Background:

Michigan's most recent statistics on infant mortality show the potential for stagnation in reducing unnecessary deaths of newborns and infants. While a trend of at least three years is needed to indicate an appreciable increase in infant mortality, the most recent data does indicate the need to maintain and even increase our commitment to reducing infant morbidity and mortality in Michigan. (See attachments) Now is the time to review our efforts and focus in on specific indicators that allow further reduction of the infant mortality rate.

Fifteen years ago, Michigan took notice of its alarming infant mortality rate, and stepped up efforts to reduce these rates. Community-based efforts were employed where particular indicators allowed for targeted approaches, along with the statewide programs and policies implemented. These programs included Maternal Support Services (MSS), Infant Support Services (ISS), Maternal and Infant Health Advocacy Services (MIHAS), and expanded Medicaid eligibility for pregnant women. Infant mortality rates have dropped for many of the subsequent years, and simultaneously the programs launched or expanded during this time have seen strong support from local providers and advocates. Now, as Medicaid has moved to a capitated managed care model, many of these same programs have seen declining access at the same time as infant mortality rates have stagnated or begun an increase.

MSS, ISS, and MIHAS have all developed innovative ways to connect pregnant women and newborn's to needed health and other non-medical services, critical to healthy birth outcomes. The core of this work is performed by community health workers, also called community health advocates or maternal support workers, and provides assistance in navigating the health care system for at-risk women.

Expansions in Medicaid eligibility for pregnant women improved access to basic prenatal care, which improves birth outcomes. However, non-medical support services, such as MSS and ISS, are critical components to improving the health outcomes in at-risk populations, and must be combined with the access to medical services. If managed care organizations do not provide adequate access to MSS and ISS or providers feel pressured to limit access to reduce costs, at-risk pregnant and new families suffer adverse consequences. Infant mortality rates will again increase, and communities will lose the benefits reached through years of hard work.

Recommendations:

• Reconvene a state-level review of infant mortality to assess current programs and policies, and develop a work plan to maintain past reductions in infant mortality as well as target new initiatives to further reduce the rate in particular subpopulations.
• A reimbursement system for MSS and ISS services through managed care organizations should be developed that makes payments to plans only when services are delivered and includes incentives and disincentives for reaching or exceeding minimum objectives.
• Evaluate the performance of each managed care organization's compliance with state objectives for MSS and ISS and provides corrective plans with measurable objectives for each plan.
• Provide technical assistance and education to health plans to improve understanding of the purpose of MSS and ISS.

Additional Resources:

Joe Moore, M.D.
Michigan State Medical Society
616/391-2851

Robert Lorenz, M.D.
Michigan Section., American College of Obstetricians and Gynecologists
248/551-0395

Cassandra Joubert, Sc.D.
Mott Children's Health Center
810/767-5750

Sharon Claytor Peters
Michigan's Children
517/485-3500