Rural Maternity and Obstetrics Management Strategies – MaineHealth
The Georgia Health Policy Center recently spoke to Dora Anne Mills, chief health improvement officer, and Caroline Zimmerman, senior program manager, at MaineHealth, Maine’s largest health system, about the surprising findings of their first-year assessment.
To date, what has been the biggest accomplishment or win in your RMOMS program?
Dora: Over the past 16 months, completing the assessment was probably our biggest accomplishment, and it identified priorities that were different than what we had put into the proposal. When we were writing the grant proposal a couple of years ago and talking to people, we were told diabetes, obesity, and hypertension in the perinatal period for pregnant people were the big priorities. However, when we did the full assessment, what rose to the top by far were mental health issues in the perinatal period. In rural Maine, there are not many providers who can either prescribe or provide talk therapy for mental health issues, particularly for pregnant people. So, it has been a big accomplishment to identify that mental health is a major issue in the perinatal period, and that allowed us to start addressing it. We are now contracting with telehealth groups to provide those services to pregnant people across rural Maine.
Caroline: We are proud of the statewide network of all rural labor and delivery hospitals coming together to work on a shared set of goals. This consists of small, independent hospitals and large integrated health systems that do not always work together on a single project. It is an active network and people feel heard. We also have strong participation in our activities across our domains — education and training, telehealth, and workforce data and evaluation. Around all these topics, people have made connections and launched activities.
What is a tip or early learning that you would share with an organization launching a similar program?
Dora: I think the biggest lesson we learned so far is to be flexible. As I mentioned, when we did the full assessment, we learned something very different than our very preliminary look. A tip I would share is to make sure you do spend that first year conducting a full assessment. You may be surprised by what you find, and your strategies then may change as a result. I think our pivoting as a team was just reflecting back what we were hearing.
Caroline: The other lesson learned for us was meeting our network members where they are. Everybody is understaffed and overwhelmed, so, we try to be flexible in reaching out to them, offering quick phone calls, or offering to come out to meet with them when it worked for them. We found that for some partners who initially sat back a little bit, as soon as we launched a couple strategies that really met their needs, they jumped right in and were fully engaged in those activities. So, I also recommend being flexible and ready to allow people to participate in ways that work for them.
How do you see participation in the RMOMS Program as impacting your broader health improvement efforts?
Dora: In Maine, we have a statewide public health agency, a couple of small local health departments, and then we have a long strong history of our nonprofit health care systems working in partnership with government to accomplish our goals of improving public health. Our RMOMS board has several representatives from state government and other hospitals. So, this work is not just part of MaineHealth’s vision, but it is part of state public health in Maine and all other hospitals in Maine. That is just how we get things done, and a lot of what we do in rural areas generally, and in Maine, we do in partnership.
What’s next on the horizon for your grant-funded program?
Dora: We are focused on two areas. One is to implement programs with these grant funds and at the same time seek funding — particularly from MaineCare, the state’s Medicaid and other insurers — to cover these services on an ongoing basis. This includes reimbursement for the mental health providers we are hiring to do telehealth for prescribing and talk therapy with pregnant or postpartum people. Another example that we were also trying out via telehealth is using registered dieticians within perinatal dietary issues to address obesity and diabetes. We are currently using grant dollars to fund these efforts, but at the same time seeking insurance reimbursement, which we think is doable within the grant period, so that these efforts will be sustainable.
The second set of strategies came out of the RMOMS assessments. A finding of the workforce assessment is the need for fellowship training for family physicians to be able to do C-sections. We are seeking ways to address that, not through RMOMS, but with our partners. Another example that came out of the workforce assessment is working with educational institutions to identify ways that that can provide short training opportunities for current existing labor and delivery nurses in rural areas to come to a busier hospital to work. We cannot just take a labor and delivery nurse from a rural area and have them come to one of our more urban hospitals because of the issues around liability and malpractice. But we are working through a partnership with an educational institution to address this other need that emerged.
Caroline: The other piece relating to workforce is looking at innovative staffing models to leverage care team members and maximize their expertise by making sure people can work at the highest level of their licensure or credentialing.