Recent research indicates efforts to improve maternal health in the U.S. have largely failed, with the maternal mortality rate more than doubling over the past two decades amid vast disparities between racial and ethnic groups. [ US News] 

Maternal mortality in the U.S. has gotten worse in recent decades, a study shows, particularly for Native and Black women.

READ: Maternal Deaths Rose During Pandemic

Findings from a novel state-by-state analysis of maternal deaths, published this month in JAMA, show the rate of death among people 10 to 54 years old who were either pregnant or had been pregnant within the past year rose from 12.7 deaths per 100,000 live births in 1999 to 32.2 deaths per 100,000 in 2019, with total maternal deaths increasing from 505 to 1,210. Between the decades of 1999 to 2009 and 2010 to 2019, the study found increases in maternal mortality rates across nearly all states and among all racial and ethnic groups.

Across the five racial and ethnic groups included, the study’s estimates show American Indian and Alaska Native females, as well as Black females, had the highest maternal mortality rates in 2019, along with the largest absolute mortality rate increases since 1999. Among American Indians and Alaska Natives, the national maternal mortality rate more than tripled over the two decades studied – from 19 deaths per 100,000 live births in 1999 to 69.3 per 100,000 in 2019 – while maternal mortality among Black women more than doubled, from 31.4 to 67.6.

Among whites, the maternal mortality rate also roughly tripled, from 9.2 to 27.9. Similar patterns were found when examining median maternal mortality rates across states.

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If you are interested in more information about IOMC's Maternal Health and Child Workgroup, please contact IOMC at iomcstaff@iomc.org

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The U.S. health care system is not set up to improve the quality of life of the most vulnerable, chronically ill, elderly people, especially those who are poor. Older poor people often face loneliness, depression, a lost sense of purpose, and an inability to live independently in their homes. They also encounter many health service hurdles, including inadequate care coordination, fee-for-service reimbursement that often reflexively encourages medical treatment over other forms of care, and a dysfunctional nursing home industry. [Harvard Business Review]

To help improve services for these patients, we analyzed the design and implementation of a national program called PACE: Program of All-Inclusive Care for the Elderly. We focused on this program because all PACE participants are vulnerable: They require nursing home–level care, and 90% are eligible for both Medicare and Medicaid. Few integrated-care programs serve this dual-eligible population, which now numbers 12.5 million Americans.

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Delivery-related maternal mortality in U.S. hospitals decreased for all racial and ethnic groups, age groups and modes of delivery during 2008 to 2021, likely due to national strategies to improve delivery-related hospital care, the Department of Health and Human Services reported. Advanced maternal age, racial or ethnic minority group status, cesarean delivery and comorbidities were associated with higher odds of mortality and severe maternal morbidity, according to the HHS study, published in JAMA Network Open. Adm. Rachel L. Levine, M.D., HHS’ assistant secretary for health, said the results “underscore the need to better manage women’s health, including identifying the most significant risk factors and supporting access to improved care.” [AHA]

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Gov. JB Pritzker's administration has applied to the federal government to extend Illinois’1115 waiver for behavioral health services, with officials saying it will help with their goal of “healthcare transformation.” The five-year extension application to the Centers for Medicare and Medicaid Services proposes 10 programs. Along with continuing four pilots originally approved by the agency in 2018 related to substance use disorder services, the waiver seeks to address food and nutrition services, employment assistance, non-medical transportation and community reintegration for previously incarcerated individuals. “The section 1115 demonstration request is an essential component of Illinois’s strategic plan to build an equitable and sustainable healthcare system,” Pritzker wrote in a letter to Health and Human Services Secretary Xavier Becerra. “This comprehensive initiative will leverage the existing transformation framework of the 1115 demonstration activities within the current program to include additional foundational innovations to address the health-related social needs of Illinoisans.” CMS originally approved the state’s 1115 waiver in 2018, granting the Department of Healthcare and Family Services the ability to implement 10 pilot programs to address the state’s behavioral health system. The initial goal, officials said, was to pilot treatments for addiction to opioids and other substances that were not directly available to Illinois Medicaid beneficiaries. But numerous factors in recent years, ranging from the COVID-19 pandemic and its challenges to Pritzker being elected after the initial waiver was submitted, have changed priorities. Officials are now seeking to rename the plan the Illinois Healthcare Transformation Section 1115 Demonstration to “better align with the state’s overall goal and current efforts to create an equitable and sustainable healthcare system for Illinoisans.” “(HFS) now seeks to leverage Section 1115 Demonstration authority to secure additional Medicaid resources to sustain the groundbreaking work already underway and seed additional innovations,” according to the application. CMS said late last month that they have extended the state’s demonstration through next June as the two sides continue negotiations over the current extension application. The federal public comment period will be open until July 28. ###

Chicago Mayor Brandon Johnson’s administration last week unveiled its transition report that touched on ways to improve healthcare in the city, including reopening all city-run mental health centers "in phases." [Health News Illinois]

The report, compiled by Johnson’s transition team, says identifying which centers will also house 24/7 mental health crisis and stabilization services are important for community care and crisis response. It does not set a timeline for when the reopenings may occur.

“In addition to appropriate staffing by behavioral health professionals, community health workers should be hired to staff mental health centers, crisis response teams, and to engage individuals with high levels of unmet need via community-based services,” the report states.

The city closed six of its mental health clinics in 2011, a decision that has drawn criticism from progressives like Johnson, who has repeatedly called for the centers to be reopened.

The recommendation was part of the transition team’s goal to overhaul Chicago’s mental health system, one of 12 healthcare goals listed in the report. Other goals include:

·    Improve the city’s ability to apply for federal and state grants.

·    Integrate services to better address social determinants of health.

·    Declare a human services state of emergency.

·    Improve surveillance and data infrastructure.

·    Increase focus on addressing environmental health.

·    Recognize the importance of the healthcare workforce.

The report says the goal of healthcare reform in the city should focus on addressing longstanding racial inequities in the health system.

“We envision a Chicago in which all of the health and human services needs of our constituents are anticipated and met throughout a person’s life and in which each person is provided the specific support they need to grow, thrive, and live healthfully.

 Read the full report here

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It’s been three years since healthcare organizations and industry groups across the country made promises to achieve health equity.

Lessons learned and experience shared here.

Listen to the full podcast to hear more details. 

Made in the wake of a national racial reckoning—driven in part by George Floyd’s murder and the stark racial disparities made evident by COVID-19—these commitments zeroed in on how organizations can weave health equity into their everyday work.

At Stanford Medicine Children’s Health, that meant building out a Diversity, Equity, and Inclusion committee. The organization started its change toward stronger health equity focuses at the top with leadership, but then moved throughout the organization to build out a committee that would be multifaceted.

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July is National Minority Mental Health Awareness Month, a time to bring awareness to the unique struggles that racial and ethnic minority communities face regarding mental illness in the United States.

According to the Substance Abuse and Mental Health Services Administration, in 2021, it was estimated that only 39 percent of Black or African American adults, 25 percent of Asian adults, and 36 percent of Hispanic/Latino adults with any mental illness were treated, compared to 52 percent of non-Hispanic white adults.

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There’s no question that the next version of the COVID-19 vaccine in the US will contain

components of Omicron subvariant XBB.1.5.

What’s still up in the air, though, is who should get the shot when it debuts this fall.

On June 15, members of the US Food and Drug Administration’s (FDA) Vaccine and Related Biological Products Advisory Committee (VRBPAC) voted unanimously to recommend updating the COVID-19 vaccine composition to a monovalent XBB lineage.

On June 16, the FDA announced that it had advised manufacturers planning to update their COVID-19 vaccines that they should specifically target XBB.1.5. Scientists from Moderna, Novavax, and Pfizer had told the FDA and its advisory committee that their XBB.1.5 monovalent vaccines could be ready to inject into arms by late July or early fall.

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The reimbursement changes also reflect an estimated 0.2% increase due to an updated fixed-dollar loss ratio, according to regulators.

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Should immigrants lacking permanent legal status arriving in Chicago in big numbers get free health care paid for by the state?

It makes sense to provide at least basic medical services to refugees and others in need. Immigrants lacking permanent legal status often are refugees with children who have undergone arduous journeys and have few resources at their disposal. Paying attention to preventive care in the present often prevents expensive emergency room visits and other costly interventions down the road. And refugees deserve a humane welcome to the state. [Chicago Tribune]- Photo by Antonio Perez.

Nobody in an advanced society wants to deny a sick child medicine. Nor should they ever do so.

But U.S. health care mostly relies on a system of private insurance, something that immigrants lacking permanent legal status typically do not have. And health care in this nation is wildly expensive. That explains why Gov. J.B. Pritzker announced Friday some limitations on what had been closer to a carte blanche. 

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