Maternal health leaders working to support CBOs, doula training to improve care in Florida

By

Shane Ersland

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Maternal health leaders are working with community-based organizations (CBOs) to improve care for moms and their babies in Florida. They discussed their efforts at the 2024 Florida State of Reform Health Policy Conference last month.

Dr. Kristyn Greifer—chief medical officer and senior vice president of enterprise care management and utilization at Sentara Health Plans—said Sentara works with local organizations and providers to provide health initiatives for local communities.

“One of the things we can do is fund CBOs,” Greifer said. “We do a lot of grant funding for CBOs, including Healthy Start. If the communities are healthier, the moms and babies are going to be healthier.”

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Broward Healthy Start Coalition CEO Monica Figueroa King said Fort Lauderdale—which is in Broward County—has more than two million people, 22,000 births a year, and seven birthing hospitals. 

“Healthy Start at Broward does an intake assessment on 18,000 women every year,” King said. “We have to think differently about how we support that population. There’s not enough money to take care of all those women, so we’re thinking about triaging data. There’s a workforce support element that’s needed around training for doulas. The evidence is there that they help with outcomes. We engage with about 2,000 women monthly on intensive home visitation services. So we have a good bridge into what they’re seeing and hearing.”  

Florida has many maternal healthcare deserts, Greifer noted, and Sentara aims to help address those by supporting doula training programs. 

“Our goal is to connect pregnant women to doulas as quickly as we know they’re pregnant so they can have (them) the entirety of their pregnancy; it’s not just at birth. We’re funding initiatives to bring midwives closer to deserts where there aren’t any OBGYNs (obstetrician gynecologists). We also fund mobile clinics that go to the areas people need them to go to. Because the reality is no prenatal care can happen if you can’t connect pregnant women with something. We see our role as connecting the dots. We want to help with the navigation.”

— Greifer

Loreen Chant, president and CEO of Health Foundation of South Florida, said the foundation supports CBOs as well. The foundation recently funded three maternal health collaboratives.

“In 2022, the foundation (had interest) in funding community collaborations to address disparities,” Chant said. “We are one year into a three-year pilot project. We’ve invested over $2 million in integrating work with CBOs and health providers.”

The foundation funded a collaborative in Monroe County, which is an OBGYN desert, Chant said. It is 110 miles long, only has three or four OBGYNs, and most of its pregnant women have to travel to Key West or Miami to give birth, she said. 

The foundation also works with Jackson Health System on a collaborative in Miami-Dade County. The collaborative made a goal to make Jackson—the safety net hospital for the county—a doula-friendly hospital, Chant said.       

“We (recently launched) the 24/7 on-call doula program for Jackson. They previously had not had doulas in Jackson’s birthing care. We provided the funding to support the workforce training of the doulas. We will train 65 doulas; we’re at about 30 so far. We will have over 150 doula-supported deliveries in the next two years so we’re able to look at the outcomes of those births. The idea is, if we can reduce complications and costs, we would hope to see more consistent and better reimbursement rates for doulas, so this is a workforce we can count on in the healthcare system.”

— Chant

The foundation also supports a collaborative in Broward County. Broward Health Associate Vice President Rose McKelvie said part of the collaborative included creating another prenatal clinic there because there’s an OBGYN desert in the center of the county.

“We had been doing some work at Broward around this topic, talking about how we would do it differently,” McKelvie said. “At the same time, Community Care Plan—a Medicaid provider—was working to build a resource center so people could come and deal with social determinants of health (SDOH) and job training. They also wanted to do some work around doula care. We stepped in and said, ‘Let’s put a clinic there,’ because we have a large prenatal clinic in one of our (federally qualified health centers) that is the sole provider of OBGYN care in that zip code. It’s a high-risk population.

We brought in Healthy Start and (Urban League of Broward County) to work together. The resource center (that will) work with moms and families on SDOH—that they need resources for—will be in the same space. At the same time, we’ll be providing prenatal care in that space. It’s a multi-specialty space in that shopping center. And in that space we’ll be offering CenteringPregnancy, which we’re already doing at our other clinic. And that’s been a huge success. We’ll also be doing telehealth and doula training there.” 

Florida CBOs need to continue to advocate for the resources they need, Greifer said.    

“My big request for all CBOs is to keep asking the payors to come to the table so we can help earlier on how to structure something so you will get paid for it the way you want to do it,” she said. “Not us saying, ‘We’ll give you this money if you do exactly what I ask you to do.’ The reality is you know far better than I do what the right thing to do for those women is.”

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