COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES Room 400, City Hall Philadelphia, Pennsylvania Friday, March 8, 2024 10:06 a.m. PRESENT: COUNCILWOMAN NINA AHMAD, CHAIR COUNCILWOMAN QUETCY M. LOZADA, VICE-CHAIR COUNCILWOMAN CINDY BASS COUNCILMAN MICHAEL DRISCOLL COUNCILWOMAN RUE LANDAU COUNCILMAN ANTHONY PHILLIPS
COUNCILMAN CURTIS JONES, JR. RESOLUTION: 240115 - - -
Good afternoon, everyone. This is a public hearing of the City Council Committee on Public Health and Human Services. The purpose of this meeting is to hear testimony on Resolution No. 240115. I recognize the presence of a quorum of Community members. And will the Clerk please call the roll.
Present. Good morning, colleagues and viewing public.
All right. So we are very pleased to see all of you here. I wanted to recognize my Vice-Chair here, Councilmember Lozada. All of these folks have more experience than I do. This is my first public hearing for a Committee, so thank you for being here and making it extra special. What I'm going to do now is just give brief opening remarks and then we'll get started. Today is International Day of the Woman, so Happy International Day of the Woman. (Applause.)
The United Nations has a theme today, to invest in women, accelerate progress to commemorate this day, and we're going to take that into our hearing today to see that we are doing that for women and all birthing people. France just amended their Constitution today to guarantee the right to abortion. They already had fully paid abortion. Here in our country we're struggling with so much with our right to productive freedom. We just -- you've all heard about the IVF dilemma that is going on spreading across our nation, so we must stand up and fight for our reproductive rights. And this hearing is part of that whole continuum. 5 times more than White maternal 24 mortality. That is unacceptable, 25 all of it. There is nothing like lived experience to drive the message home about the impact of maternal mortality. I never met my grandmother who died at child birth when my mother was 2. I saw how that impacted my mother throughout her life with chronic health issues and abiding sense of deep loss from which she never recovered. I can be in this hearing today to assess where are we regarding maternal mortality since a lot of work has been done by many in this room actually and others elsewhere. Progress has been made, but we still have far to go. I'm specifically interested to examine the racial disparity in the rates of maternal mortality in Philadelphia. Let me underscore that, specifically interested to examine the racial disparity in the rates of maternal mortality in Philadelphia and to address the fact that Black birthing people died three times more than White birthing people. In Philadelphia, an average of pregnancy-associated deaths 6 per year occurred between 2013 and 7 2018. And pregnant Black people, 8 43 percent of people who are able 9 to carry a child, they represent 73 10 percent of maternal deaths. 43 11 percent can give birth. 73 percent 12 represent maternal death. This is 13 deeply alarming. I believe, 14 however, there is new data coming 15 out, which we don't have access to 16 yet, that will show that we have 17 made some progress. I feel 18 encouraged, but we have work to do. 19 Racism in health care has 20 serious consequences. It is real. There is a myth -- there's lots of examples which are documented, research that show that there is real racism in how health care is delivered. There is structural racism embedded in our systems. And when it's embedded in health care, it has dire consequences. You know, there's myths about Black people having thicker skin, less sensitive nerve endings, and we can go on and on, kidney function, so many other things. Today we have people, very esteemed experienced people on our panel who are going to speak to some of these issues. And I just want to highlight one thing that's relevant for this discussion. Since 2007, obstetricians have counseled patients planning to give birth after a previous C-section with the help of a simple calculator designed to determine the likelihood of having a successful vaginal birth after Cesarean, a VBAC. The VBAC calculator is one of several clinical algorithms that have been recently challenged over the use of race adjustment. Providers across specialty have questioned the inclusion of race and ethnicity in the variables that are programmed into that algorithm, which these are social not biological factors, and they're decision-making tools pointing to the risk of perpetuating existing health inequities. But because obstetricians have this VBAC calculator online, it could prove much easier than with other corrective tools to get updated calculator and maybe some of our panelists will speak to that. And race correction needs to be abandoned systematically as a tool in response to these equity concerns. So I'm just going to stop here and just give any of my colleagues here if they want to make any comments before we proceed with our testimony. )
Thank you, Madam Chair. I just want to commend you on raising this issue. Many years ago we had a Health Commissioner come and testify about the statistics you just mentioned, and they tried to figure out if it was the water, if it was racial demographics. And the only thing they came up with for particular areas that are impacted with poverty and stress was stress kills. And they were talking about showing a comparison between war-torn areas of the world and what mothers went through in some of our neighborhoods. And I equated it to, you know, on Monday you found out there was an eviction notice, on Tuesday you had food insecurities, on Wednesday there was internal strife in the household that caused arguments that all led up to these statistical impacts. So I'm looking forward to the testimony not only to figure out what's going wrong but what we can do, Madam Chair, to make it right. So thank you for this hearing.
Thank you, Councilmember Curtis Jones. That was so apropos to what we're going to be discussing today. So what we'll do next is will the Clerk please call the names of the first panel and read the title of the resolution.
Resolution No. 25 240115, authorizing the Committee on Public Health and Human Services to hold hearings examining proposed solutions to racial disparities in the maternal mortality rate in the City of Philadelphia. The first panel, Alexia Doumbouya, Saleemah McNeil, Pastor Michele Suggs. (Witnesses approached Witness table.)
Good morning, Honorable members of Philadelphia City Council. I am Alexia Doumbouya. I hold a Master's in Organizational Leadership. black. We are a nonprofit 501(c)(3) that works to build a sustainable doula workforce. We serve moms in three key stages of pregnancy, post-partum and compassion for the loss of a child or significant loved one. We support these moms by providing free doula services and free mental health services. It is with a heavy heart that I'm compelled to shed light on the persistent unjust crisis facing Black moms and birth people in our city. I stand or sit before you today as a wife, as a doula, and one of my most important roles, as a mother. I represent the 13 percent of people who experience 14 symptoms of depression, postpartum 15 depression as well as anxiety and 16 psychosis. I also represent that 45 percent who went untreated. My own experience in this vein almost cost me my life. The challenges endured compounded by systemic racism, housing insecurity and social determinants of health demand our urgent attention and sustained action. Our Black moms are not being listened to. The World Health Organization shared data that 1 in women reported 5 experience one or more types of 6 mistreatment such as loss of autonomy, being shouted at, scolded, threatened, ignored, refused or receiving no response at all to requests for help. I also represent this data. This has nothing to do with a medical diagnosis or family history, but just basic human kindness. It is imperative that we confront these injustices head-on and craft legislation that not only acknowledges the gravity of the situation but also provide tangible solutions to reduce or eliminate maternal deaths, especially among Black and Brown birthing people. Structural inequities pervade every aspect of maternal health care in Philadelphia, perpetuating a cycle of mistreatment, neglecting disregard. Black mothers and birthing people are disproportionately subjected to substandard care, dismissive attitudes and systemic biases. Their voices are silenced, concerns dismissed and their lives endangered by a system that fails to recognize their inherent worth and dignity. At times, the only time they are heard is in the name of family surveillance. This crisis is not merely a matter of statistics. It is a profound human tragedy that demands our collective empathy, compassion and resolve. black we are dedicated to providing these mommas regardless of their zip code or financial position, access to doulas who can assist them during childbirth and offer a glimmer of hope amidst the darkness. Doulas like Nyfisa Rabb with over years of experience serving moms play a crucial role in advocating for maternal health, providing emotional support and ensuring that mothers and birthing persons receive the care and attention they deserve. Because of amazing doulas like my one mentor, Ebony DeBrest, a full spectrum doula for over 10 years, others are yielding to the call to become a doula and support the doula workforce, like our City's own Reverend Lorina Marshall-Blake who understood the importance of service and the importance of supporting moms through this maternal health journey. However, the mere provision of doula services is not enough. We must also develop strategies that address ownership and accountability of hospitals and health care providers for their actions or lack thereof. Building metrics and setting expectations, implementing robust accountability measures are paramount to ensuring that every mother and birthing person receive quality care. We can't afford to turn a blind eye to these injustices. We must confront them head-on with meaningful change. In Philadelphia, Black women and birthing people make up 39 percent of the population and 43 percent of the births, but 73 percent of the pregnancy-related deaths.
As a member of City Council and ourselves, you have a moral and ethical obligation to stand in solidarity with our most vulnerable communities and champion the cause of maternal health equity. We must listen to the voices of Black mothers and birthing people, amplify their stories and advocate to address the root causes of maternal mortality and morbidity. HHS Secretary Becerra spoke about health equity by design, which simply means systemic changes with protective outcomes for all mommas. This also means implementing meaningful solutions like the following: One of the first being understanding that health equity also includes the balance of resource distribution like funding for programs offered by community-based organizations, implementation of publicly visible, actionable information and qualitative metrics that help evaluate the health care systems, patient, partner and doula engagement. This promotes a cultural welcoming of doulas and inclusive of fathers. To quote our partners in paternal health, Daddy University, fathers are having a baby too. Continue advocacy for coverage for doula services during pregnancy through postpartum by health plans, funding for programs to also subsidize these services for moms, including our justice-involved moms. We want to see more investment in women of color-led community-based organizations like even our own that offers a perinatal health academy for current and aspiring doulas. Launching public awareness campaigns that work in collaboration with health systems, community- and faith-based organizations. We need grantors to offer more patient-centered, action-based funding opportunities. This is often heavily focused on research but also giving them the opportunity to pilot and see what the result is of these solutions implemented, and make the Medicaid assignment process a lot easier, especially for our doulas and other maternal mental health professionals. In closing, I urge you to heed the call of conscious and take decisive action to address the crisis in maternal health. We often quote the African proverb that it takes a village, but our villages, our communities have been disempowered. Let us work together to remove the fences, the structural systemic barriers, and let us craft legislation that reflects values, uplifts our communities and ensures that every mother and birthing person in Philadelphia receives the care and support they need to thrive. The time for action is now. The stakes could not be higher. Our mothers, our sisters, our daughters, they're counting on us to make a difference. Let's do more than try. Let's yield to the cautionary message even given to us by the CDC and hear her. I always say I decided to become what I did not have. Who are you becoming as we consider the same for our city. Thank you in advance for helping to build a sustainable workforce for our doulas, developing action steps hospitals can take to enhance engagement and with birthing persons and families. And thank you for allowing your legacy to reflect the important change to come.
Thank you. So what we're going to do is have all of you testify on this panel. Then we will hold our questions until later. And I want to recognize our colleague Rue Landau who just joined us. She's on this Public Health Committee as well, so thank you for being here. We recognized Councilmember Jones earlier, yes. Thank you. My colleagues are taking care of me to make sure I'm doing everything right. So we'll go to our next panelist. Please state your name for the record and proceed with your testimony. MS. McNEIL: Good morning. My name is Saleemah McNeil, and I'm the Executive Director and founder of Oshun Family Center. Thank you all for hosting this hearing and allowing us to tell our stories in hopes that we are able to move things in a way that feels just for the population of people that we serve. Today you're going to hear stories from a lot of people like myself who started organizations like Alexia to be a solution to the problems that we've encountered. However, I sit here kind of pissed off because we are yet again talking about another way to have a solution to a problem that we already know what the issues are. And when I think about a great usage of time, I also think about how we should inform another Committee to then talk about the issues regarding Black maternal morbidity and mortality and move collectively into a solution, action-oriented task force to start funding and providing those supports and balances of resources to organizations that are already doing the work. We already have the solutions and we need your support to continue to fund those things to those families who are impacted. I come to you wearing several hats. I'm a reproductive psychotherapist here in Philadelphia. I've also founded this nonprofit organization in 2018. I am sitting at this table specifically because of Ms. Nina Ahmad, now Councilmember, because five years ago when I told my story in another room, she said you should be here at a hearing that was hosted by State Rep Morgan Cephas down at St. Joe's University. And with the joy in my heart to be here again to also share this story is also with the same dismay because we're telling the story over and over and we are five years later and still in the same space. I am also a maternal health researcher, and I come to their research space without a doctorate degree but also with the passion that I need to make sure that the clinical trials that are being served and done on Black birth bodies are formulated and curated by people who look like us. Our diversity, equity and inclusion efforts are under attack. And when we look at how that impacts the racism that Black families face, it is paramount. We work within these health systems. We have doulas in there that aren't treated well and we are working for them to get better treatment. We're working for burdening families to get better treatment. And all of that comes down on multiple levels. I'm also the curator of the Maternal Wellness Village, which is a collective of Black birth workers who was formed in 2019 to be on the front lines of tackling this issue. Because you look far and wide for experts to sit on your panels, you look far and wide for people to share their stories, but we're all here. But we're here telling our stories in hopes to make shift happen because people's lives depend on it. I also come to you as an overall disrupter, and I'm going to let you know how I feel and why I feel those things. Because as we are servicing those families, it is us on the direct lines providing those services. So who heals the healer. When we are all stretched to be here, to leave, to go run the business, to come back and look at legislative pieces to get feedback on what the verbiage should be, and we are all your constituents. So when we come to this place, it is with multiple hats, multiple feelings and already some solutions. At Oshun Family Center, we provide Black people with Black birth workers and therapists.
Everybody who walks through our door is somebody who identifies throughout the African Diaspora, whether it be a client and/or somebody that I employ. We work diligently within hospital systems to help them understand the impact of Black maternal morbidity and mortality on the Black birthing families, specifically in the centralized area of North Philadelphia currently. We are also there to provide the emotional and social support with our doulas and lactation consultants that work within our Change of Heart program in collaboration with Temple University. All of that is the inception of 10 Black women sitting around a table at a café in West Philadelphia in 2017, for 2018 to be the year that we launched and 2019 to be visible, and we are still in the fight. When I look at where we are going now, sometimes it feels stagnant but I know that you all can support to move things forward in a way that feels honorable to the families that have been impacted by the Black maternal mortality rate. I've been very specific about not sharing my story today because I believe most of you have heard it, and I don't want you all to have the pulling heart strings of another Black woman sitting here telling you how I was impacted by the injustices in the health system. We know that it's wrong. So as we move forward, I think we can bank the stories that we do have, that our ancestors have already led the way to do and build on that. So my challenge to you all and everyone else in the room 21 is to move from a place where we are sitting and listening and being in community with one another in this way, and to move to be action- oriented, how we can shape, how can we move, how can we implement these legislative packages and get them passed on the floor. Working on the Momnibus with State Representative Morgan Cephas' office and we are introducing another bill that was already shot down twice, how is that a good use of our time. How is that a good use of the families that we need to support. So I'm here today to charge you all to move instead of listen, to shape instead of watch and to also join us in the fight that we do every single year day-by-day to move things forward. Black Maternal Health Week is coming up and we have been lead organizers, the three of us that you see sitting here with a few of us that are behind us as well every single year to raise awareness, and we are doing a very good job at doing that, because y'all aware, right? ) MS. McNEIL: Okay. As long as we know. So again, my name is Saleemah McNeil. Thank you so much for giving me the time and opportunity to express those things to you. Not a testimony in its traditional sense, however I want you all to know and understand that there are programs out there that are doing the work. We need a balance of resources. We need funding and we have solutions to the problem. Thank you.
Thank you, Saleemah. We appreciate that. We will go to our next testifier. Ms. LaMAR-SUGGS: Good morning. I am Michele LaMar-Suggs, Certified Nurse Midwife here in Philadelphia at a large health institution. Today I bring a unique perspective as the clinician serving at a major health institution, committee member on the Philadelphia Mortality Maternal Review Committee, Pastor of a local church and founder of Royal Generation, a nonprofit organization aimed at improving social determinants of health by providing things women need to thrive, not just survive. In Philadelphia, women but significantly higher rates of Black women are dying senselessly at the hands of those individuals and institutions who have been charged to protect and save their lives. The sentiments echoed when caring for Black women is that hospitals are as triggering to them as police stops for Black men. They often let out a sigh of release to have a provider of color who they can racially identify with which brings them comfort, but for me this is a burden. Being the first Black midwife of 30 years of a major health institution is quite disparaging. In general, by health systems across the City their voices are being silenced, concerns are not being affirmed, they're being treated as second-class citizens and leave our hospitals feeling as if their bodies are broken. We all know that Philadelphia is the poorest of the nation's 10 largest cities. Every single day women struggle to feed their families, lack quality education, have little or no 18 housing resources, often live in the worst zip codes that are poorly funded, lack safety, have fallen victim to substance abuse, lack transportation to attend prenatal appointments, suffer silently from impaired mental illnesses like debilitating anxiety and depression, are forced to make decisions to return to work immediately postpartum or at risk of losing their minimum wage jobs that are not nearly enough to provide for their most basic needs. Is this the reason women in our city specifically are dying at record rates or specifically you may be asking yourselves is this just an injustice limited to the impoverished? Of course not, and here's why, and we have data to prove it. Black women in even the wealthiest of neighborhoods do worse than White, Hispanic and Asian mothers in the poorest areas. Black mothers who are college-educated have worse outcomes than women of all races, but especially White women who have a high diploma or less. Is this a problem limited to people who have risk factors? No. We know that obese women of all races have better birth outcomes than Black women of normal rate with no other risk factors. Most are quick to make hospitals the major culprit for maternal deaths in our city. But the data shows us that this may not actually be the case. And we know that numbers don't lie. While a subset of women die from complications like hemorrhage, cardiac disease and other medical conditions, it also shows us that most women are actually dying between 6 weeks and 12 months after leaving hospitals. So what does this actually means? It means -- and we have the data to support it, that large populations of women in our city are dying as a result of gun violence, by homicide or suicide, dying of drug overdose, dying because they are victims of intimate partner violence, dying to the effects of a mental health diagnosis and a large majority of these deaths are preventable. We don't need to be convinced of disastrous effects of the crisis by hearing more grueling statistics affecting women surrounding birth. We have been trying to fix the symptoms of this crisis, but have turned a blind eye to the root causes. The roots of racism, the roots of classism and gender oppression. Unless we agree that systems are broken, we can never fully optimally function. We must assure optimal birth outcomes for all people with the willingness to address racial and social inequities in a sustained manner.
There must be equitable distribution of money, of power and resources at national and local levels with our most vulnerable populations being made priority. So what should we actually focus on? Addressing the root causes of inequities in health care systems by expanding education, trainings that are addressing head-on implicit and explicit bias without compromise, providing simulation drills surrounding racism, dismantling structural racism and classism in government, to begin to delegate funding and resources directed at recruiting in hiring clinicians, specifically midwives, nurse-practitioners, physicians, mental health therapists and nurses that racially and ethnically represent the demographics in which our hospitals are located in the populations we serve. Racial congruency amongst providers makes a difference. They can't -- we cannot be -- there cannot be successful maternal health without successful paternal health. We have to create environments where Black men are not criminalized. Paternal health initiatives geared at including and building fathers as a vulnerable member of the maternal support team where applicable through the entirely perinatal and postpartum periods. Every day when I walk in my office I see the look of surprise on the face of Black fathers when I address them, when I say hello, when I ask their opinions, when I include them in the discussion. And often they say, Michele, you're the first who ever acknowledged me. This is an absolute disgrace. Providing supportive programs and resources for victims of intimate partner violence, establishing more safe havens and transitional housing for women in this vulnerable group. We need to expand access and care surrounding mental health and substance abuse. There is no reason that in this industrialized nation that women are waiting six to nine months after expressing attempts of suicide to take their lives, expanding access and increasing funding for safety in the most vulnerable zip codes first. In many areas of our city, women are being killed senselessly, but the surveillance cameras have not been operable for at least a year or more. Removing barriers for women accessing care such as providing transportation and working to fund and establish mobile prenatal care connected to local delivery hospitals. Ensuring that insurance carriers reimburse for doula support during pregnancy and postpartum as well as expanded funding for home visiting organizations. Campaigns aimed at destigmatizing DHS and non-traditional ways in helping them value their services and not being seen as punitive, passing legislation to establish paid parental leave with full benefits at 100 percent for at least six weeks. Lastly, allocating funding and grants for grassroots community organizations like my own and many others represented here, which will enable us to expand our reach in services as we continually continue to fight tirelessly to support women as trusted community partners. In closing, while we all may disagree on why and how we have arrived at this point, we can all agree that women are senselessly dying and everyone in (inaudible) to change this. The key to this vital change is one word, accountability. Accountability on the front lines in health care institutions, accountability for lawmakers, accountability for insurance companies and accountability for community stakeholders. I am confident that together we will make the needed changes on all levels to bring about sustainable, meaningful and lasting change. Thank you. )
Thank you so much. I deeply appreciate all your passion, all your work. This panel is representing years and years of work and investment that you have made, and now it's time for all of us to work with you. So I'm going to ask if there are any questions from our panel before we let you go. Yes, Madam Vice-president -- Vice-Chair.
First, I'd like to say thank you to each of you for coming here today and for sharing your stories with us, sharing your work with us. I can say that I share your frustration because often times as government we are experts at sharing the issues that our constituents share with us, and we can legislate and legislate and legislate. And at the end of it all, it always comes down to money, right. How much money are we willing to put towards a particular initiative or towards a particular group, and it takes us some time, right. You guys started talking about this particular issue in 2018 if I'm hearing correctly, right, in a café somewhere. But I'm sure that this has been an issue that has been discussed amongst you a really long time. And here you are 2024 and we're still having the same conversation. And so, for me I am excited to hear the rest of the panel that will share information with us. I know that State Rep Morgan Cephas has done a lot of work on this. And so, I'm really looking forward to continuing the work alongside her and her colleagues in the Statehouse to figure out how do we really get to work, how do we put action behind the conversations that we're having here and how do we seriously start to identify those dollars that are necessary to be able to end the loss of another person in our community. So thank you so much again for sharing your stories. I look forward to continuing the conversation this morning.
Thank you, Councilmember Lozada. And I recognize Councilmember Rue Landau.
I also just want to thank you so much for sharing your words, for sharing your stories with us. It means the world and I promise you this: We've got a new Council and we've got a new Administration and we've got a lot of energy of folks who are looking at things in different ways and prioritizing things differently. Nothing is more impactful to me right now than hearing the three of you talk on International Women's Day to put the charge into us to know how sincerely you are doing the work and how hard it is on the ground and how we collectively have to come up with solutions for this. This is not even something obviously that came about even 2018. Obviously this has been going on for so long and we must end the systemic racism, the systemic misogyny, the sexism and everything that's going on in our health care system in order to make sure that women are being treated equitably, that we are making sure that we are caring for our Black and Brown mothers and residents of Philadelphia. I just came from giving a keynote speech at a big company that does a lot of technology and biotech work, and I'm seeing how much in our current roles we're reaching out to meet people in various other sectors of this City. I'm somebody that's a little more like you, community-based, legal services, public interest person. But as we meet these folks who say they want to be connected and they want to help, I can't wait to make those connections if that's part of what we're doing here along with the funding of connecting them to you so they can help fund, so they can help work on this, so they can come up with the technology that you need in order to further your work. I can't wait to do it and we're rolling up our sleeves. And thank you so much.
Thank you, Councilmember Landau. I want to recognize Councilmember Bass who has joined us. You know, I actually -- before I was in Council and I was a member of the National Organization for Women, I testified on your hearing that you had in 2019 before the pandemic, and so much was structured then. And then we had this big break that took us, you know, we're still recovering from that. And so, I want to thank you for what you did and this is a relay race. There's other people in this room, State Representative Morgan Cephas. I spoke to Rep Gina Curry this morning, she's not able to join us. Rep La'Tasha Mayes, she's another person on the western side of Pennsylvania. There's a lot of people who have done good work and there's others I'm not mentioning now but who have been doing this. So I think this relay race is continuing until we pass the baton to the last leg. We're not done. So I wanted to see if there were any other questions.
Okay. Oh, Councilmember Bass, did you want to say something?
Well, you know, I will say just briefly -- my apology for being late, I had a funeral this morning -- but I will say there are two people that I have something in common with, two famous people, Beyonce and Serena Williams. The thing I have in common with those two women is that all three of us had preeclampsia during pregnancy, which is obviously a very serious condition. And it doesn't matter necessarily income level or status or notoriety or any of those things, education level. There is really something, you know, not right with the way maternal mortality is handled and maternal health care is handled in this country. And so, we can do better. We've been saying for a long time we can do a whole lot better, so I look forward with working with the new Chair, Chairwoman, to advance this effort. So thank you so much, Council Lady.
Thank you, Councilmember. I recognize Councilmember Curtis Jones.
Thank you, Madam Chair. I want to move this from adjective to a verb. And what do I mean by that. I'm going to ask a series of questions. Feel free to jump in. Do the insurance companies fund what you do? MS. LaMAR-SUGGS: No. 14 MS. McNEIL: No. 15
Okay. Have we sat down with the insurance companies to ask the question or get an answer why? MS. McNEIL: Yes.
I know that there is progress that we are making actively because a part of the challenge is in the state of Pennsylvania like many other states, and I'm going to speak specifically for the coverage for doula services, it's not 100 percent clear on how to cover those services based on the track that it's taking to educate and train. So one of the programs that we are accurately working on is building that out. So when we put together our curriculum program to certify and train our doulas, we built a task force. We included disciplines that are represented even in this space, including at the table. And so, one of the things that we did was that we want to lead in what that discussion looks like to build the certification requirements, not that they don't exist right now, but helping to build a coalition to come together to influence that. Because one of the things that also happens is there's a lot of organizations that get undermined or ignored because of larger ones and they don't necessarily look like us. And so, the ones that we are running are pushed to the wayside. And so, we want to be a part of sharing and what it looks like to help train and prepare those doulas to serve. Based on that track, we believe that it's going to help to fund a lot of these programs that insurance companies can provide services. So I have background in health care administration so I understand the process in how those procedures go. So that's one of the tasks that we are currently working on to help be able to fund coverage or provide coverage I should say for doula services. And part of that comes with developing a track of certification and continued education that health insurance companies can get behind because they know what steps they've taken to prepare themselves for this role.
-- colleague here knows what disparate impact is. And if this is disproportionately impacting a group of people, there is reason and rationale to hold them accountable for their lack of fairness and their impact of discrimination. That's number one. I'm sorry I interrupted. Please continue. MS. McNEIL: That's okay. When it comes to the mental health portion of it, that is something that is covered by insurance. However, you don't get to pick your therapist. You don't get to find somebody that's racially and culturally concordant. You don't get to find somebody that has the specialty that everybody in my organization has. So all of our therapists, even from our front desk staff to our directors are all trained in perinatal mood and anxiety disorders to be able to understand and know what the presenting issue is so we can curate our services to them. However, one of the barriers is the hoops that you have to jump through for the reimbursement that's almost not worth it. The time spent to get the reimbursement exceeds the amount that's going to come back in a way that's going to actually serve a positive purpose for organizations like my own. So we are embarking on our capital fundraising journey to establish a brick-and-mortar location in Cindy Bass' District in order to have the Medicaid credentialing so we can service that population. But those things have to come in succession. You need a brick-and-mortar and an address in order to be credentialed on CBH, in order to tackle the Medicaid population. And then when you are credentialed to bill for those services, what our standard for services are, they come in at significantly lower.
My second question -- MS. LaMAR-SUGGS: Can I answer about midwifery --
Go ahead. I'm sorry. MS. LaMAR-SUGGS: So in terms of midwifery coverage, we have found that most insurances will cover midwives inside of the hospital. But unfortunately, this limits patients' rights to choose where they decide to give birth. In many aspects, home birth is not covered and sometimes even birth centers. So people who choose to give birth at home are forced to spend $8,000 sometimes to $10,000 of money they don't have and going to reckless extremes to acquire that to be able to have freedom of choice. And so, even in our health systems there's a hierarchy of who's better. And sometimes midwifery is often looked at as a threat to larger health care institutions because we have the data to show that midwives involved in care give better outcomes maternally and neonatally, and this is not just something that we're becoming new to. This is an every-other-industrialized country in the world. So it becomes a fight against reimbursement, which ultimately only affects the patients.
So interestingly enough, Morgan Cephas just called me. Do you want me to ask a question, Rep? STATE REPRESENTATIVE CEPHAS: (Inaudible).
All right. She said carry on. Second question: The advances that came under COVID for telemedicine, in any way can that impact service delivery? MS. McNEIL: Spe -- MS. LaMAR-SUGGS: Yes. And -- sorry. MS. McNEIL: Specifically for us it actually gave us the opportunity to expand our services beyond Philadelphia County throughout the entire state. And so, one of our goals is to tap into those rural areas where there's maternal deserts and amplify our maternal telehelp platform in the near future so we can continue to have our services throughout the state of Pennsylvania. MS. LaMAR-SUGGS: And if nothing more, please continue to echo the sediments that telehealth works. And in large institutions, hospital institutions, it has become to a point where, oh, we receive less reimbursement. I don't care about reimbursement if it saves my mother from not coming to an appointment because she doesn't have child care or she doesn't have transportation. We need to make telehealth priority where appropriate. And in some situations, it's not appropriate but it needs to be a platform that's used to help to benefit our patients.
And I can even speak from the telewellness component of it even for doulas. I'll back up a minute and say too, from a Medicaid perspective, while Medicaid will reimburse in certain expenses, same thing, there's so many hoops and things to jump through to get it for certain doulas that they're not even choosing to sign up and receive it because they would rather just support even using their sliding scale. But if we make it more accessible, it will be beneficial. And we found ourselves, individually we found that it works to be able to provide doula support even from that virtual component or that remote component because you can be there -- I have texts and email testimonials from moms who were like, you prepared me for this, I'm so excited, thank you for being that support. It's allowed us to train over 200 people across the country in being prepared to serve as doulas. It has allowed us to create jobs and employment opportunities for people who are trainers. And so, I think leveraging technology, that's where we can utilize it our best. But again, being able to compensate for those services well, I will add, is where we need to move more efficiently. MS. LaMAR-SUGGS: And in health care we have become very focused on having the patient come to us. It's about we create a model where we go to the patient. It's not about what's convenient for us, but what works and what's efficient for the patient. And with telehealth, we're able to go into their environments instead of having them just come into our office where we can't get a real perspective on what's going on outside of our offices.
So my final point, Madam Chair, is during the pandemic we learned some things. And you're right, that sometimes people were reluctant to come to us, so we had to make an effort to come to them. And there was a Health department mobile called Aardvark that would ride up into public housing, set up shop, do testing, give, you know, kits. And I just think that that kind of model might work if we went to where the clients are to be able to make it convenient for them. A lot of people don't like traveling downtown or to a hospital but would be willing to come out in a mobile unit to check on things that might be not so normal with a pregnancy. So I don't know if we can reach out to the Health Department -- MS. McNEIL: It sounds like Councilman Jones is going to get a bus or -- MS. LaMAR-SUGGS: Yes.
Say it again. MS. McNEIL: It sounds like you're going to get us a bus. MS. LaMAR-SUGGS: It sounds like you're going to get us a mobile clinic. MS. McNEIL: We're going to be a mobile clinic. Thank you so much. COUNCILMAN JONES. Oh, I'm sorry. I yield, Madam Chair.
Thank you. We do have to have the Department here. And all of this is going to be recorded. We're going to look at it all very carefully. I just want to yield to my colleague here, Councilmember Driscoll. Go ahead.
Thank you, Madam Chair. And thank you to the panelists. This is very, very informative. We can feel your compassion. I did want to recognize State Representative Dorisha Parker. I had the honor of serving with Dorisha in the House of Representatives and you had an advocate up there for women's health issues. And I think as Councilmember Landau said, I think it's appropriate and that she highlighted that you guys are here today on International Women's Day, so this is -- and I don't think that's a coincidence. I think that maybe we're getting some higher powers in here today. So, Ms. McNeil, you referenced a state bill that failed? MS. McNEIL: Yes.
Yes. Rep Morgan Cephas has a bill around implicit bias, I believe.
Yeah, I'm going to pursue that. So thanks for highlighting that. And thank you again for you being here and your testimony.
Thank you so much for your testimony. And this is just the beginning. I just wanted to take a minute to recognize again Rep Dorisha Parker. She just was able to get $250,000 for menstrual products for the state of Pennsylvania. And I want to really highlight that and thank you for the work you did. You know, as they said, you have to put your money where your mouth is. And that's what you made happen. So I thank you for that. STATE REPRESENTATIVE PARKER: Thank you.
Next panel is David Jaspan, Sindhu Srinivas, Diana Montoya-Williams. (Witnesses approached Witness table.)
Good morning. Thank you so much for being here. Please state your name and provide your testimony.
Good morning. My name is David Jaspan. I am the Chair of Obstetrics & Gynecology at Einstein, Jefferson Einstein Hospital in Philadelphia and Jefferson Einstein Hospital in Montgomery. I'd like to start by thanking you for the opportunity, but I'd also like to recognize the passion, commitment of the prior panel. Their words and emotion rang deep inside of me and I'm sure everybody here. It is through the collaboration with all groups across the City, state and quite honestly the nation that we will begin to continue to make changes that are necessary. We're not going to change it today or tomorrow. But we have to also I think recognize the work that we have been able to do so that we're not stalemated by the fact that we're not getting anywhere, because we are making progress. These meetings and opportunities to sit before Council and others provide us the platform to show that if given support and when given funds, change can happen, but not quickly and not slowly and it can never stop. While the issue of maternal mortality remains significant, the tremendous leadership of the City from Dr. Aasta Mehta, bringing together the -- there's only five hospitals in this City that deliver babies. That's it, five. Remember that not too long ago there were 19. There are 5. We all work together with all of our efforts to bring care to patients that can be enhanced. Are we where we want to be? By no 10 stretch of the imagination. But we have the opportunity to move it forward. And it's to the leadership and collaboration with people in this room today that it should be no matter what hospital in the City a patient presents at, their care is equitable, inclusive and safe. We're not there yet. We have made significant achievements though. When we sat before this Committee in 2019, there was broad recognition of areas of concern that were raised just previously and the data supports. Factually most people who have outcomes that are less than desirable don't have those outcomes inside the walls of a hospital, but they have them outside the walls of a hospital. And previously, it was a question: Is the health care environment or are the health care hospital systems supposed to take care of those cultural-related concerns? Now, the answer is yes, we are absolutely supposed to, and that's a stride that has to be recognized. It is very recent that people are even screening for social determinants for health- related social needs. The screenings are not the answer. The recognition of what those screenings bring forth provide us the opportunity to build programs that meet patients' needs, not that we on ivory tower decide what patients want. Some of those things are recognition of the absolute requirement for doula services, the absolute requirement that there should be better, enhanced midwifery care, the absolute understanding that there should be culturally congruent care. And just to take an aside for the culturally congruent aspect, we have to start early, elementary school, junior high school, high school to give people opportunity to see themselves in these positions. The opportunity and the pool of recruitment for people who would be culturally congruent is not large enough, and we are responsible and we can own that responsibility to enhance that opportunity for people so they can see themselves in these roles. That's decades of work, but that's where in my mind it needs to begin. Some of the work that we've done is to enhance the opportunity to screen for and provide service and counseling for intimate partner violence. But quite honestly how do we do that? By a wing and a prayer. If I don't have a grant to do it, I don't get any reimbursement for that. It's not funded. Patients are at risk every day and I am at risk every day for not getting that grant renewed. And if that grant is not renewed, I don't know how I would fund the services that patient needs.
And when I say that service, I'm talking an individual, one person for all of our system. That's not enough. But it's the best that we can do because I rely on grant funding. Through work that people sitting next to me had essentially started, Dr. Sindhu Srinivas and the Penn team, the Heart Safe Motherhood opportunities that create the ability for patients to screen themselves through AI technology for their postpartum hypertension just became funded by one company. But it was only through completely dedicated grassroots efforts that we were able to get to that point. It wasn't just, oh, we should fund it. And my point to the insurance company was I would bet if it was a cardiac monitor for a male patient I wouldn't even be on the phone. I'm sure my colleagues in the room will speak to more, but I do want to recognize that centering pregnancy is important. Centering pregnancy is group prenatal care, but it's so much more than that. I wish I could sit before you today and tell you we've published unbelievable work about how centering has made differences. Sadly I can't do that because the data doesn't support it. But what centering pregnancy does, and we know it, is it creates cultures and communities of people who support one another. It enables us to help our patients to understand health care, health care literacy and most importantly, learn to advocate for themselves and for their families. Centering, again grant-funded. If I don't have the funding to support it, potentially all of the resources that go towards centering would just go away. In other states, in other cities, there is enhanced reimbursement for all of the work that goes into centering. Not here and not today. I will close by saying that all of us are committed to this work and this is work that can happen in a silo, and this is work that must happen every day with every patient, with every single patient interaction. And I'm not even sure it should be with patients. People walking through the halls of the hospital or walking towards the office have to be and understand that this is a safe place and they will be heard. Thank you for the opportunity.
Thank you very much for that. We'll go on to our next testimony. Please state your name and proceed.
Good morning and thank you for the opportunity. My name is Dr. Sindhu Srinivas. I'm a maternal fetal medicine physician at the Hospital of the University of Pennsylvania. I'm a practicing OB/GYN MFM specialist and also the Vice-chair for Quality and Safety and the Associate Chief Medical Officer of the Hospital of the University of Pennsylvania. And today I'm here in that capacity and also as President-elect of the National Society for Maternal Fetal Medicine, and probably most importantly as an actively practicing maternal health care provider. I've been providing direct care for people with complicated and uncomplicated pregnancies in Philadelphia for over years. 11 And as providers, my colleagues and 12 I and our community partners that 13 you heard from on the first panel 14 and my colleagues next to me and 15 many of the colleagues across the City and the state are really driven to develop these solutions together not in silos, but collaboratively to really impact the maternal health crisis. The patient that expresses fear of dying in a pregnancy because she's a patient of color, we hear about that in our offices. The patient that states during a postpartum visit that she didn't feel heard during her visit or during her care, we listen to that and we hear that when we're trying to think about what are the solutions and strategies to fix that. And the patient that expresses gratitude for the incredible team work that she experienced when she had a significant hemorrhage, all of these experiences that we as providers and interactions we have with our patients, they drive us on an hourly, minute-by-minute basis to really strive and drive us to do better and strive for that excellence. In the Department of OB/GYN at Penn, I'm proud to say that we are really taking a broad and comprehensive approach to reducing disparities in maternal morbidity and mortality. We are focused on several strategies in this hearing. You sort of focus on wanting to hear solutions so I'm going to share some strategies that involve the areas of leadership, education, addressing bias and racism, research in quality improvement that prioritizes equity and also technology and innovation and clinical care, which you've heard a little bit about. From a leadership perspective, and I can't underscore the importance of this as sort of a statement from a system or an institution or from Council to say that Penn Medicine created a system-wide goal across its five birthing hospitals to reduce maternal morbidity and mortality in Black women. And this goal was articulated by the CEO of the system and was tied to financial incentives for all of the highest leaders across all these hospitals. In our first year of work collaborating with teams from all of our birthing hospitals, two of which are in the City of Philadelphia and do over 9,000 deliveries, we saw an almost 30 percent reduction in severe maternal morbidity in Black women across our system. And we continue to do this work across the system, using a data-driven approach to reducing disparities in maternal morbidity and mortality. And I want to just underscore the importance of this hearing and the statement and the leadership to -- a leadership statement that really drives change across the system. From an educational perspective as a department, you heard -- we talked this morning about structural racism and the importance of all of the systems that are in place that perpetuate racism. From a provider in a hospital on a staff perspective, what can we do to sort of start to really think about that. We have taken on several educational initiatives, intradisciplinary department book clubs, focus on anti-racist foundations, implicit bias trainings, additional educational sessions, grant rounds and actually launched a narrative- based reporting and response system called Lift Every Voice, which allows for staff and others to report when they observe racist sort of behaviors.
And these initiatives have really led to more open dialogue about the role that racism plays and bias plays in these disparities that we're observing. And that open dialogue and the conversation has really been foundational as we strive to improve maternal outcomes. From a research and a quality perspective, we have several nationally-funded research studies addressing disparities and maternal outcomes, including a large NIH-funded trial that aims to enroll, just started enrolling 2300 birthing people of color across our two hospitals in Philadelphia, with the goal of evaluating the impact of a comprehensive coordinated approach to social determinants of health and the role that will play in reducing maternal morbidity and mortality through one year post-pregnancy. And last year the Penn Department of OB/GYN was awarded the inaugural March of Dimes Research Center for Advancing Maternal Health Equity. And the goals of the center are to implement data-driven and actionable solutions. And one of research projects of that center that I'm co-leading with Alexia who you heard from this morning is a really, truly community partnered project on integrating doulas and functionally how do we do that. How do we integrate and implement doula care across the continuum maternal health with communities and health care institutions partnering. In our quality improvement work, we really do everything through an equity lens and have been really focused on reporting our data stratified by race so we have a clear, consistent approach to how we're reducing disparities. You brought up the -- Madam Chair, you brought up the VBAC calculator, the Vaginal Birth After Cesarean calculator, and how there is racism embedded into decision-making tools that we use in medicine. One example that we're proud of is something that is very related to that topic, which is when we evaluated how embedding race into anemia-treatment protocols and pregnancy influenced our care of patients of different races, we found that we were undertreating women of color because of differential thresholds for anemia treatment. And our group actually evaluated that and published and actually have been able to change the national guideline around anemia treatment in pregnancy for women of color, really changing the way in which we're doing that. So it's sort of an example, a tier point of how we need to systematically dismantle some of these institutional calculators and other things that have clearly perpetuated mistreatment of different conditions. You heard a little bit about telehealth and innovations, about Heart Safe Motherhood, which I'll talk a little bit about. But innovations in clinical care and leveraging technology, I really cannot underscore the importance of innovation in developing truly patient-centered, patient-partnered approaches in our request to ensure healthy moms, parents and babies. The Heart Safe Motherhood example that Dr. Jaspan just mentioned is an example of a program where we before discharge, enroll patients in this bidirectional text-based platform that allows us to monitor blood pressures of patients that had preeclampsia at their delivery, and it allows us to really partner with them for them to do self-monitoring but for us to be in constant communication so that we're able to actually impact and manage blood pressures while they're at home, so not bringing them to us but actually bringing the care to them in a very patient-centered way. We published several articles on this program. We've shown that it eliminates disparities, that it reduces adverse maternal outcomes like stroke and seizure for up to six months postpartum and through a grant that the City received, we were able to help other hospitals across Philadelphia implement this program. But as Dr.
Jaspan mentioned through a grant, right, we've had multiple publications on this program and we've had multiple conversations with the insurers across the state and yet we cannot get a program like this to be funded despite in a consistent way, despite a number of pieces of evidence that demonstrates its impact on outcomes, its impact on disparities and the fact that it actually saves money. And so, again another example of just the need for funding, funding that prioritizes maternal health and reducing disparities. We have some work that we've done on workforce diversity as well as community partnerships, and I'm happy to answer any questions about that. And finally, Penn Medicine is very committed to maternal health and reduction in disparities in Philadelphia and beyond, and evidenced through our department's strategic plan that incorporates this commitment and many of the members of our department really partnering with a lot of the community organizations you've heard from this morning as well as with the City to work on multitude of initiatives. And I do want to reflect on what Dr. Jaspan said as a member of the Philadelphia Maternal Mortality Review Committee for over a decade. We have evolved and we have made progress, and that's inspiring, but it's also very humbling and disappointing that we haven't made more progress. And so, we're here because we have the people, we have the collaborations and we have the desire, but it's an underfunded area and we need the commitment to move forward and make our progress happen even faster. One other thing that I'll mention is as Representative Cephas is here, is an exciting initiative that speaks to funding community organizations and other organizations in the areas of maternal health and innovation, Representative Cephas was instrumental in helping obtain $5 million of funding across the Commonwealth for maternal health innovation. And I'm co-leading the Grant Review Committee to review a lot of these grants that are coming in from across the state, many of them are in Philadelphia, and reviewing this to fund these amazing programs that are community-based programs as well as some from health care institutions to really truly accelerate maternal health innovation, and that's the kind of work and support that we need to continue to fund programs and develop and discover new programs that could be implemented and scaled. In closing, the mission to ensure optimal and equitable birth outcomes for all is one that we are all clearly very passionate about. No woman should go into pregnancy fearing a significant complication or death and having a child should be a joyous time, but far too often complications arise and these impact not just the patient, but their entire family and community. We need to continue to do more and I want to thank the City Council for holding this hearing and for providing me this opportunity to speak, and my colleagues and I look forward to continuing to be active leaders and partners by developing and implementing solutions with all of our partners in this room to mitigate the crisis in Philadelphia and beyond. Thank you so much.
Good morning, Chairperson Ahmad, Vice- Chair Lozada and members of City Council Committee on Public Health and Human Services. My name is Diane Montoya-Williams. I'm an Attending Neonatologist at the Children's Hospital of the Philadelphia, a Researcher at CHOP PolicyLab and an Assistant Professor of Pediatrics at the University of Pennsylvania School of Medicine. It is such an honor to be here today. Thank you for this opportunity to testify. As a neonatologist or as my kids call it, a baby doctor, I have the privilege of taking care of infants in the Neonatal Intensive Care Unit, and I'm here because my patients are directly affected by the ongoing maternal morbidity and mortality crisis. As we know, maternal health is infant health and what we do today and in the days, weeks and years to come has the encouraging and exciting opportunity to also impact the infant mortality crisis that is also ongoing here locally in Philadelphia and in our country. I know this Committee is very deeply aware that the maternal mortality rate continues to decline in other high-income countries, but here in the United States it is rising and we have heard and you guys have uplifted for us the racial disparities that exist within those statistics. So today like my colleagues I want to talk about solutions. And as a researcher, I am particularly interested not only in the drivers of racial and ethnic disparities in birth outcomes such as pre-term birth, low birth rate and infant mortality, but also what we can do about those disparities. And so, it's grounded in that work and the available data that I want to talk about one particular approach, integrating community-based support persons into our health care system as one possible path forward in this crisis. When I say community-based support persons, I mean people like doulas which we have heard from today, but also peer-support persons who have experienced pregnancy already and have other types of lived experience, community health workers, bilingual care navigators and other such people from within our community who have received training and/or lived experience and unique skill sets to help our mothers navigate both pregnancy and the postpartum period. The data that we have shows us that incorporating community- based support persons as part of a care team can accomplish three goals. First, it can help us address racial disparities in maternal and infant health. Second, it can help our perinatal workforce become more culturally responsive and diverse and in that way really help mitigate the bias in our health care system. And three, there is emerging data that it can be a cost-effective care model that uplifts the perinatal professionals doing the hard work in our own city who we've heard from today and will continue to hear from. Research has shown that community-based support persons are associated with improved attendance at prenatal care visits, decreased C-sections and decreased odds of preterm birth. Doulas in particular have also been associated with significant improvements in rates of maternal anxiety and depression. I'm also very excited about data from a randomized controlled study that's being actively conducted in the NICU at the Hospital for the University of Pennsylvania, which is one of the NICUs I work in. This is a study that is led by a colleague Dr. Heather Burris and it's showing that NICU mothers that have a doula assigned to them at the time of their preterm baby's birth are getting to their postpartum visits days sooner than those who do 5 not have an assigned NICU doula. 6 This means that for that 7 very high risk group of mothers, 8 having a doula in those early days 9 during an extremely traumatic 10 period of their life can lead those 11 moms to having a three-week earlier 12 and potentially better chance at a 13 life-threatening physical or mental 14 health problem being recognized and 15 addressed.
16 There is also evidence from 17 around the country that peer 18 counselors and doulas are 19 associated with improved 20 breastfeeding rates and human milk provision which we know is a win for both mothers and babies. And in some of my own research here with Latina mothers here in Philadelphia, the majority of whom do not speak English, in one of the studies they shared with me that they went to prenatal care visits earlier and experienced less discrimination when they were accompanied to those appointments by someone that they trusted and who was bilingual. This example shows us how bringing community-based support persons into our health care teams can also help us mitigate the impact of racism and bias on our health care delivery. Ensuring those of us who already are and have an established role in perinatal health care receive implicit and explicit bias training is critical, absolutely. But it only gets us so far. To truly move the needle for birthing people and their children, we will need to bring new voices in a true compensated and equitable and recognized way to the perinatal care table. Voices that will help us connect to our patients and ensure that they feel heard and respected. I'm very excited about the State Medicaid efforts to make doulas and community health workers a billable workforce, but it will be critical that this advances in a way that fairly reimburses them for the work that they are doing, and we should be seeking similar policies for roles such as bilingual community navigators and peer lactation counselors. Beyond my research, what I have learned from working with Black maternal health practitioners, some of whom are in this room today, and NICU family advocacy organizations is that we can have all the best technology in the world in our best hospitals, but we will never close the racial gap when it comes to maternal and infant health outcomes if we continue to operate in silos in our health care systems. Support for community-engaged maternal care models needs to be formally woven into the fabric of our health care system in and outside of research in a sustainable and equitable way, including policies and benchmarks to ensure we're doing it right. To end, I just want to talk to you as a mother. I have two little boys myself. And every night that I can I sing to them and they are my heart and my world. And when I read statistics like these even as a researcher, all I can do is picture my boys growing up without me and I know we must do better. If we want to do what's best for all the children in Philadelphia, then we need to protect and nurture the people who give birth to them. And as a doctor and researcher, I firmly believe that we can make progress towards that goal if we take a more expansive holistic approach to who is on perinatal health care teams. And on behalf of myself and CHOP, I sincerely thank the Council and the Committee for the opportunity to testify today and I'm available for questions.
Thank you so much. I appreciate that. I'll take the privilege to ask the first question and then we'll move to our Vice-Chair. I think this was Dr. Srinivas who mentioned -- I'll just be very specific because of time issues. Let me just find my -- you said that you were providing incentives, monitoring incentives to improve outcomes. Did I hear you correctly?
Sure. I think it was in sort of the context of our system has quality goals, metrics, and severe maternal morbidity and mortality in Black women was a goal that was elevated to one of our system-wide goals by our highest health system leadership. And those goals sort of show a commitment from this institution to that being an important metric to be watching and it be trying to improve. And it ties incentives of some of the highest leaders across the system and each individual birthing hospital to that metric, which then leads to the investment in different initiatives to improve that metric. And so, in elevating it to that level and tying those incentives to it, we were given the opportunity to create a true infrastructure across our system to work together to actually accomplish thinking about strategies and solutions together as a system, and we do over 20,000 births across our system. And in that about 9,000 or a little more than that are in Philadelphia. Two of the hospitals in our system are in Philadelphia. And so, it was really through this hospital-based incentive program where maternal health -- was the first time that maternal health and that Black maternal health was really a goal, was a goal elevated to that level.
So the incentive was given to the department that improved their outcome. And were there any measures such as implicit bias training that was part of this process to improve the outcomes?
So the incentives was to individual health center leaders. So the incentive wasn't to the department. The department was doing the work, but the support came from the leadership and the leadership -- so the CEOs of each of the hospitals and other leaders in the hospital were incentivized to sort of help support this work and elevate its importance. So we were very excited as a department that this metric was elevated to that level. The how we accomplished the work, implicit bias trainings were actually a part of some of the work that we did, but we did several different things, some of which were related to postpartum hemorrhage, as a system and some of which was related to trying to implement different aspects of a disparities reduction bundle, one of which includes implicit bias training which was implemented across the system.
Thank you for your testimony today. All of you mentioned in your testimony the importance of not working in silos. And so, can you all speak to me a little bit about the work that each of you have done to try to avoid that, right? Is there grassroots work that is actually happening on behalf of each of your -- in your spaces. Are you all on the ground, right, because it's really easy for us often times to participate in a health event in the community or do little drops in different places, but we will see different outcomes if we're really connecting with people at their doors, at their community-based organizations, partnering with those who do family planning, right. Is any of that type of work happening? And if so, can you speak to us a little bit about that?
Sure. I can talk a little bit about some of the work that I'm doing within CHOP and the HUP NICU, the Hospital for University of Pennsylvania NICU. So we identify it as we all have the role of implicit and explicit bias on the health care that we provide within our NICUs. And part of what we're doing to try to address that is we created an interdisciplinary family-centered and community-engaged coalition that has been supported by CHOP PolicyLab's Community in Research Partnership grant, to really think about how we implement strategies in our own NICUs to mitigate implicit and explicit bias and how we measure the impact of those solutions on patient experiences. And so, what I want to highlight there is that we have these opportunities within PolicyLab now to have funding solely for the creation of partnerships within researchers like myself, research coalitions within our institution and community-based organizations, local nonprofit advocacy organizations and the funding and the money is meant for the creation and sustainability of those partnerships so that the work that we're doing within our health care system is informed by former NICU family partners and local nonprofit organizations. So that's an example of how with the funding and the recognition of this work can be moved forward with funding, those partnerships can be created and sustained so that the work doesn't just happen in the NICU without the voices that we need to make that work actually actionable inside the NICU.
But can you tell us who are those partners, right? In the community it's important to partner with some nonprofits. Nonprofits are on the ground. They touch people every day. Who are they and are they culturally competent --
-- partners that you all are touching? Just give us an example of that.
Sure. For example, my partner in this work is an organization called Once Upon a Preemie, which is an organization that aims to tackle maternal and infant racial disparities specifically as they arise and impact families within the NICU. It was formed by an incredible leader in maternal health care who was a former NICU mother herself, and she's a Black woman here in Philadelphia and she is my partner in this and our funded co-lead in this particular example that I'm talking about.
Another -- it's a really important question and we've really tried to embed community partnerships into all of the work that we're doing in a more deliberate and intentional way, which historically hasn't been the case. And so, community partnerships on developing integrated care models, so I mentioned our doula work project in terms of Alexia spoke about funding doulas and sort of some of the things that we need to be considering, part of our work together, she's my co-lead on this project, is really thinking about you can get the funding, but how do you actually implement the care team, this collaborative care team that really has all of these different partners that's a part of it, that's part of the implementation science aspect of the work. So while we all believe that we should all be partners in the work that how do you actually do that and how do you do that in a way that's respectful, collaborative and has an impact on the patients together that we're trying to have. And so, she has been a tremendous partner in our organization. We work a lot with Maternity Care Coalition as well, which is an amazing and sort of institution -- an amazing institution and community organization in Philadelphia that has a number of programs, so really weaving in how we work together and creating sustainable models for that being just the way work is done, not that we sort of partner with them if we think about it. And I think at our institution we're really making that part of the fabric of how we're accomplishing the important work that we're all trying to do together is to try to break down those silos and really do the work together. But it's sometimes challenging, right. It's operational challenges to how you fund that organization through your hospital or health system. So these are all sort of those barriers that cause a little bit of friction to make it a little bit more difficult, but I think we're really making strides on how to do that, but it really has to be the way we do the work, right. It's not just sort of an extra thing. It's a part of a fabric and I think that that's incredibly important.
Thank you. This will be quick. First of all, thank you so much. This is another panel giving us hope that progress can be made, is being made and can be made. And I think normalizing doulas and midwives and peer advocates and support, everybody needs a coach, right, normalizing this in your work is the most important thing so it will be continual and not just one grant funded. But I have a question. I think it's for Dr. Jaspan. You talked about working with, treating patients with substance use disorder. As you know, we have a large population of people of substance abuse disorder here in Philadelphia. Can you tell us more about that program and what your successes look like? Thank you.
So I didn't specifically mention that but I think that was in partner violence. But we do have a program that again grant-funded from the state and it is utilizing a multi-disciplinary approach to patients with substance use disorder in pregnancy, so it's Toxicology from our emergency room 19 colleagues, it's Social Services, it's Behavioral Health, Maternal Fetal Medicine, Neonatology, Obstetrics & Gynecology all intertwined to care for patients. The most difficult part of this patient population is actually the disease itself, because the disease itself causes those patients not to be able to be compliant. It's not that they don't want to be compliant. The disease interferes. And so, they're falling in and out of care on a regular basis makes it really difficult because we only have as much as 40 weeks to manage and care for them until they have to be passed off to our NICU colleagues and that baby potentially can spend an extended time in the NICU, if we're unable to manage during the pregnancy or even sometimes when we are. But again, that's a grant-funded project. There is reimbursement for the obstetrical care for the counseling. But for all of the infrastructure that's required, that's all on a grant or we just take it on as ourselves.
Okay. Thank you. If there are any other questions -- you wanted to ask another question.
-- one other thing. Sorry. We have a very similar program and we know that opioid use and substance use disorder affects so many of our pregnant people that we care for and really requires as Dr. Jaspan said, an interdisciplinary approach. And one of the things when you talk to the providers that care for patients in our outpatient program as well is the glue that holds that program together is the certified recovery specialist, which is just another example of a peer-support --
-- community, support person in a particular area that is often recovering from a similar condition themselves and are just incredibly important to the success of that care and that team. And so, that reimbursement again are funding in sustainable ways that are not just about grants but that are the way in which teams are created is just so incredibly important and it's just another kind of evidence-based example of a community-based person being part of a team that is kind of critical for the team's success.
I heard from all three of you, particularly from Dr. Jaspan and Saleemah McNeil about reimbursement. It seems that how maternal care and I guess reproductive health care and women's health care, how is it prioritized within the insurance system seems to be something I am hearing, right. So I know we have a panel that some folks coming on from that industry, and I think I would love for you to just comment about the struggle to change valuation of patient care.
Well, there's no comparison group for a delivery. The comparison group I'll give you is any gynecologic surgery compared to any similar surgery to a male, the reimbursement is arguably 30 to 50 percent less for women's health care. And when we go to administrators, they literally say can you prove to me why a patient, female patient, for me should have a robotics procedure. Why do they ask that question? Because our reimbursement for that procedure is less than it would be for a male. So the hospital truly loses money every time we do the case. And that just can't be the way it is.
I think the other friction is really in the structure of health care reimbursement in general, that whenever you're thinking about doing -- so one of it's just sort of a disparity in the actual reimbursement amount, and the second part is when you're trying to innovate and when you're trying to do things in a different way than the traditional way, people don't know how to pay for that. They don't know what to do. And we have been meeting with the -- somebody asked earlier, we've been meeting with the Medicaid payers in Philadelphia for several years, years bringing up this evidence really trying to think about how to fund -- how to structure care that's innovative and how to structure the payment for that care, and it's a real challenge because we're used to a fee for service model. When I'm looking at a patient in front of me, I don't know what their insurance is. And if I have an evidence-based program, everybody is going to get that program, not some people will get it and some people don't. And so, that's I think a challenge for all of us again to break down the silos and bring us all together in terms of how are we going to accelerate thinking about the way that health care is delivered and paid for.
So the one progress here has been the one-year Medicaid reimbursement for postpartum care, right. So thank you for --
Indeed, indeed. So progress can be made. We have to be persistent. So I thank you all for your testimony. I'll ask the Clerk to read the names of the next panel please.
The next panel is Dr. Aasta Mehta, Dr. Stacey Kallem and the Honorable Morgan Cephas. (Witnesses approached Witness Table.) STATE REPRESENTATIVE CEPHAS: I think I've been designated to go first.
Good morning. So happy to have you. STATE REPRESENTATIVE CEPHAS: Listen, if you don't know who I am, I am State Representative Morgan Cephas. My name has been brought up quite a bit, but I do want to stress, yes, I may be the legislator, but it is the advocates, those that are sitting next to me that give me the direction as to what we need to be doing on the state level. And as you heard several times, on the state level we're really just scratching the surface on this issue. And some of the successes that we have achieved collectively is as a direct result of so much of the testimony that you've heard thus far, particularly from the advocates, the representatives that are representing doulas, the hospitals. I feel like Aasta has given me a crash course in maternal health in what we need to be doing. I know we are not moving fast enough. But I will talk to you about some of the successes that we have had thus far. But again, first how I got to the conversation was a roundtable conversation with Senator Bob Casey. And during that time, it was roughly around 2018, and someone asked a question. There was a conversation with a group of Black women across a series of different sectors, so business owners, advocates. And one of the questions that was asked at the time was what are we doing about Black maternal mortality. And as an elected that is not an expert in all things, I absolutely said I will have to get back to you on that. And lo and behold, my Republican colleague -- Councilmember Driscoll knows him very well -- Representative Mackenzie, right, Mackenzie who is a Republican colleague of mine, actually introduced legislation, got it to the Governor's desk, then Governor Wolf, to establish a Maternal Mortality Review Committee. And it was the first time ever in the state, and mind you I want to say the City of Philadelphia has had its -- and Aasta will talk about it, but has had it over years. 10 So again, that is not necessarily a new conversation that's happening for Pennsylvania, but legislative movement is new. And again, when we talk about extension of Medicaid, not every state as you have seen has taken full advantage of that, but we were able to because we had a Democratic Governor and we had the passion of the advocates that are behind me where it was just a no-brainer, we didn't have to provide another research study, we didn't have to show data, we didn't have to have hearings. But because of their work for a very long time, we were able to get that done. So not only do elections matter, but I know some of your questions are going to be what should we do next. And I will stress you to make sure you just listen to the experts as to how you can move the numbers in the City of Philadelphia. There are a series of reports that people are going to talk about that are getting ready to come out. They're not trending in the right direction. We are still not out of the woods with this situation. And as you saw in the resolution that was offered, Pennsylvania represents -- I mean Philadelphia represents 13 percent of the population but 20 percent of the deaths. So if you, again, listen to the experts that are here in the room, if we move the needle by percent, which is a very tall order and is very difficult, we move it for the entire Commonwealth. I do want to stress it's not just the City of Philadelphia that is tackling this issue. We have Cameron County, Forest County, Juniata County, Sullivan County, Wyoming County, Republican counties that are tackling this issue just as much we are. We talk about the five birthing hospitals that we have, imagine a rural county that has to travel close to 45 to 50 minutes just to access care. And the beauty of this moment that we're in is everyone is talking about it. Again, not just on the Democratic side, but you know in Harrisburg we deal with the Donald Trump kind of Republicans.
So when we talk about things like implicit bias, they don't necessarily believe that it exists, bias even exists. So it is very much of an uphill battle for us to get a lot of these measures across the finish line. But the beauty about government is it's not just the legislative branch, right. We also have the power of the budget and we also have the power of moving policy and regulations. So a lot of the bills that I'll talk to you about briefly in our Pennsylvania Momnibus package, we will have to look to Governor Shapiro to urge his departments to move the needle in those areas, and implicit bias is extremely one of them. I can't even promise that we would get it out of our chamber with the Democratic majority because again we have still some of our colleagues on the Democratic side that don't necessarily believe in the issue. But what we do have the power to do is have conversations with the Medical Board Chair who Aasta -- that was a recommendation of Aasta's, to have a conversation around how can we require implicit bias training similar to how they made a requirement about opioid education and pain management. It didn't need the legislature to pass that type of measure, so we're going to be looking at the same strategy as it relates to this issue. But some of the other things that we've been able to accomplish, we help establish the Pennsylvania Doula Advisory Commission and we launched the Perinatal Doula Certification Program. We also with the help of the Tuttleman Foundation have doula care in both Muncy and Cambridge, which is two of the state prisons. Since then, we've serviced close to 50 incarcerated people again as a result of the Tuttleman Foundation as well as provided 78 doulas certification as a result of the Advisory Commission. Additionally, we were able to provide $25 million of the American Rescue Plan. That was under then Governor Tom Wolf. And as Sindhu stated at the University of Penn, yet another idea that I got from an expert on the ground, we established a $5 million maternity health innovation fund. And that is something as you all come up on Budget season something that you can actually replicate. And again, those dollars went across the Commonwealth of Pennsylvania. Some of the funding from the $25 million funded the Temple University Maternity Care Unit that they are developing. We also had an opportunity to fund the OVA, which Aasta will talk about. We also funded the Maternity Care Coalition, and again it's not just in the City of Philadelphia but it's across PA. And again, it was a direct result out of the Safe Motherhood conversation that some of my colleagues and I were able to have. Additionally, when I talk about that everyone is laser-focused on this issue and, you know, our memory is like a fish in a fish bowl, so we don't tend to focus on things for a very long time. million to address the issue of Black maternal health in the Commonwealth of Pennsylvania. million. And as we come from budget hearings over the past three weeks, this was a constant conversation that was coming up. And again, some of the recent testifiers talked about the social determinants of health. So it's not just the Department of Health that has to tackle this problem. It's every single department that you all have a purview under what are you doing. Just as we're talking about gun violence, just as we're talking about police brutality, what is every department doing as it relates to this issue to tackle this problem. This is not something that the Department of Health should be tackling alone. And I'll close up because I know I'm taking up a lot of time here. So some of the other pieces that we've been able to do is pass a series of bills. One is we are now tracking maternal morbidity. That will be an annual report. We've taken down the reporting process from every three years when it comes to Maternal Mortality Review Committee to now do it every year so we can have data in realtime.
We also passed legislation around Dignity for Incarcerated Women, again that is in our state prisons to ensure that we are addressing pregnant people that are incarcerated. Again, I mentioned that we are doing the Medicaid extension up to a year postpartum, but know that that is only a pilot for five years. We actually have to move legislation once that five- year period comes up. And I know, Councilmember Nina, you talk about data very much so a lot, and that is going to be one of the only ways that we are going to be able to get it across the finish line with a divided legislature. And as I mentioned, we launched a Pennsylvania Black Maternal Health Caucus where we will be laser-focused specifically on that issue on maternal mortality and morbidity. And as a direct result, we've had close to 60 of our colleagues join both from the House and the Senate. We also got a couple of Republicans. Now, it's a handful but it's still progress. And some of the things that we'll be considering in our Momnibus bill is insurance coverage. How are we insuring and reimbursing at an equitable rate when it comes to doula care as you've heard so much in this chamber. We also want to provide insurance coverage and reimbursements for the blood pressure cuffs. Again, a conversation that we've been having with ACOG as well as Sindhu who again has brought this issue to our attention. We also want to begin addressing maternal health deserts, which has been brought up by -- has been brought up by, I forget the organization. I'll mention it later. But they've identified maternal health deserts as not having access to maternal health care and how can we use innovative strategies like mobile units to help address those concerns. We'll also be looking at the postpartum period when it comes to mental health services. So the data shows, and it's similar here in Philadelphia, that over 51 percent of the deaths are happening during the postpartum period. So if we can really target our resources, target our legislative focus to that period, we'll really be able to make a dent in our numbers. And last two pieces, again which will be difficult to get across the finish line, is requiring implicit bias training as a continuing education for individuals that are in the medical space which will really address the issue that you're talking about. And we're also going to be looking to establish a permanent maternal health community fund, again so we can continue funding innovation and using data to help drive the conversation with insurance coverage and reimbursements. So we do have our work cut out for us. Again, we are just scratching the surface in a real way up in Harrisburg. Again, if the one question you're going to ask me is what more can you all be doing here locally, I would say don't let this be the only time that you're having the conversation up in Harrisburg. We routinely have monthly meetings with stakeholders, so being sure that we're making the right legislative proposals, making the right investments. But also when we see a needle shift in either direction, that we're able to pivot as a direct result of ongoing conversations with the advocates. So with that, I thank you.
Good morning or maybe it's good afternoon. Thank you so much for having me. My name is Stacey Kallem. I am the Director of the Division of Maternal Child Family Health here at the Philly Health Department and I'm also a practicing primary care pediatrician. So just a bit about our division at the Health Department. We're a team of over 50 multi- disciplinary staff whose mission is to empower all Philadelphia mothers, infants and children to have healthy lives. And central to that is a commitment to reducing racial health disparities. So my colleague Dr. Aasta Mehta, she'll be describing the really comprehensive work of our Philadelphia Maternal Morbidity and Mortality Program. I want to use my time to talk about the work that we've been doing to increase access to doulas, which really has been a theme echoed this morning, the importance of doulas for maternal mortality. So back in 2020 in response to data that showed the proportion of pregnancy-associated deaths due to drug overdose was rising, we embarked on launching the Community Doula Support Program from MCFH, and this is a doula program that is specifically focused on those families that have substance use disorder where we provide doula support during pregnancy for an entire year postpartum, knowing that many of the drug overdoses happen in that later portion in the postpartum period. All the doulas in our program are Philadelphia women of color who are trained in trauma-informed care, principles of racial and reproductive justice and they provide education on pregnancy, infant care, they do research navigation which includes linking to prenatal care and to substance use treatment centers and they also accompany our participants to their appointments, they advocate for participants during labor and delivery and most importantly, they build a relationship with our participants based on nonjudgmental support. And since we've began the program in 2020, we've served over 200 Philadelphians and conducted over 2,500 visits. But 200 isn't enough, right. In order to make a wider impact, the availability of doulas needs to expand beyond who we can serve in our Community Doula Support Program. So to that end, we have applied to the Federal Healthy Start grant to create a new program where doulas will support Philadelphians if we're awarded the funding in West and Southwest Philadelphia and be broadly available for all residents in those neighborhoods, not only families with substance use disorder. However, under the current Federal Appropriations Plan, the entire Healthy Start Program which is a grant that's existed since 1991 that the Health Department has had since 1991 and then our colleagues Maternity Care Coalition and Einstein also receive, that entire grant is currently not even included in federal appropriations under the mistaken assumption that it is duplicative of another program, the Maternal Infant Early Childhood Home Visiting Program. So that aside, we are still working on doulas. So Rep Morgan Cephas talked about the state Maternal Health Innovation awards. We've applied for that to create a doula training program through the Health Department so more Philadelphians can become doulas, and also specifically have training in how to support those with substance use disorder. And then last, it's also been mentioned this morning the Pennsylvania Doula Commission, which is advocating for Medicaid reimbursement for doulas. We are active participants in that process. And I think the key here is that it needs to be done right. And by right, I mean that the Medicaid reimbursement needs to provide a living wage for doulas so this is a viable career opportunity and is actually worth the while to go through all the credentialing process. If that happens, I think it will greatly expand access to doulas in Philadelphia. But doulas are just one of the many solutions that are needed to address the alarming racial disparities in maternal mortality. So I'll set this up so that Dr.
Aasta Mehta's going to go next as my colleague and she's going to describe the work of the Philadelphia Maternal Morbidity and Mortality Program. Thank you so much.
Good morning. Is this on? Oh, it is. Hi. Good morning, Chair Ahmad, Vice-Chair Lozada and the members of Public Health and Human Services Committee. I am Dr. Aasta Mehta, Medical Officer of Women's Health at the Philadelphia Department of Public Health and a practicing OB/GYN in Philadelphia. Thank you for the opportunity to provide testimony on proposed solutions to racial disparities in maternal mortality in Philadelphia. I purposely didn't put a lot of data since I had a feeling that lots of people would be talking about the data, and we talked a lot about the data in 2019, so my goal here really is to talk to you about the robust work that we've been doing to address these disparities here within the Health Department. But I will touch on the data a little bit. So in 2010, Philadelphia established the nation's first nonstate-based Maternal Mortality Review Committee, a pioneering effort predating similar state committees, even the Pennsylvania Committee and CDC initiatives. This Committee has been pivotal in reviewing pregnancy- associated deaths, identifying systemic weaknesses and resource inadequacies in a maternal health care system. From 2013 to 2018, Philadelphia was responsible for 7 percent of Pennsylvania's 8 pregnancy-associated mortality 9 despite only contributing to 15 10 percent of the state's births. 11 The leading preventable 12 causes of pregnancy-associated 13 mortality were identified as drug 14 overdoses and complications of 15 cardiovascular disease with stark 16 racial disparities in outcomes. 17 Notably, about 77 percent of these 18 deaths occurred postpartum, 19 underscoring the critical need for 20 community-centered interventions. To address these challenges, the Philadelphia Department of Public Health evolved the initial MMRC framework into the Philadelphia Maternal Morbidity and Mortality Program within the Division of Maternal Child and Family Health. This comprehensive program consists of two main arms, the Maternal Outcomes Data Analysis Review and the Organized Voices for Action or the OVA. The Maternal Outcomes arm focuses on collecting and analyzing detailed data on pregnancy-related morbidity and mortality. At its core is the Philadelphia Maternal Mortality Review Committee, which is now realigned with national standards for methodology. This Committee formulates prevention strategies based on thorough case reviews, providing evidence-based recommendations specific to Philadelphia's health care context. Additionally, this arm has developed the nation's first, notice nation's first, Severe Maternal Morbidity Surveillance Program, which will track unexpected outcomes of labor and delivery that result in significant and short- and long-term health consequences. This program plays a critical role in identifying and understanding SMM trends within Philadelphia's hospitals, using hospital-level clinical data for indepth analysis. It's a proactive system for identifying SMM cases, offering valuable insights for public health improvements and pinpointing opportunities for targeted interventions. The OVA arm is structured under three pillars: Implementation teams, community education and building bridges. At the core, the implementation teams consist of multi-disciplinary experts and community members who enact recommendations from the Philadelphia MMRC. Their efforts are significantly bolstered by the inclusion of community members, ensuring solutions are both practical and grounded in real- world experiences. This cross-sector collaboration is vital in tackling the complex challenges of maternal health. A notable early success is the administration of a technical assistance mini-grant program aimed at supporting Black-led, Black- serving grassroots organizations focused on maternal health, directly tackling disparities within their communities.
Further achievements include developing City-specific guidelines for pregnancy-related cardiovascular disease and instituting universal IPV screening across Philadelphia hospitals, enhancing early detection and community-support connections. The community education pillar is crucial for starting awareness about maternal mortality factors, ensuring that the responsibility does not solely rest on the birthing person. Through this initiative, we successfully launched a community-oriented training program highlighting the early warning signs of postpartum complications with ongoing efforts to expand our educational outreach to include training on postpartum depression. To date, this program has engaged nearly 500 individuals across community-based 17 organizations. Additionally, we 18 distribute educational materials 19 such as magnets and posters to 20 further disseminate crucial 21 information. Complementing these 22 efforts, a comprehensive three-pronged city-wide public health campaign is under way. This campaign addresses a critical intersection of maternal mortality with intimate partner violence, postpartum depression and early warning signs of postpartum complications. The third pillar, building bridges, pivotal in providing ongoing support for key multi-stakeholder conversations. Under this pillar, we facilitate dialogue amongst obstetrics leadership from the City's delivery hospitals, encouraging the sharing of best practices and fostering collaborative initiatives. This group was instrumental in implementing Heart Safe Motherhood, a tech-based postpartum blood pressure monitoring program developed by Penn and already talked about today in four of the five birthing hospitals in Philadelphia. It also served as a conduit for disseminating implicit bias training to all OB/GYN departments in the City. Furthermore, discussions involving OB leadership, Pennsylvania Medicaid and Southeast Pennsylvania Medicaid managed-care organizations having crucial and removing administrative barriers for cardiac screening in pregnancy and aligning payment with evidence- based care, including trying to figure out establishing a reimbursement mechanism for innovations such as Heart Safe Motherhood. Additionally, the perinatal opioid use disorder collaborative, a part of this pillar, brings together frontline providers supporting individuals with perinatal substance use, creating a space for discussing realtime issues and sharing vital information. The Philadelphia Maternal Morbidity and Mortality Program's effectiveness was highlighted at the Birth Justice Philly Summit on October 26, 2023. This event, attracting 300 attendees, served as a platform to showcase the ongoing efforts of Philadelphia to improve maternal health outcomes as well as to initiate critical discussions on sustainability. The Summit successfully raised approximately $150,000 in sponsorships from a diverse array of stakeholders, including all of Philadelphia's major health systems, health care payers, community-based organizations and private foundations enabling the event to take place. This strong financial and participatory support from such a wide spectrum of sectors stands as a clear testament to the commitment to building sustainable systems and programs aimed at improving maternal mortality in Philadelphia. New initiatives are under way to address maternal health challenges in Philadelphia, each targeting a specific area of need. Birth Bridge Philly in collaboration with Penn Medicine is undertaking a landscape analysis of prenatal care in the City. This analysis will inform the development of a prenatal care consortium, a practical and collaborative platform for health care providers. The consortium aims to enhance service provision capacity, foster an environment of continuous learning and optimizing resources.
A key initiative that we're currently seeking funding for is the enhancement of the Care Connect Warmline for perinatal individuals facing substance use disorder. This project aims to expand support services, create structured pathways for assistance and increase access to specialized knowledge. The goal is to establish a city-wide resource that offers support for both clients and providers, incorporating ongoing evaluation for impact measurement and sustainability. These initiatives are critical steps in improving health outcomes for Philadelphia's perinatal population and addressing key contributing factors to maternal mortality. In conclusion, addressing racial disparities in maternal mortality in Philadelphia necessitates a comprehensive multi-pronged approach. We envision a re-imagined perinatal care system with integrated support, streamlined transitions between health and social services and enhance community awareness. Acknowledging the systemic nature of these issues, our approach is long-term, focusing on both immediate interventions and gradual societal shifts centering the needs and voices of Black birthing people, innovating beyond traditional interventions and disrupting the current system are key to our efforts. This challenge transcends health care, calling for collective commitment to impactful and sustainable change. And a lot of times, and this is not in my testimony, but people ask me why I do this. So as I said, I've been part of the MMRC since 2010. I personally myself have read every single case of maternal mortality that's occurred in the City. And when I say read, I mean I read death certificates, the way people are found, who found them, I hear their voices in my head. And that's why I do this work, because I actually want to be out of business. I don't want to be doing this anymore. I'd love for us to say that we've solved this problem. I've had children. I see my kids' faces when I think about the kids that these moms have lost, right, or that have lost their moms. I swore I wasn't going to cry, but thank you so much for the opportunity to address you. And I'm happy to answer any questions that you may have.
Thank you so much (inaudible). It deeply touches us, you know. We see people -- I see my mother's face when doing this hearing. It impacts you for life if you lose a parent, and particularly a mother. So I thank you all for your testimony. I'll yield to my, go ahead, to Councilmember Rue Landau.
Thank you. I feel like a broken record here, but thank God for you guys. Thanks for all of you. This is amazing. We are so lucky, Rep Cephas, to have you at the state level advocating for all of this as much as you do. You're incredible. For the local physicians in our Health Department, thank you for all that you do. We know you do it for a reason and appreciate it so much. I am still struck by our numbers of how many of our maternal mortality deaths are based on overdoses. And I am curious as a City whether there's been any connection to try to help create housing and social services on the other side. And as somebody who's worked for the City before, I understand how we're so siloed. You do the health part. Someone else does the housing part. Someone else does this part. But there's got to be a way if somebody is coming to you with substance use disorder and withdraw while giving a baby, for example, and I clearly am not a doctor and do not know what I'm talking about here, but let's just go with this, there's got to be a way that when we discharge that parent, that we know that that person is receiving more care, maybe even has a pathway to housing. Maybe we can give the person three months of transitional housing to start, and then where we're going to work on this end. I just can't imagine sending somebody out into the world and saying oh, well, especially with this little tiny baby to care for, everything is going to be okay, so if there's any way to address that. And I'm asking this, knowing you might not have the answers, but really telling you again we want to fix this. We want to be here to help. We want to help connect the dots. So any ideas that you have, please give them to us because we will work on it. Thank you.
I wasn't sure if there was -- so housing is such a big issue in the City, and I'm sure that every advocate that comes here is advocating for housing on behalf of the population that they're advocating for. And we recognize that there is a -- it's a finite resource that everybody needs. There is not really a sort of special path for pregnant folks. I would encourage you to potentially talk to some other -- Office of Homeless Services or DHS about if there's opportunities if you're talking about sort of the postpartum transition, if there are opportunities to create pathways for housing, for lots of different people but certainly those that are afflicted with substance use disorder. That's one of the biggest sort of barriers. There are inpatient and outpatient treatment programs. Some of them do have housing available, sometimes not families, right. So it's not just there isn't housing, like it's sometimes housing doesn't allow for other children to be there. Maybe they're allowed to take your newborn but you're not allowed to take your other children that you have, and that prevents people from doing that. So solutions, you can just create a concrete goods fund because who are we to decide that you have to do the X, Y, Z, like people have different kinds of needs. And so, if there's a way for them to get the resources they need at the time without sort of being so prescriptive about what that resource is, that I think allows for some diversity in what people can access at the time that they need it. Another issue with substance use really is that even if it's identified, there's a lot of worry about accessing health care because what does that mean for my baby, right, like they'll take my baby away and really thinking about a public health coordinated approach to be less punitive and become sort of supportive in terms of keeping families together, giving resources to families so that they can stay together. You know, you think about the intersection with depression and knowing postpartum is that time where it really is -- some of it is true postpartum depression, right, the physiologic impacts of pregnancy that led to depression, but a lot of it is really just situational, right. You have to go back to work or you don't know how you're to be able to feed your kids or you don't have a safe place to stay. And so, really a lot of the supports have to be built around figuring out what that person needs. And I think that the answer really is giving them the opportunity to decide versus us being prescriptive in that way. More flexibility in resources.
Thank you so much. Thank you, Rep Cephas, for all of the work that you're doing here. I really hope that like I mentioned earlier that we can take this beyond just a conversation and really put ourselves to work with action to be able to move this situation forward. As it relates to folks who are suffering from addiction who will end up pregnant, I mean that -- over the course of the summer somehow or another or for some reason, there were many women who were in Kensington who were pregnant, many at the same time all of a sudden, so much so that I took notice and many others took notice to it. And I had an opportunity to talk to one of them about, hey, what's going on, you know, what's happening out here. And of course they all have a different story. They all have different lived experiences. This one individual, one of the reasons why she wasn't even going to get checked was because of the fear of losing her child as a result of her addiction. And so, I appreciate your question, Councilmember. I appreciate your response. I think that we have to do better as a city in general as it relates to the opioid crisis, right. I think I've been very vocal and transparent about the issues that are happening in Kensington and how we address the person who has suffered from addiction. But today my concern and my focus, right, I think that I'm really thinking about those women who I saw over the course of the summer, where are they now, right, where are their children now. How do we in the process of figuring out a plan of how do we restore quality of life in Kensington, how do we prioritize women who find themselves in this situation, right. How do we prioritize the children who are brought into this situation without fault, right. And maybe part of the plan needs to be prioritizing them in a transitional housing space, right. How do we have a conversation -- someone mentioned earlier where are the gentlemen in this conversation. And I guess, Rep Cephas, what are we doing at the state and what can we do at the City to start having conversations about healthy family planning earlier in our families, because in Black and Brown communities we don't have this conversation, right. This is almost like a taboo. You don't have this conversation unless you're married, you bought a house. In our heads and in our culture we're supposed to do things a certain way, right. And so, how do we start having the conversation earlier, how do we involve our young men into the conversation, how do we resolve the issue when we throw on top of now I'm living in a home where there's substance abuse or my partner is on substance abuse, what do we do. How can we start a better education campaign and how do we as we're talking about addressing the crisis that we're experiencing on the ground in the Kensington community, how do we keep conscious the fact that there are women who are put in certain situations who don't have health care, who don't come into health care even if they had it and had access to it because they're afraid of losing their child? STATE REPRESENTATIVE CEPHAS: I think that's the right question that we're asking, is that it's not just what's happening in the medical bed. It's taking a holistic approach to managing the pregnant person where they are. So when you hear the series of panels talk about 51 percent of the deaths are during the postpartum period, the majority of the deaths are not happening at the hospital bed, but we're expecting our hospital system to manage essentially social services beyond them just giving birth or not being able to manage their everyday activities, it forces us to collectively have a conversation about how holistically are we managing this situation. So when they're talking about doulas, I mean you don't just have doulas at the medical bed.
You have postpartum doulas that can handle and manage the depression, and these birthing people are more than likely going to be more closer to that doula than any of the systems that they are then forced to navigate. So when we're talking about doulas throughout the entire continuum of an individual being or even thinking about being pregnant or being pregnant during the postpartum period, that's exactly what they mean. We have to fund the holistic and prioritize giving birth in the City of Philadelphia. When they talk about community birth workers, we have to start ensuring that we're providing adequate funding to them as well. Because again, that doctor is not -- not that they shouldn't, but they don't necessarily have the capacity to manage the food insecurities to -- yes, they can identify substance use disorder, but if we don't have a provider network that can actually meet that individual where they are as it relates to their condition, then we're failing that person in this system. So I think to address your question we have to start looking at an individual holistically and in every single system, every single provider that intersects with that person at any point in time has to be brought to the table as to how are they going to manage and address this crisis in their own individual seat at their own individual table. So when you go through -- for example, your upcoming budget hearings, you're asking SEPTA how are you managing the issue of maternal health in access to mass transit. When you think about not just the Health Department, but when you're thinking about our recreation centers, how can we create mobile health care clinics to help support the individuals that again can't readily connect to a hospital. So in my District, I actually had the young woman Lashana Gilmore that you all just provided some funding for. She passed away, in my District, at a hospital that's not even in the City of Philadelphia. So imagine you having to navigate your entire life while you're pregnant and having to connect with services that are not readily available. So to answer your questions, again we have to take a broader approach and a holistic approach to addressing the patients where they are, but getting them connected to the resources that they need and properly funding physicians and doulas. Everything in the maternal health network has to be a part of this conversation, has to be adequately funded to ensure that we're not just all relying on one system to do all things and we really want them to be focused on the things that they do well and that they're licensed to do.
I want us to more consciously work with the School District of Philadelphia, right. I want to make sure that we are having a conversation with them about this issue. We talk about everything else. We talk about gun violence. We need to be more conscious about preparing young people to become tomorrow's parents, right, tomorrow's future, tomorrow's representatives. And we need to -- again in Latino families we don't talk about this enough. And so, I'm sure that it doesn't happen in Black and Brown families, all Black and Brown families, right, because I consider my parents to be really down to earth, like very open, right, but it's just not something, family planning and healthy family planning is not something that we've often talked about. So I think that reaching out to our young people, partnering with the School District of Philadelphia and having conversations with them about the importance of this is extremely important and identifying dollars, right, to be able to create these programs in their spaces where young people are comfortable about it, male and female. I think it's extremely important in order for us to be able to move the dots.
I was just going to say thank you so much for that point, Vice-Chair Lozada. That really makes me think about comprehensible sexual education, which currently Pennsylvania does not have as a requirement and how that comprehensive sex ed. K through 12 age-appropriate could really be the right venue for initiating these types of conversations in the schools.
I also just want to say that it's not just about family planning but also healthy relationships. We've seen a big association with intimate partner violence in terms of maternal mortality and I think -- I mean, it's understanding and having the understanding of healthy relationships in sexual education but it's also connection to resources, which is also a big issue, right. When you think about Kensington, there isn't a lot of access to reproductive health care and we've done some work with Prevention Point, increased that access, but it really also takes some expertise, right. This is a population that has gone through trauma, may not feel comfortable having these conversations and may have had physical and sexual assaults in the past. And so, these types of intimate conversations take expertise and this type of expertise needs funding and opportunity to be able to really gather that and bring that to these communities. And so, it really is -- we can educate as much as we want. If we don't provide access, we're not really going to see a difference.
One other question while you're here: For the City folks, do you know approximately how much it costs to fund one year of postpartum health care work? I know you're saying there's a variety of things that people need access to. But approximately how much does it cost for the year and can you compare that to the savings of the positive health outcomes that come to the people?
Do you mean a cost for the insurance or which particular resource?
You said that we're now providing -- the insurance companies will now cover one year of postpartum care.
So do you know approximately is there any dollar amount --
-- what the cost is per person. Do you know? STATE REPRESENTATIVE CEPHAS: Yeah. I don't know what the cost per person is, but it's something we can definitely get back to you on. And again, the extension is going to be happening up to about five -- well, not about five years. It's going to be for five years. That's what was in the American Rescue Plan. And obviously, there's going to be analysis paralysis around to your point is the investment worth the outcomes that we're seeing, so we will see that in the near future. But one thing I do want to give a plug for is the Philly Joy Bank, which is right now a pilot that I want to say it's like almost the first in the country where they're providing universal basic income to pregnant people in the City of Philadelphia, but I'll pivot.
Oh, they both gave me the mic so I can talk about the Philly Joy Bank. So the Philly Joy Bank is from MCFH through our CAN, Community Action Network, which is a collective impact group of lived-experienced experts and community-based organizations, and we'll be launching in the spring and providing 250 pregnant Philadelphians $1,000 a month no 5 strings attached for their pregnancy and a year postpartum with the aims of improving birth outcomes and reducing racial disparities in birth outcomes. We're incredibly excited about that program, grateful that we received a state maternal health innovation award that helped support it. And I know there's going to be a later Council hearing on guaranteed income, but I look forward to giving more details about it then. (Applause.)
Wonderful. Thank you. I just want to say I come from a country when I was -- a small country called Bangladesh with a very high population. And I remember talking about an education program. I remember a family health, a family planning campaign that the government put in. That's why I'm sharing this. It was on every T.V. And what it said was a small family is a happy family. It was in my language (Bengali translation). What that said to me was that made a huge impact, and there were also resources that came along with it, right, birth control and contraceptive and condoms. And this is a poor country with big Islamic majority population. We were effectively able to reduce the population with a campaign, an education campaign that reached every corner. And so, it can be done is my point. And some of you spoke about an education program, including you did. We have many tools. There's going to be many spokes to this wheel. That one needs to be very prevalent, and I haven't seen anything like that in Philadelphia at all. STATE REPRESENTATIVE CEPHAS: And just to your point, and Councilmember Driscoll knows this, a lot of what we're talking about today will never see the light of day in Harrisburg because of again a divided legislature. But trust and believe, people look to the City of Philadelphia for innovation and for pilots and a lot of the things that we are doing here in Philly so, for example, the Philly Joy Bank, they're replicating across the Commonwealth of Pennsylvania so there will be like a Pittsburgh Joy Bank. And some of the things that you all are talking about we might not be able to do, but if you all do it here in the City of Philadelphia, shine the light on moving the needle on maternal mortality and morbidity, it is something then I feel like the state will look at and replicate. So if you keep that in mind again as you go through your budget season, that would be great.
And just want to plug that again, my colleagues Dave and Sindhu have talked about payment. So there's access and then there's access that people feel comfortable accessing, and that requires money, right, and that requires building infrastructure so that people feel comfortable. These are not even just vaccines, right. These are intimate conversations about your sexual and reproductive health that needs to be invested in. And so, just want to plug that. If that is sort of the nature of something like this, that needs to be done really in an important manner of thinking about that.
The budget is a moral document. Let's see where we put our priorities, right. Absolutely. Thank you so much to the panel for a very interesting conversation. (Applause.)
The next panel is Reverend Dr. Lorina Marshall- Blake and Dr. Seun Ross. (Witnesses approached Witness table.)
Thank you so much. Good afternoon. Please state your name for the record and proceed with your testimony.
My name is Lorina Marshall- Blake and I have the pleasure serving as the President of the Independence Blue Cross IBX Foundation. The Foundation has awarded grants totaling more $85 million to local nonprofits and research since 2011, including more than $50 million in funding to Philadelphia County to serve the needs of our neighbors. Chairwoman Ahmad, Vice- Chair Lozada and members of this Committee, I want to first thank you for holding this hearing today and clearly acknowledge that we have an obligation, I think it's been said throughout the day, and a duty to the health and well-being of this community. Our health care system can sometimes be reactionary, meaning we don't address something until it's a problem. When leaders and conveners come together to address and change these issues, they're often playing catchup. Racial disparities in maternal health have existed for many years, leading to considerably higher pregnancy complications. That's why I'm so excited to be here today and why I thank you for acknowledging that this problem will take really a village to solve it, all of us. I'm here testifying on Resolution No. 240115, which examines proposed solutions to racial disparities in the maternal mortality rate in the City of Philadelphia. The IBX Foundation's philanthropic initiatives are dedicated to strengthening the health care safety net with community health centers, advancing nursing education with area nursing schools and enabling solutions for greater health equity through the institute for health equity, a $15 million commitment to equity in maternal care, medical education and digital health, which we announced in 2022. The IBX Foundation's Institute for Health Equity is engaging in strategic partnerships with community and clinicians to promote maternal health equity through several initiatives to date. And one of those has been talked about considerably today, advancing the professionalism of doulas. And I have to note for the record that as of this year I am now a certified doula. (Applause.)
That's okay. Advancing the professionalism of doulas by establishing the first Doula Curriculum and Training Review Committee with Cocolife.black who testified earlier, a Black-led nationally recognized doula training organization and the Pennsylvania Board Approved nursing schools. This work will do a few things, develop interprofessional curriculum and simulation for doulas to augment maternal care and nursing education, enable greater access for patients who seek the support of a doula during delivery and postpartum, support regulation and integration of doulas in the health care system. Another way we're addressing maternal health is by supporting community anchors that provide maternal services while enhancing the economic, social and cultural well-being of their neighbors. For example, by supporting the Oshun Family Center, and again they testified earlier, located in North Philadelphia, we are helping expand the maternal health workforce. Oshun is the City's first Black-led, women-run, integrated maternal wellness center in North Philadelphia. By meeting the Demand for Care model reaching predominantly Black pregnant people city-wide, it improves health outcomes, reduces the risk of complications during pregnancy and childbirth and supports wraparound services that include a doula, a lactation professional and mental health support. Finally, the IBX Foundation is helping improve access to care through our support of the FBC and Family Health and Birthing Center, Philadelphia's first birthing center located in Southwest Philly. The Center uses a doula-midwifery model in partnership with the Hospital of the University of Pennsylvania Maternity Care Coalition and the University of Pennsylvania School of Nursing. We are very excited about this work, as birth centers have been shown in studies to protect against racial disparities and lead to improved maternal and infant health outcomes. In conclusion, this is our time and our opportunity to deliver on the much-needed change for maternal health in this City. Again, Chairwoman, I can't express enough how important this is and I promise to work with you on making that change a reality here in our community. Again, I thank you for giving me the time and I do look forward to working with you and the Committee on this initiative. Thank you.
Good afternoon, Chairwoman Ahmad, Vice-Chair Lozada and members of the City Council's Committee on Public Health and Human Services. Thank you so much for the opportunity to testify on Resolution 240115 examining for proposed solutions to racial disparities in the maternal mortality rate in the City of Philadelphia. My name is Dr. Suen Ross and I serve as the Executive Director for Health Equity for Independence Blue Cross. 5 million in Southeast Pennsylvania, including our home city of Philadelphia. Chairwoman, on behalf of Independence, we appreciate your leadership on this critically important issue. At Independence we are passionate about our mission to enhance the health and well- being of the people and communities we serve. We are so excited to join you in this work and on the Committee of the Public Health and Human Services towards figuring out the right solutions for our shared goal, and improving health care here in the community. Addressing the root cause of health inequity and creating healthier outcomes for every person and every community we serve as a focus of our mission. So I want to briefly share with the Committee some of Independence's initiatives to reduce maternal morbidity. Independence is working with the Blue Cross Blue Shield Association on a national health equity strategy. The strategy aims to change the trajectory of health inequities and reimagine a more equitable health care system where no one is left out and we can all live our healthiest lives regardless of our zip codes. This strategy includes collecting data to measure disparities, scaling effective programs and working with providers to improve outcomes and address unconscious bias. The programs that we have are Cayaba Care. It's a relatively new organization located in West Philadelphia, whom we've partnered with to help manage the health of our moderate to high- risk pregnant members in collaboration with the members' treating obstetrician and other clinical specialists such as behavioral health, dietitians, lactation consultants right in the member's home and in their community. black is another organization that we've partnered with to support pregnancy and postpartum care and compassion care, which is the loss of an infant during pregnancy or labor or the loss of a significant other or family member. The Regional Coalition to eliminate race-based medicine was convened by Independence and the Coalition has committed to focus on clinical decision tools, 4 including obstetric tools, vaginal 5 birth after C-section and 6 race-based anemia guidelines that 7 adjust results based on the 8 patient's race, potentially causing 9 delays and inequities in care. 10 This group is working 11 together to phase out the use of 12 race as a variable to assist in 13 improving outcomes and the 14 Coalition includes health systems 15 in Philadelphia, New Jersey Delaware. The High Risk Pregnancy Condition Management Program is for members who are diagnosed with depression and may be at risk for hyperemesis gravidarum, gestational diabetes and preterm labor. We also have a pregnancy- induced hypertension program for enrolled members where they receive information about parental classes, lactation consultants, they receive breast pumps and other additional services and resources. Baby Blueprints is a longstanding program that supports expected mothers and promotes healthy pregnancy throughout each trimester by providing them with educational materials and other information as well as a health coach for high- risk members eligible for condition management. Independence also offers birth workers access to the March of Dimes' Implicit Bias Training Awareness to Action, dismantling bias in maternal and infant health care training. In support of birth workers, Independence hosts quarterly maternal health education events to connect birth workers to resources, build relationship network access and discuss the future vision of the birth worker community.
Lastly, Independence hosts a yearly Health Equity Summit to engage our membership in important conversations that include maternal health. We want to solicit and share insights from health equity experts and learn about local examples of implementing systemic change to address to build whole person health and health equity to build trust with the community by promoting the Independence health equity strategy and to demonstrate our commitment to hearing and centering the needs of our members. We also want to inform them of our strategies and to ensure that they align with community priorities. These are just some of the initiatives that we have to support our pregnant members in, and Independence is committed to being a leader and working to eliminate racial disparities on maternal morbidity. So we applaud this resolution and look forward to joining you and the Committee in this important work. Thank you so much for the opportunity and thanks so much for your leadership.
Thank you for your testimony. I'll start off with a question for you first about the Coalition that you have looking --
-- at the measures to reduce racial 14 bias in our health care. I noticed 15 that our -- and I don't know if they're still here, our Philadelphia Public Health Department --
-- they're not partners on that I noticed. Is that because you're not working with local government? How was that Coalition put together?
So the Coalition was started with the organizations, the hospitals and hospital systems that we have value-based agreements with. Our model is a little bit different than CERCA, which I think you're referencing in New York where the Health Department actually started the work. Here in Philadelphia, we wanted to start it with our partners, our network in doing that. So they are not excluded. We have conversations with the Health Department with the progress of the Coalition periodically.
What you're doing is what we need, right. We need to dismantle these barriers and these institutional ways all of these barriers come through over the decades and generations. Quick question before I hand it over to my colleague, to Lorina or either to you: We heard a lot from our previous panels about reimbursement issues, about how insurance companies work in this space and the fact that Dr. Jaspan had brought up about the disparity between things that impact men versus women. And so, I just wanted to hear -- I know you're from the Foundation side, but is there any work along with this dismantling racial bias and gender bias in how reimbursements work?
Yes. So I think there are a number of challenges when we talk about reimbursement. Our national insurer CMS actually is the one who creates the physician or provider fee schedule. And so, in terms of how things are reimbursed they actually lead the way. We are working with BCBSA who is our, you know, parent association to tackle that issue in terms of how things are reimbursed regarding gender. We're also working with them to elevate the need for CMS to actually add monies to community health workers. So right now there is a code that someone can use, but CMS added $0 to that. Another thing that we're working with CMS on is the unbundling of maternal health services. And what that is, is when a birthing person is pregnant and identified as pregnant, from that moment us as a payor, we no longer see any claims for that member until they actually deliver, and we recognize that this is something that causes disparities because we cannot intervene prior to an unintended or bad outcome.
Let me just adhere to -- I would be remiss if I didn't say we are not working collaboratively with our legislature, especially with regard to the doula issue and some other issues. So it's not like it's off the table. People are working behind the scenes trying to see how do we get there and what do we do, so we are all talking together. I was just recently in Harrisburg, so yes.
Yes. Thank you. Because we need to continue this conversation. We can make a lot of policy changes, but if there's no money behind those policy changes, unfunded mandates are useless. And we here are not going to do that. So in order for us to have fully-funded mandates, we need to understand the process and see where we need to push, where do we need to advocate all the way from federal, state and local resources and also in our private insurance companies as well as our other philanthropic sources. We need everybody to come to the table. If we are going to have a healthy population and the first instance at birth they're losing the parent, we are already handicapping someone for the rest of their lives. And so, if this isn't a priority, I don't know what it is, right. So you will be hearing about --
This is the moment and this is the priority.
-- going to let this go. A dog with a bone, not going to let it go. And I have all of these community advocates who are going to keep us on track and hold us accountable on this measure as well because we have so many other things coming, but this is about the beginning of life and giving life.
Thank you so much for your testimony. I just want to follow up on we heard earlier from advocates who are not a part of systems like the larger ones. And so, how do you make those spaces available to them? What are the barriers that exist that prevent them from getting in? How do you all open up those opportunities to providers that are on the ground touching people every day and who often times because of their community relationships do the work better, right. Sometimes the bigger corporations because you are so large depend on your hospital relationships, but there are people that are on the ground in the neighborhood on the block. How do you open up opportunities for them to become a partner, a community partner, where their impact is greater because of their trust relationship that they have with a woman and/or family?
Okay. I will. Councilwoman, again when I look at the Foundation side and the fact that I say consider us boots on the ground and we support over 60 health centers throughout, and that's not just federally-qualified, that could be smaller ones, you know, one shop. So again, we are literally out there in the community and working with the health centers, number one. Number two, we partnered with they mentioned Oshun, they mentioned Cocoblack, they're just one of many that we work with. But again, we are literally out there working with the community. And you mentioned a keyword in that they trust, they trust us. So we -- what is it, our yes is yes and our no is no, but we work directly with them on an ongoing basis, whether it's the health centers. Again, we mentioned the fact that our sweet spot for us is nursing, so we cover all of the nursing schools. And when we talked about that curriculum with regard to the doulas and working with the dean of the nursing school in an effort to get the -- as the new folks are coming out, that they understand it and they get a hand-ons opportunity. So again, I often say -- my joke is I call myself a street woman, only because I'm out there hearing what they're saying. And again, they want a trusted, I say trusted messengers with trusted messages from trusted venues. And I believe the Foundation and IBX over 85 years and the Foundation almost years have been out there 6 and have always been accessible for 7 that. 8 So again, I can commit that 9 we're going to be there. We're not 10 leaving, but it's important to us 11 when the community's better, we're 12 even better. So again, it's a 13 hands-on approach through the Foundation from --
I get it. I just want to know how do we better connect the smaller, the on-the-ground folks, right, on-the-block folks? How do they reach out to the Foundation? Where's the relationship, how do we bridge that? How do we use Council to be able to say, hey, Pastor Michelle, your organization is not with the Blue? How do we connect that, how do we become the bridge?
And I would say from the corporation from the business perspective, we have been very intentional particularly in maternal health about connecting with small business organizations, and that was the maternal health mixers that I mentioned. Quarterly at Independence LIVE, we invite all of these community organizations to come and talk to us and talk amongst each other so that they can stay connected with us. That's one way. Another way is we were also very intentional about partnering with, having partners who are in Philadelphia so they can affect our members' outcomes, things like Cocolife.black and also Cayaba Care.
I appreciate that. One of the things that I learned working at one of the grassroots organizations during the pandemic was that true community engagement will change outcomes and make communities healthier. But I learned that we just can't be at a health fair. We just can't be at --
-- somebody's church, right. We need to be at their door. My team and I registered 4,000 people for the COVID vaccination during the height of the pandemic. And so, it's very easy to say, yeah, we're a partner, we're a community partner, we're out there, we've been around for many years. Yes, I understand that and I know that the Blues are a trusted name. I just want us to go beyond that name, right. I want us to figure out truly how do we become a community partner, a grassroots partner in people's neighborhoods and on people's blocks. And we know because we heard it today that there are people doing that work. We need to be more conscious about connecting with those people, the people that are in this neighborhood, not the large organizations, community- based organizations that have large budgets. I'm talking about if we want to make Philadelphia a healthier city, then we need to do and be really, and I mean really committed, not just by talk, really committed to knocking on the door to those providers that are the smaller people who again, like I said, are the trusted partners, the real trusted partners of community residents.
Thank you. Thank you panel for your insightful testimony. I'll ask the Clerk to please read the names of the next and final panel.
Our final panel is Lonnesse M. Bodison, A. Bruce Crawley and Archbishop Mary Floyd Palmer.
The Archbishop is unable to be here to testify. (Witnesses approached Witness table.)
Good afternoon. Thank you for being here. Please state your name for the record and proceed with your testimony.
Good afternoon. My name is Lonnesse Bodison and I'm the Senior Director of Programs at Maternity Care Coalition and I'm also a Philadelphia native. Each year Maternity Care Coalition works with hundreds of families across Philadelphia providing home visiting, child care, community and parenting education, doula and lactation support and behavioral health services for pregnant people, children Birth to 3 and their families. Our agency was founded in 1980 to address this very issue of high rates of maternal mortality and infant morbidity in the City of Philadelphia. And it's truly disheartening that here we all these years later are still addressing these same issues. For over four decades, MCC has worked to ensure parents impacted by social and racial inequities can birth with dignity, parent with autonomy and raise babies who are healthy, thriving and growing. As you already heard throughout the day or throughout this morning, rates of maternal mortality and morbidity persists across our nation, in Pennsylvania and in Philadelphia. I thank this Council for focusing attention today on solutions as these rates will not improve until we directly address the underlying disparities, which are rooted in systemic racial and social inequities. Improving outcomes will require a multi-pronged and multi-sectoral approach and we are guided by the evidence that suggest improving the conditions in which Philadelphians are having and raising babies is a critical step. At MCC, we focus on social determinants of health, the conditions in which people are born, grow, live, work and age, the same conditions that influence maternal health and birth outcomes. Factors such as income, education, housing, food stability are social determinants of health that are negatively impacted as a result of systemic inequities experienced by Black and Brown people. Simply put, Philadelphia must invest in resources to address these social determinants to achieve equitable birth. At a systems level, we would support our local insurance payers and hospital systems to actively pursue, actively pursue improving outcomes for Black and Brown birthing people. They can implement strategies to combat implicit bias, develop and implement strategies to diversify the perinatal workforce and ensure equitable access to doula care, maternal mental health, lactation support and home visiting. At the community level, we must consider the physical and behavioral health of pregnant people before they get pregnant as well as through our pregnancy. We can do this by investing in programs and supporting interventions that focus on pre-existing physical and behavioral health chronic conditions that can negatively affect birth outcomes. On an individual level, we must acknowledge that every birthing person is an expert in their own experience. They need to be respected, listened to and given access to resources to support healthy birth outcomes. Every parent has a right to set goals for themselves and their babies and seek success through their own definitions and methods, free from value judgments and expectations established in systemically racist institutions. As an individual who's delivered three children in Philadelphia and continued to receive care in Philadelphia, I have a personal interest in advocating for this issue. I myself who I consider to be a well-educated presenting woman have faced certain obstacles when I've encountered care when carrying my children. And although I'm eager to be a part of the solution, I too am frustrated and I am tired. And I recognize that today is another step in the right direction to eradicating this issue within our city and hopefully eventually throughout our nation. But at each minute, each meeting and each second that passes, pregnant people, postpartum people are continuing to die. I'm afraid for my daughter and my niece. I am waiting, I am still waiting and I don't expect to have any more children. My mother waited.
My grandmother waited and I don't know what's in store for my daughter if she decided to have life beyond her own. What will they face? What resources will be here for them? I am a little bit more hopeful not only from this hearing today but also with seeing different initiatives pop up within the City, one of which was referenced by one of my peers, the Philadelphia Joy Bank, which is a great example of a research-backed intervention that both targets the social determinants of health as a mechanism to improve birth outcomes and respects the autonomy of parents. It is a guaranteed income pilot designed to improve birth outcomes in communities experiencing the highest rate of low and extremely low birth weights for children. MCC is committed to partnering with City Council, the Administration of Mayor Parker, the Philadelphia Department of Health and community collaborators and organizations to find, implement these types of solutions for the persistent rates in racial disparities and maternal mortality and morbidity in our city. These are complex and multi-faceted, challenging issues. And in order to see results, our solutions must be as well. Throughout the panels today we heard a lot of talk about doulas. We have a doula training program at Maternity Care Coalition. We contract with doulas. We know our colleagues in this work, Cocolife and Oshun are equally dedicated to this work as well. But I wanted to highlight again that the problems that we see are multi-faceted challenges and the solutions have to be multi- faceted. And I love doulas, but it is not doulas and period. It is doulas in addition to. We have to be mindful to not break the backs of the doulas that are already on the ground doing this wonderful work, but be mindful of those who have an interest and passion for coming in to help us solve this problem, and just always recognize that doulas are anecdotal. Their work is -- goodness, their work is amazing, but let's not forget that doulas cannot solve alone the systemic issues that impact and have caused this issue. Thank you.
Good afternoon. I guess it's afternoon. I want to start by thanking Chairperson Ahmad and members of our Committee for convening this very important public hearing on racial disparities in the maternal mortality rate in the City of Philadelphia. It is critical, it's timely and there's much that can be done if we all would jump in, roll up our sleeves and cooperate. It's not an insurmountable challenge. It's big, but it's not insurmountable. Despite the incredible scope and depth of this topic, those of us who have been scheduled to present testimony have been challenged to carve out a primary portion of our remarks for solutions to the problem and to leave other aspects for future presentations. The conveners have also encouraged us to make every reasonable effort to be brief as possible. That being the case, I do want to launch into my brief remarks by creating a historical, sociological and health care context for the wholly unacceptable conditions that have led us to the need for today's discussion. I'll start them by briefly describing the global, national and Southeast Pennsylvania and Philadelphia nature of the problem, which can be done most effectively by quantifying the raw numbers of deaths experienced by birthing mothers and their infants in those areas. In our humble opinion, it is grossly inadequate to have race-based maternal and infant mortality disparities simply framed by media outlets, academics, bloggers, hospital administrators and podcasters as simple issues of inequity. In fact, they represent a life or death issue with disproportionately negative and often terminal impact on Black patients and on other medically-dependent communities of color. No matter how dire these issues have been, we believe that they can be addressed by encouraging first of all our elected officials to more aggressively demonstrate their political will regarding these issues. We also believe it will be critical for our community as a whole to establish new advocacy networks, direct community outreach initiatives and to adopt a sense of shared accountability for addressing these issues. We can't just sit back and say, we passed the ball to the elected officials. This is all vitally important and the corrective actions will certainly not arise of their own accord. We do offer this caveat: While some of our best friends over the years have been health care professionals, we must remember that this is not the first time that many of us have found ourselves on opposite sides of the health care issue. Let me count several of the ways. S. health care. S. hospitals did not end until the passage of the Civil Rights Act of 1964. For those who are counting, that was just 60 years ago. I was alive. So to think that the problems, the racial relations problems and the segregation problems that were rampant prior to 1964 could not have been totally eliminated up through 2023. And yet we need to understand that our subject today is a part of a larger context. This is not just something that occurred because somebody wanted to take advantage of birthing mothers and their children. Here's another report. For those of you who wondered where Black and other physicians of color are when you go into a hospital or health care facility, have you heard of the Flexner Report? C. as surviving institutions at that time. Today the number of Black Medical Schools has been increased to four, now including Morehouse School of Medicine and Charles Drew University of Medicine and Science. According to PubMed Central, if the five originally closed Black Medical Schools had remained open, it has been estimated that by 2019 those schools might have provided at least an additional 10,587 graduates. So I used to walk into hospitals and say, maybe Black folks don't want to be and Hispanic folks don't want to be doctors. The problem is that some of the schools that produced them were shut as a result of the Flexner Report. S.
practicing physicians are Black or African American, and it has also been estimated that the Flexner- related Black Medical Schools have reduced the number of Black doctors by between 10,000 and 30,000 over the ensuing century. So that's why I can't find them when you're walking through the hospital -- did they get fired. Prior to the 1960, Historically Black Medical Schools graduated nearly all of African American physicians who received their training in the United States. As recently as 2010, Historically Black Medical Schools provided training to percent of 18 Black Medical School graduates in 19 the country. As recently as 1968, 20 Black students represented just 2 percent of mainstream medical school student enrollment. Following that recognition, the AAMC, the organization of medical colleges, announced the goal in 1970 to increase the enrollment of Black medical students in its schools to 4 percent. However, over the past 50 5 years that enrollment goal has not 6 been achieved. And as of 2019, the 7 percentage of Black Medical School 8 enrollees at large mainstream 9 schools had not reached even 8 10 percent. 11 Now, I will focus on the 12 specifics related to minority maternal health, the context that we're in an environment where the people who are providers of health care and the people who have led the health care establishment have not been overly aggressive in having an inclusive environment for Black people and other people of color. S. deaths and morbidities, especially impacting Medicaid-insured birthing mothers, women of color and their infants. Exacerbating those problems from 1990 to 2000, 296 urban hospitals were closed across the country. In 2023, the Journal of American Medical Association, JAMA, reported that more than 400 maternity services had closed nationwide between 2006 and 2020. Between March and June 2022 alone, 11 health systems announced that they were closing their obstetric services. Ominously, in the year 1996 a New York investment firm called Forstmann Little & Company acquired Tennessee's Community Health Systems. They call themselves CHS for short. 5 billion. Subsequently, CHS played an important role in the closing of 129 hospitals. In 2014, CHS comprised nearly 200 hospitals, the vast majority of which were located in the Southeast and Southwest regions of the country. Southeast region of the country, 56 percent of the residents -- 56 percent of the Black population resides in those areas. Most of those areas were places that used to be part of the confederacy. By 2023, the company's hospital holdings were down to 71 from 200, spread across the same geographic areas dangerously reducing all important birthing mothers access to providers, midwives and prenatal care advisors. S. health care professionals and other leaders continue to develop strategies to reduce the country's preventable maternal and infant mortalities at the same time they seek to eliminate the related health care disparities. Perhaps more importantly, it may very well behoove our increasingly diverse nation to begin to pay closer attention to whether the growing issue of maternal health disparities should also be recognized as the country's health care canary in the coal mine. S. health care policymaking, facility closings and the setting of dangerously unhealthy expense reduction priorities, for example closing maternal health-focused maternity wards in large hospitals. We've seen that happen in Philadelphia. And that flows from people who are doing financial analysis. We got people who do investment, and they invest in all kinds of professions and industries. They invest in peanut butter, they invest in automobiles and their normal behavior is that they go in, they purchase the asset and they try to cut expenses because they're trying to reduce margin. They cut expenses. And then once they've cut expenses, then they increase the prices. This is happening at an alarming rate.
And what's happening in this country because of those two trends, reducing expenses that would pay staff and have equipment and not be stuck with using depreciated assets, cutting back on sanitation expenses and raising prices, the United States among developed nations, among the wealthy nations of the world is now at the bottom of the list for effective outcomes in health care. And at the same time, it is at the very top of the list for being the most expensive place to do health care. So if we're talking about low- to moderate-income people and we're talking about people of color, you see they're caught in a bind when they have those two pressures, and a lot of it is coming from a place that many have not talked about, and that's the private equity people. Allegations of health care industry disparities are not solely drawn as we have been led to believe from isolated incidents of interpersonal racism or from cases where providers are not simply listening to legitimate concerns of birthing mothers of color. Instead they are significant examples of structural racism which disproportionately impact access to maternal health services by women of color, and that includes policy-impaired availability of neonatal and postpartum support from Medicaid-insured birthing women of color, reduced postpartum period coverages as compared to extended coverages by private insurers. I was surprised to learn as we did research for this presentation that most of the deaths that impact birthing mothers happen during the postpartum period, not on the birthing table or one week later. And most of the insurance, especially Medicaid which has been recently extended, most of those insurances don't cover or provide coverage in the postpartum period. So the mother has baby, they bring him or her home, and all of a sudden they're three months down the road still in postpartum and they have medical complications, but they're not covered. That's beginning to be impacted and we're starting to see Medicaid take a look at extending what was an embarrassingly short time frame for coverage after the actual birth. An ongoing 16-year pattern of national system-wide closures in maternity wards, especially those with notable Black-serving and Hispanic-serving patient base are high levels of resistance to accepting Medicaid-insured pregnant women as patients is also an issue. And in Philadelphia from 1997 to 2009, these partners saw the City's maternity wards decrease dramatically from to just 6 4 hospitals. 5 million 5 people in Philadelphia. I believe 6 we've clearly explained the 7 challenge. The issue now is what 8 we plan to do about it. It might 9 appear sometimes that these 10 developments are happening in the 11 dark and that no one has spoken 12 about them or has begun corrective 13 actions. You would be wrong about 14 that. 15 In fact, we've reviewed 16 recommended solutions to this crisis, as we have been instructed to do, from 13 of the country's best health care, legal community service and medical professional associations. Our engaged influencers include the National Medical Association, the CDC, the NIH, the White House's Maternal Health Blueprint Committee, the drafters of the Congressional Momnibus Act -- every time I put it in the computer it kicks back. There's no such word as Momnibus -- the National Partnership for Women and Families, the American Medical Association, National Black Nurses Association, the Commonwealth Fund, the National Blue Cross Blue Shield Association and others.
So there's a lot of really bright people working on what the processed solutions ought to be, but the political will, the organizations within the community, communications in places like church congregations, fraternities, sororities, those kinds of people in our neighborhoods ought to know about this maternal health problem and the ramifications, not just for themselves if they happen to be planning to be mothers or they have a family and they've got a mother in their family, but they've got to really understand that it has far-reaching implications. I remember growing up in North Philly. A lot of ladies in the housing project had to go have their babies. And we would sit on the front step, wait for them to come home. My mom and other people's moms and we would say, was it a boy or was it a girl. And now, women we've been told are making sure their wills are in order when they go to have a baby because the incidence of death, something that never occurred to us, is very real. At this point, we've identified more than 50 solid recommendations, and we'll share them with you later, that would emphatically move the needle toward eliminating this horrendous crisis. We encourage you to reach out to those entities, join them and help them to organize, build constituents and volunteers and communicate excessively for the sake of your families and our next generations. It can work and we've been silent on this issue long enough. As a final recommendation, I want to talk to you about the NIH. We've got several recommendations from all these organizations and some of them are very good, but the NIH has led their solutions with, number one, fund and implement a maternal board, mortality and morbidity prevention moonshot, convene multiple federal agencies, review funding possibilities for a fundamentally transformative prevention research initiative. You know, moonshot, an original parlance was something that was seen to be insurmountable, impossible to do, too large to contemplate. And yet if you bring all the resources together and focus them, the moonshot can be successful. And so, we're talking about the National Institute of Health and they are providing that as their first solution. And again, we need to get people to be supportive of that and join in however we can. Postpartum coverage extension, we talked about that just a bit. And we got to do more of that because that's where the rubber meets the road. Improved maternal health data, NIH also said to enhance federal partnerships with state and local maternal health data collection entities, communities, hospital and researchers will have access to better data to identify outcomes during pregnancy and to make improvements to support healthy pregnancies. NIH then said, a more diverse maternal care workforce. And a part of that is what we talked about with the lack of Black doctors because they shut the Black Medical Schools, but the recruitment of diverse workforce and the maternal care workforce is critical. The mothers are going in. Some of them are young. They're not accustomed to being in a hospital. They're not accustomed to being in a culture that is devoid of people that look like them, talk like them and it would be very helpful if they could have a more diverse workforce. Now, some of that is being impacted by midwives. But the midwives, despite the great job that they do, work for the hospital. The midwives are on the payroll of the hospital. What we want is more doulas. The doulas are there to provide support and empathy for the mother, but they work for the mom. We need to expand social services, stronger partnerships between the Department of Housing and Urban Development, Agriculture and Health and Human Services will help make it easier to enroll in federal programs for housing, food, child care and income assistance. S. Department of Agriculture. So that's what WIC -- that's what -- I'm sorry, WIC.
That's what NIH is recommending, and we've got a whole list of others that we will pass on to you. I told you we've got quite a few. But I think those are the key points we wanted to make today.
Thank you. Thank you for that comprehensive list. I thank you for Maternal Care Coalition, for your testimony. I appreciate all of that. So if there are any questions from anyone?
I just want to say thank you. I'm very familiar with the Maternity Care Coalition. It is one of the organizations that partners very closely with some of our community- based organizations in the 7th Council District so I appreciate your work. And if I can be of service and my office to help share your information, if we can partner in any way, please reach out and let us know. Mr. Crawley, I appreciate your work. I know that for a long time I remember your work from the PCVB and the Multi-cultural Affairs Congress and your work to ensure that Black and Brown people were always represented at every level in the work that we do in the City of Philadelphia, so I appreciate that. I'm interested to see your testimony. Some of the numbers that you shared were very interesting, right. If we are graduating 10,000 Black doctors, where are they going after they graduate, are they staying in our health systems. I believe that folks are comfortable when they're being treated or when they're being seen or when they're interacting with professionals that they know understand their culture, understand their neighborhoods and understand where they come from. And so, I'd be interested to receive your written testimony. I don't see it here in my packet but I would be interested to receive that and really follow up to figure out where are they going. And if they're not coming here, if they're not staying in the City of Philadelphia, how do we encourage them to come back here and how do we work with our health care systems to be able to work and provide services to our community. So thank you very much for that.
Absolutely. We'll follow up with that. And to the point you spoke about the privatization of our health care, I think that's a fundamental issue of this looked at as an asset like peanut butter as you mentioned, and we can't do that. We already have 10 hospitals -- Hahnemann Hospital, which was a result of viewing it as an asset that needed to slash expenses, which means closing a hospital. So point well taken and we have to put it all together. So I thank you all for your testimony. There's no other questions. We will conclude this -- oh, before I conclude, I just want to thank everyone, all of our advocates who are still here, everyone who's still here have been patiently listening. We wanted to make sure everybody's testimony was heard. We've gone over an hour and minutes, but this is just to 12 underscore how critical this issue 13 is. We need to hear from every -- 14 everybody had very different and 15 great ideas and thoughts. We're 16 going to put this all together. We 17 will inform you about next steps, 18 what we're going to do next. 19 Hearing is great but action 20 is greater, right. And what that 21 action looks like, we need your 22 help for us to craft that. We can't do it ourselves. You guys have ears to the ground, doing the work. And we thank all the institutions who are here. We need to have a much more cohesive way of talking about this and making this a priority. And I think that is the urgency that elected officials can bring. And Bruce mentioned political will, and we need that. We need that to advocate. So I thank all of you. I thank folks who make this hearing possible, for someone taking all our testimony down. For people taking care of this room, thank you for letting us stay over time. I appreciate it. And so, this will conclude the public hearing on Resolution 19 No. 240115. Thank you and thank you to my Clerk who has been monitoring this whole thing, Duwayne Terry. Thanks, everyone.
Thank you very much. (Committee on Public Health and Human Services concluded at 1:25 p.m.) C E R T I F I C A T I O N I, hereby certify that the proceedings and evidence noted are contained fully and accurately in the stenographic notes taken by me in the foregoing matter, and that this is a correct transcript of the same. __________________________________ TANEHA CARROLL