Grantee Spotlight

Rural Maternity and Obstetrics Management Strategies  

The Georgia Health Policy Center recently spoke to Dawne Sokora, director of grants programs at CHI St Vincent Hot Springs, about the early successes of the AR MOMS program and its impact in southwest Arkansas.   

To date, what has been the biggest accomplishment or win in your Rural MOMS program?  

We have been able to provide prenatal care for hundreds of moms that otherwise would be burdened with transportation, gas, and money issues. We are proud that this has been accepted with open arms in small communities. The clinics’ utilization well exceeds our expectations. Our grant goal is to see 550 moms during the life of the grant, which is three years of actual patient care. We saw almost 200 in our first year. Employers are embracing this, too, because the moms can leave work for an hour around their lunchbreak, we will see them without them having to miss a half a day or a whole day of work. 

What is a tip that you would share with an organization launching a similar program?  

The biggest speed bump that we encountered was around being naive as to how much involvement there would be at the corporate level. I did not realize that as a community-based, nonprofit hospital that I was going to have to jump through a lot of hoops to obtain leases in areas that do not have a CHI St. Vincent Hot Springs Primary Care Clinic and that I was going to have to work with multiple layers of accounting folks. Even though you may be providing care in a rural area, you have to remember who is in overarching control, and it may not be anybody that you know. With our first grant, we did not interact with corporate on a day-to-day basis, when seeing patients in the hospital clinic. I would say that from day one of writing and submitting a grant, know who you are going to be working with at corporate and the level of communication and the level of detail that they require. That was a big struggle for us, and it would have been much easier if we knew these things sooner. You learn more and more with each grant.  

How do you see participation in the Rural MOMS Program as impacting your broader health improvement efforts? 

When we determined the counties that we should serve, we realized that they are designated by HRSA as rural maternal health deserts. There are only 36 delivering hospitals in our entire state and 12 of those are in northwest Arkansas, so that leaves 24 hospitals for the other three-fourths of the state. Additionally, our area of southwest Arkansas has a high poverty level. Here at the hospital, we have a mission clinic that is Medicaid and self-pay. Many of these moms would eventually make it here, because this is where they were going to deliver. But what we are doing is bringing that same prenatal care to these areas earlier than they would reach us here in Hot Springs.        

We have a nurse practitioner, a nurse, and a perinatal mental health specialist who get in the SUV with all the equipment to provide that same, quality care. They also take time with the women to make sure that we are meeting all their social determinants of health. You just do not get that in a busy practice. We have made it part of our practice to make sure the patients feel like every question is answered. They understand who to call and when to call. This grant allowed us to put some arms out closer to where our moms are. If over the next three years we can keep six babies out of the neonatal intensive care unit, costing taxpayers $60 million, then I have had one of the greatest wins in my life and we all feel that way about early care. 

What’s next on the horizon for your grant-funded program? 

We have had a bigger impact than we thought we would, but there are also some things we will not accomplish. While keeping the same mission and passion in mind, when we look at sustainability, we will not be able to keep every clinic open that we have. From a business standpoint, you cannot have three employees drive an hour and a half each way to see two patients. We will have to combine some of our clinics, while providing prenatal and postpartum care to about the same number of women.  

One thing that I am excited about is a plan to hire two part-time community health workers. Currently, community health workers are not reimbursed by Medicaid in Arkansas. As part of the grant, we can get community health workers trained in their own communities and get local support out to our moms from people who know the community on a first-hand basis. Then, over the next two years, we will continue to fight to get community health workers, doulas and certified nurse midwives services reimbursed by Medicaid as part of our efforts to convince the state to take better care of our moms. Sustainability is challenging because Medicaid rates for obstetric services have not increased since 1987. When you are making $17 for an ob visit and you spend 30 or 40 minutes with the patient, you just cannot sustain that. We are very proud that our hospital is a nonprofit and mission-driven entity, but the big focus for us is to push for policy change for reimbursement and expansion of services from our legislature. This will give us the ability to better serve our moms and sustain the clinics.