Hospital Council of NW Ohio
The Hospital Council of NW Ohio’s “Pathways” program is helping to ensure that at-risk women receive the care they need to achieve a healthy birth weight for their babies.
The Pathways Program’s Unique, Incentivized Payment Program is Lowering the Incidence of Low Birth Weight Babies
In the early 2000s, leaders in Lucas County, Ohio realized that their county’s rates of low birth weight babies were distressingly high. Three zip codes in the county had particularly high concentrations of low-weight births, some near 20 percent. This was problematic for at least two reasons. First, low-weight babies are prone to all sorts of health problems. Second, and relatedly, low weight babies typically mean higher medical costs for the parents and, through Medicaid, for the state. Although various prenatal services were available to low-income women in these three zip codes, too many were not taking advantage of them due the many barriers (transportation, lack of childcare) that make access difficult. In response to this problem, a group of partners got together to create a collaborative solution that could connect at-risk women to the care they needed. The result was the Lucas County Low Birth Weight Initiative, also known as the Pathways Program.
The Initiative engages six organizations under the leadership of the Hospital Council of Northwest Ohio. The partners are Mercy, Neighborhood Health Association, Toledo-Lucas County Health Department, ProMedica Toledo Hospital, the East Toledo Family Center, and the Providence Center.
Pathways’ model is threefold: identify at-risk women, connect them to care, and measure the outcomes. Its lies in its creative use of existing community health care workers active in the target neighborhoods. “There are a lot of people in the community whose job it is to work with the prenatal population, so [we said] ‘Let’s overlay Pathways on top of it,’” Jan Ruma, the Initiative’s director, explained.
Through a HUB operated by the Hospital Council of Northwest Ohio, the initiative connects pregnant women identified by community health workers to needed medical and social services. “[We] really focus on the connection piece—dealing with the social issues and barriers to get them to their appointments,” said Ruma.
In order to ensure that the initiative’s ultimate goal of reducing the rate of low birth weight was achieved, the collaborative established a unique, incentivized payment system for the community health workers. The system is based on specific outcomes, Ruma emphasizes. “We focus our payments on outcomes, not on process, and we have agreed-upon payment points.” Those payment points include:
- Enrollment into the Initiative: The goal is enrollment in the first trimester whenever possible, so this means finding women early in their pregnancy. However, enrollment at any time to connect a pregnant woman to prenatal care is known to have a positive impact on the birth outcome. Health workers received a payment when they enroll in a new woman.
- Prenatal visits: Payment is received when the community health worker assists the pregnant woman to attend each of her prenatal and Maternal Fetal Medicine and ultrasound appointments.
- Healthy birth weight: If a healthy birth weight is achieved—that infant is at least 5 pounds and 8 ounces—the community health worker receives another payment.
- Post-partum care: A further payment is issued if the health worker connects the mother and her new baby to ongoing healthcare once the baby is at home.
- Connection to social services: Each time a pregnant woman is successfully connected to a social service which removes a barrier to a healthy birth outcome, the community health worker receives a payment.
By using this outcomes-based payment system, the initiative has seen success from the onset. “At first we weren’t sure if the [target] population wanted to be helped; however, it turned out that this wasn’t a barrier at all,” Ruma says. “At one point we had to stop enrollment because we had so many good outcomes and couldn’t pay for them.”
Since the HUB became operational in late 2007, it has served more than 1215 at-risk pregnant women, and reduced low birth weight rates among at-risk women from 15.1 percent to 6.7 percent in 2011. At the onset of the program only 30-40 percent of the women received post-partum care, but now 81 percent of women are receiving post-partum care. Moreover, of all of the babies that the organization has served, only 5 percent have had to spend time in the (expensive) neonatal intensive care unit.