Governor Steve Bullock today announced a $10 million, 5-year federal grant to launch a program to address disparities in maternal health and improve health outcomes for pregnant and postpartum women living in rural Montana.
“This is an excellent opportunity to elevate healthcare services for pregnant and postpartum women who have little or no access to high levels of obstetrics care,” Governor Bullock said. “The launch of this program gets us one step closer to ensuring that every woman in Montana has equal opportunity to access affordable and quality care.”
The Montana Obstetric and Maternal Support (MOMS) program is expected to launch beginning in early 2020. The new program will leverage existing telehealth efforts, focus on specialty care, bring more obstetric-focused training opportunities to rural Montana communities, launch or expand mental health and substance use counseling, and establish medication-assisted treatment for pregnant and parenting woman battling addiction.
“This program will help us build on current efforts with our partners to create sustainable changes to the way we’re delivering healthcare in Montana,” said Sheila Hogan, Director of the Montana Department of Public Health and Human Services (DPHHS).
The program will use telehealth to connect OB/GYN specialists living in urban communities with providers treating high-risk pregnant and postpartum women living in remote areas of the state to ensure patients have expert care. Beginning in early 2020 using Billings Clinic’s Project ECHO (Extension for Community Healthcare Outcomes), urban-based OB/GYN experts will be linked to rural providers to share their expertise via mentoring, guidance, feedback and didactic education.
Later in 2020, OB/GYN physicians from Billings Clinic and other urban centers will offer live remote consultation to rural providers who have high-risk pregnant and postpartum patients. Consultations will take place during emergency situations and during regularly scheduled appointments, making it possible for rural providers and their patients to gain access to an OB/GYN without leaving their community.
A toll-free dedicated maternal health call-in line for rural providers to access OB/GYN experts and receive live, real-time consultation on specific cases will be available.
The need to implement these evidence-based strategies is due, in part, to shortages in OB/GYN specialists and mid-level providers of maternal healthcare. More than half of Montana’s counties do not have an obstetric physician or mid-level professional, such as a nurse practitioner, providing maternal healthcare.
“Big Horn County is over 5,000 square miles and we don’t have a single hospital with a delivery program,” said Kristi Gatrell, CEO of Big Horn Hospital. “The nearest birthing hospitals are more than 50 miles away from Hardin in Billings, and many more miles away for women in more remote areas of the county. Access to this type of expertise on a regular basis will be a tremendous benefit to our patients.”
The program will be available statewide using Project ECHO technology, and will launch initially among rural hospitals and clinics within the Billings Clinic’s telemedicine network, which serves nearly 30 Montana communities throughout Montana.
According to the US Centers for Disease Control (CDC), Montana has the 6th highest maternal mortality ratio in the nation. Women in Montana’s rural and Native American communities face the highest risks.
“By bringing more resources to rural Montana, we hope to improve maternal health outcomes by collaborating on high-risk pregnancies, promoting the importance of prenatal care in the first trimester and identifying and consulting on these cases early in the process,” said C.H. “Tersh” McCracken III, MD, FACOG, an OBGYN at Billings Clinic and Medical Director of MOMS.
The Simulation In Motion-Montana trucks will also be part of MOMS and will travel to participating rural clinics and hospitals to offer high-tech training using life-like manikins.
The grant will help fund a Maternal Mortality and Morbidity Task Force that will include members from state and local public health professionals, providers, payers, legislators, tribes, physicians, and other partners. The Task Force will be charged with reviewing select cases and providing recommendations on prevention activities.
In partnership with the MOMS program’s evaluation team at the University of Montana, the funding will also be used to collect and analyze maternal health data to improve maternal health interventions and to support isolated rural providers.
MOMS will complement the existing Perinatal Behavioral Health Initiative, now known as the Meadowlark Initiative, which supports hospitals around Montana to develop teams that include behavioral health providers and care coordinators to address problems such as depression and substance use. The effort is a partnership with the Montana Healthcare Foundation and DPHHS. Currently, 11 hospitals and health centers from communities across the state have joined the initiative and are providing pregnant and postpartum women and their families with effective, supportive care for behavioral health needs like mental illness and substance use disorders.