Maintaining Stability of Evidence Informed Strategies Amidst a Changing Landscape of Maternal and Child Health Needs

Full Description: In 2010, with the advent of the Affordable Care Act, Kentucky (KY) launched a successful outreach and enrollment program for the new state Medicaid expansion. The expansion improved access for direct healthcare and decreased the need for direct services through the financially burdened local health department (LHD) system. Early recognition of a changing healthcare landscape and public health transformation was the impetus for establishing a structured Maternal Child Health (MCH) coordination program, leaning into evidence informed strategies to align with the KY chosen national performance measures. Drawing upon the expertise of focus groups and MCH staff, KY developed evidence informed strategies, informally known as “Kentucky MCH Packages”. The “packages” allowed the decentralized LHD system autonomy to use MCH Title V allocations for local community engagement, innovative partnerships and focus on short to long term strategies to improve outcomes for the MCH population.

An allocation formula was designed including a base rate, along with various population, poverty, and Medicaid enrollment density measurements. A guidance document defined the scope of work for prenatal, maternity and pediatric care coordination, child fatality and injury prevention efforts, and childhood lead poisoning prevention, reporting requirements and use of MCH Title V funds. In 2012, the first “package” was moved to action in the LHDs. It specifically addressed, safe sleep activities to reduce incidence of Sudden Unexpected Infant Death. Over time, MCH integrated 10 more “packages” to fit emerging needs, or ongoing needs identified in the 5-year strategic MCH Title V plans.

Over the next 5 years, MCH phased out Title V grant supported LHD direct services. LHD skills improved their population health skills leading MCH to challenge them to think innovatively in engagement of community resources to build sustainability of work and to leverage funding or work of partners to meet local MCH goals. Simultaneously, the “packages” were adapted to include language related to strategic planning, partnership building, outcome measurements, equity, financial and program monthly reporting, and fidelity to the use of funds. The LHD could design and implement best practice initiatives by opting into a package to address infant mortality, and up to 4 other “packages”. They were granted autonomy to designate the use of funds per package, submit annual strategic plans, and close out the fiscal year with an evaluation of the strategies chosen, as well as suggestions for improvement. This practice led to multiple innovative partnerships and in some instances, large wins for the MCH community.

This session will tell the story of Kentucky’s roadmap to population health engagement at the community level, examples of successes, and detours that were needed to refine and improve the evidence informed engagements at the local level.

Abbreviated Description: This workshop will tell the story of Kentucky's roadmap to building population health, evidence informed strategies addressing the identified MCH needs at the local level through innovative collaborations with the decentralized local health department system, community partners. The speakers will share the history of the program development, reporting and financial fidelity, and how the successes learned locally were replicated in other counties in the state to improve MCH outcomes.