necessary steps to help at-risk patients.  

Fostering relationships between health plans and CBO’s can assist in better identifying target population needs. Reputable CBOs generally cultivate a high level of trust and rapport within their communities. The following are a few example areas where CBOs can assist with solutions to achieve maternal health equity: expanding prenatal care, conducting cultural sensitivity trainings for medical staff, collecting survey data, health education, providing childcare, and hosting prenatal education classes.  

Example areas where CBOs can assist with solutions to achieve maternal health equity

Illustrating Success  

When looking for a best-case example of a CBO addressing maternal health equity, one can look to ProspHire’s office location in the greater Philadelphia area. The Maternity Care Coalition in southeastern Pennsylvania partners with neighborhoods with high rates of poverty, infant mortality and health disparities. 

The Community-Based Health Care Program, funded by the Department of Health, provides funding to existing community-based care facilities to expand or build upon existing services. The Commonwealth Fund has identified the following community-based models which health systems can invest in to improve the patient experience and health outcomes for vulnerable patients: 

  • Community-Based Doulas 
  • Midwifery Services  
  • Group Prenatal Care  
  • Non-Hospital Based Birthing Centers 

For health plans seeking to adopt evidence-based models of care to improve maternal health outcomes, they may find it beneficial to partner with these existing services.  

Community-based models which health systems can invest in to improve the patient experience and health outcomes

Important Considerations 

Basic criteria which are important to assess when identifying potential community partners include: how they operate in the local area, their reach and expertise. To allow these partnerships to reach their full potential, it is important to identify a general set of challenges that come with health plan-CBO partnerships. According to the Center for Health Strategies, some important considerations include:

  • Establishing sustainable funding models 
  • Selecting and collecting partnership impact metrics 
  • Sharing patient-level data

How ProspHire Can Help  

Health plans can utilize ProspHire to help identify SDOH drivers for maternal health, pinpoint areas of greatest need and establish criteria for potential CBO partnerships based on the unique needs of your service area and most vulnerable patient populations. From a population assessment and recommendation to implementation, our work is focused on addressing health disparities across communities of greatest need and improving equitable care and outcomes.   

ProspHire can help identify SDOH drivers for maternal health