Road MAP: NJ Quality Institute issues call to improve maternal care

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To do better, you have to know how something is currently performing. New Jersey is No. 47 nationwide for maternal health outcomes. On top of that, the playing field is uneven, with Black women seven times more likely than their white counterparts to die from a pregnancy-related complications. So, there’s room to grow in the Garden State when it comes to Maternal Infant Health.  

First Lady Tammy Murphy launched the Nurture NJ initiative in 2019 to tackle that task. To achieve the goals of addressing maternal mortality and morbidity and ensuring equity in care, the New Jersey Health Care Quality Institute released the Maternity Action Plan – yes, it’s a MAP – July 12 to guide those efforts. The plan is made for action.

The MAP outlines four priorities to improve Maternal Infant Health and outcomes: 

• Expand and diversify the perinatal workforce
• Collect and use data – including patient-reported experiences – to improve equity and equality 
• Reform payment systems to drive high-quality holistic MIH (including behavioral health services)
• Strengthen community-based social supports before, during and after pregnancy

It includes 11 specific recommendations and supporting materials for regulatory and policy changes that can be made to achieve the goals of and “operationalize” Nurture NJ. But the information can also be used to “operationalize” others, in the private sector or at the community level. There’s even a chart. Which is handy, because the report is packed with details. It highlights the intersection of the MAP’s recommendations and Nurture NJ’s goals.  

Here’s a closer look at some of those proposals: 

Workforce

Expanding the MIH workforce is essential to ensuring more equity within it. The MAP identifies that effort to build more diversity – both of background and experience – as collaborative across the public and private sectors. To achieve this, a closer look must be taken at what services are needed, and what types of providers are appropriate to deliver them. On-going anti-racism education and training are also recommended, and not just for MIH professionals. “Change will not occur without attention and training, and reinforcement for shifts in practice for all staff levels from the top down,” the report states.  

How it happens: Create a state accrediting body to award a “racial equity designation” for public, private sectors; convene the private sector to incentivize and engage them in taking action on racial equity issues; all health care system CEOs and health professional societies should commit to action, including with explicit steps 

Data

It’s not that there isn’t data, but the data that is available is spread across different organizations in New Jersey, limiting its use. The state launched its Maternal Data Center in 2019; according to the MAP, the New Jersey Department of Health is committed to improving and expanding the MDC to collect, analyze and report on MIH-related information from New Jersey’s different silos. The MAP identifies this facet as “foundational” to implementing the Nurture NJ Strategic Plan. In addition to improving data and its access, that information should be acted upon to improve quality, payment models and public reporting.  

How it happens: Private sector businesses or associations should fund, conduct and disseminate a business case for racial equity analysis specific to the Garden State; all 49 birthing hospitals should meet or attain rates lower than the national target for cesarean births; hospitals should institute systematic changes to accommodate doulas; NJDOH should work with health care providers to increase accountability on racial equity initiatives.  

Payment

The MAP suggests initiating new pilots to explore payment reforms and how they can be leveraged to further equitable and quality MIH. Additionally, many pilots that are already active are time-limited; the plan says these must be evaluated beyond their pilot periods, while private sector payers and stakeholders should consider whether new payment or care models are aligned with services they already offer so it is easier for consumers, communities and providers to understand what’s available and how to access it. 

How it happens: The state Division of Consumer Affairs should examine standards of care related to MIH; value-based care models should be assessed to ensure health providers that disproportionately serve communities with higher social needs are not penalized; increase the number of Baby-Friendly designated hospitals to at least one in all infant mortality hotspot areas. 

Support

It’s not just the medical system that needs to recalibrate to affect changes in MIH. The approach should be “multi-sector,” according to the MAP, to address social determinants, as well. All families in the state should have a safe, secure place to live. On top of that, support should extend into childhood via child care, which the report identifies as a “critical” statewide industry. The MAP suggests that financial aid should be maximized so that there is access to high-quality child care in the state and that awareness should be built up around the Connecting NJ referral process.  

How it happens: The New Jersey Economic Development Authority should provide targeted support to child care providers; housing developers, funders, advocates and stakeholders throughout the state should develop efforts across sectors to increase quality, affordable housing for pregnant individuals and women with young children.

The complete New Jersey Health Care Quality Institute released the Maternity Action Plan is available here.