Support for Arkansas Week provided by the Arkansas Democrat-Gazette.

The Arkansas Times and Little Rock Public Radio.

Welcome to Arkansas Week.

Thanks for being here.

I'm Dawn Scott.

Arkansas has the highest maternal mortality rate in the nation, making it one of the riskiest places to have a baby in the United States.

This is a topic we've discussed at length here on this program and with many state leaders.

And we continue this now with State Representative Aaron Pilkington of Knoxville.

He is involved with a number of bills filed for the upcoming session that begins next month.

And we certainly appreciate you being here and we appreciate you sharing your knowledge and your information to try to tackle this very important issue.

One of the pieces of legislation would require Arkansas's Medicaid program to provide blood pressure monitors to pregnant women and postpartum women for up to a year after giving birth.

So let's start there, Representative.

What is this initiative and why is it so important?

Well, it's one of the issues is we found a lot of a lot of maternal deaths are related to cardiovascular issues.

And so by by providing these blood pressure cuffs to women who are on Medicaid, we're able to track and use remote patient monitoring tools to make sure that if there are problems after birth, we're able to identify them early on and get them seen by the provider they need to be seen.

And so this was through a working group on maternal health I've been a part of with other legislators in other states, was the model legislation we've seen in a few other states and so I wanted to put it forward.

You know, currently I understand Medicaid will allow you to rent them but not have them.

And so we want to we want to have the most be able to take them home, have them.

Now, worry about the concern, because obviously someone's getting back to the doctor's really hard.

And so this is a good way to monitor these women, these high risk women that are most likely to have a negative health outcome.

And so by getting in and doing this early intervention, we can prevent the something catastrophic from happening.

I mean, the numbers are staggering.

I mean, just, you know, earlier this year, Sarah Huckabee Sanders, our governor, was sharing that of the 35,000 pregnancies in Arkansas each year, 10,000 women wait until after their first trimester to see a doctor.

11,000 women never see a doctor until they're in labor.

Why are the numbers like this?

Well, it's it's a couple of things.

So, one, I think access to care is a huge issue.

You know, we have a lot of deserts, maternal health deserts here in the state.

You see labor delivery units all across the state shutting down.

Actually, recently I saw a few months ago, Newport, Arkansas, just lost their labor and delivery.

So access is one part, but but another part, too.

I think there's a little bit of a, you know, a kind of a cultural aspect of it as well.

You know, people think, I don't need to go to the doctor this soon.

It's very early on.

In reality, though, as soon as you think you're pregnant, you probably should go start seeing and take care of yourself and do doing prenatal care.

So that's that's one part.

But another part, too.

And this is why I filed the bill on presumptive eligibility, is a lot of people think, ah, sorry, a lot of women get pregnant, but say, I don't have insurance, I'm not covered.

And so or they don't know how to they're working.

Maybe they're they're single, you know, seem to be single mothers or they they don't have time to take off work and it suddenly becomes a big bear for them.

And then they put it off and next thing you know, they're walking into the E.R.

when they're about to deliver, and which is probably the worst.

We're glad they're going into a hospital.

But, you know, we would have liked to see them months ago because so many of these birds are high risk births at that point.

So by allowing women to get presumptive eligibility, they can go in and see that doctor early on.

They can get prenatal care that they need.

And then that way, we're not having these situations where, you know, it's 11:00 at night and a young woman walks into to a hospital saying, I'm in labor and I need to be seen.

And a lot of these allegations do not know, you know, the patient history or or any of any of case there might be.

So they're flying, you know, a little bit flying in the dark.

And so, you know, then that also adds to having bad outcomes, because if you're having to do an emergency C-section or something like that, because it is a high risk pregnancy, I mean, those just add complications and costs and of course, you know, increase the risk of a maternal death in the future.

I mean, to that point, UAMS data showing 8.6 deaths per 100,000 live births compared to the national average of 5.4.

So, I mean, clearly we have the third highest infant mortality rate in the nation with 7.67 infant deaths per 1000 live births as 2022 data.

But it points to why this is so important because some might say this is a health care issue.

It's not a legislative issue.

Why is Representative Pilkington talking about this?

But we have to have help.

We've got to have support.

Sure.

And, you know, in six, 8% of all births are Medicaid births.

In Arkansas State pays for it is you know, that is the payer that's the Medicaid is so you know we have to be involved because a lot of times we're paying for these.

And so I tell people all the time, if we're able to reduce the C-section rate, we save the state money.

If we're able to reduce these outcomes, we're able to say to save money.

So there's actually an economic issue to it as well.

But, you know, the state regulates health care quite a bit.

It's just the nature of the beast.

And so because of that, we have to be involved.

We have to be part of it.

But I think, too, you know, a lot of our constituents ask us, you know, this is a problem, but they don't know how to fix it, but they want to see something change.

And so I tell people all the time, you know, we claim to be the most pro-life state in the nation.

We are, according to a lot of pro-life groups, But let's put our money where our mouth is and and take care of women in the prenatal care and postpartum areas of their life because if we're not, then I think we're not living up to what we believe in ourselves.

To say that we care about women and babies from womb to tune.

Well, one piece of legislation specifically that you had, I believe you had proposed was that Medicaid coverage for Arkansans lasts then for a full year after birth.

Currently, it's only for 30 days following.

Is that correct?

So currently it's for six weeks.

49 other states have done the extension from six weeks to 12 months.

And so we had legislation last session to expand that.

We didn't run it.

There was belief that among a lot of my colleagues that and through DHS that everyone was already covered and so we pulled it back.

We want to make sure that we could find coverage for everybody, because there are some pockets where Medicaid expansion state and so there were some would fall into that.

Now, we actually had a report that came to the public health, I think, two months ago, and we saw that actually one third women were falling through the gap and they weren't getting coverage.

So I filed new legislation for this upcoming session to do the 12 month expansion, but making sure that we auto enroll them into the Ah Homes program, which is an existing program which you know, you heard the governor say before that she wants to make sure that we're utilizing existing programs, not just adding on new programs that may create inefficiencies within government.

So that's what I really like about that, Bill, is we're actually utilizing our existing programs.

And then if they don't qualify for our homes, our traditional fee for service, we could do an expansion for a much smaller population, which, you know, if you're a provider, you would rather have them on those qualified health plans because they actually they reimburse better and they don't end after 12 months.

They go to month 13 and 14 and and so on.

So I think it's a it's a smart way to to extend that policy.

But it's it's a great way to, in my mind, you know, that six six weeks is not a lot of time.

And so when you think about especially if you've got you know, had a traumatic birth experience or anything like that, you know, you're trying to get back to work, you're trying to heal and trying to take care of a new a newborn, all this is going on.

And then when you get a 42 page and Medicaid enrollment document, it's really easy and you don't fill out in the right way.

It's easy.

Get kicked out of the system.

And reality, I just think at that moment it's the government should come in and say, if you are in this situation, you're vulnerable.

Let's make it to where it's a little easier for you to get coverage because in reality, we want you to get seen by your doctor.

We want you to get taken care of.

I mean, it's better for the state of Arkansas for you to be happy and healthy than to be in a situation in which you now develop a chronic issue that we're going to have to be paying for for the rest of your life.

Are you unfortunately passed?

So is there any legislation or anything you're working to do to make that process easier for not only women but anyone who needs, you know, Medicaid?

Well, the the the bill I mentioned about the 12 month auto enrolling and in our homes is big.

The presumptive eligibility, which that was a suggestion from the governor's task force on maternal health.

Those are two big ones to kind of make that process easier and kind of put the burden more on the state and less on the individual.

Because, you know, these, like I said, are the most to me.

If you want to talk about taking care of the most vulnerable, which Medicaid is there for, that is that most vulnerable group.

So those are those are kind of two bills.

I think that helps streamline the process because I think and it saves a lot of time in my colleagues, I'm more interested in people than systems.

And a lot of times we get very protective of the systems that we create in government.

And and unfortunately that comes at the expense of the people we're trying to serve.

Sure, our our desire with these programs is to make sure people get seen and they get served and they have health care.

We need to make sure that that's efficient.

And then that's the best way to take care of people.

And so so that's there's a phrase I use all the time.

So I'm more interested in making sure that we're helping out people and making sure that we have the perfect systems.

Well, it makes sense.

And I think we're going to have to reach people, especially in our rural areas.

And a lot of that is education and outreach.

And I don't know what the legislature is doing or can do to support that.

I know Uams is working on that piece of the puzzle.

Yeah, you're Miss has been a great partner in this as well.

You know, obviously they've got an OB department.

Dr. Manning's done great work.

We've given them money to create a midwifery program to help use mid-levels to expand a span of care into rural areas, which is a big help that we'll we'll see that grow.

But yeah, there is I mean, we need to also work through our education partners and community partners to make sure that there is more education around maternal health and and to even just having primary care doctors.

You know, a lot of them sometimes will see women for their prenatal care or even their postpartum care, because there's so there's a lack of jobs in certain parts of the state.

So helping and making sure that they get educated and giving them the resources so that that's an easier, easier ask for them is better to do because they're already overburdened.

I mean, our rural providers have so much on their plate and try to ask them to do more is really hard.

But this is such a vital issue.

And if we want to make sure that we're taking care of people, we've just got to tackle it head on with all, all institutions.

I think pulling in the same direction.

Sure.

What type of support are you getting for this initiative?

Well, you were talking about the Medicaid coverage expansion.

I know one of the thing I read about was expansion on ultrasound testing for women or other lawmakers supporting you.

Yeah, it's I would say it's there's 135 members, 35 100 the House.

So I would not say all of them are, but I would say a lot of conversations I've had, especially when this incoming session has been I heard on the campaign trail, this is an issue.

We've got to do something.

And so they say, I don't really know what that is, but I'm glad you're working on it.

You know, let's talk more.

And and so everyone, I'd say, is pretty receptive to it.

You know, obviously, when you hear about expanding Medicaid, people get like Vietnam flashbacks of of private option fights back in 2014.

Sure.

But then when you remind people what a small group this actually is, and especially now that the reporting we have that only, you know, puts the 34% of women are our fourth, the cracks.

That number gets even smaller when we talk about state spend.

So, you know, it's just there's there's some of that aspect of it.

But people want to make sure that we are being efficient and they say, gosh, you know, Medicaid takes up so much of the state budget.

So, you know, how is spending more going to do anything?

Because we have been spending more of we don't feel like we're getting the health outcomes that we actually want.

And I do think it's it's being smart and making sure that we're doing policies that actually make sense and get people the care they need.

But I would say most I would say from the right to the left to the center, everyone in the legislature does feel that we need to do something.

And for the most part, you know, everyone's got a bunch of ideas coming in as well.

So it's not just me.

Representative Lee Johnson has got legislation around dual as Mary Bentley.

He's got some legislation as well, as well as Missy Ervin, as Irvin has legislation around as well.

So there's a group of us who are working together to try to make this happen and and to see some improvement, all coming in from different angles.

And I remind people that there's no silver bullet.

There's not going to be one buildings.

If we pass this, we're going to shoot up to be to be in the best place in the in the country to have a baby.

But it is going to take time and it's going to take us all all working on the different systems, because I remind people, health care is an ecosystem.

It's it's not just one thing.

So when you pull in one string, it moves others.

And there's multiple factors and creating the situation that we have.

And so that's why you do see actually so much legislation around it, because we're trying to fix this part and this part in this part.

Well, we don't want to be last anywhere for sure, and we definitely want to take care of our moms and babies.

So we sure appreciate you being with us.

Representative Aaron Pilkington of Knoxville, thank you so much for being here on the program.

Thank you.

Thank you for we appreciate you.

And you are a mess.

Launched the maternal health scorecard and we will hear more about that after a short break.

Welcome back.

We are diving deep into maternal health in Arkansas.

Why are the numbers so high and what is being done to improve outcomes?

The University of Arkansas for Medical Sciences is taking steps to address these issues with the launch of the Arkansas Maternal Health Scorecard, as well as a study to address prevention strategies to reduce maternal and infant deaths.

So joining me, U-M's Dr. Jennifer Callahan.

Karru is an associate professor at the Fe W Bozeman College of Public Health, and she is also the director of the Primrose Project.

And we also have with us Dr. Stephanie Kennan McGill, who is the senior program manager for Bio Ventures and also the grant principal investigator and the project director of the Delta Mother Project.

Lots of titles for both of you.

You are deep into this.

We know we had a lengthy discussion with State Representative Aaron Pilkington doing his part on behalf of the legislature for this issue.

But we want to talk to you and we'll start with you, Dr. Callahan.

Karru We want to begin with the maternal health scorecard.

What is it?

How does it work?

How did you come up with this?

So the scorecard is a public data site that provides very easy access and contextual explanations about maternal health indicators in Arkansas.

So all of this information was already available, publicly available, but it was very difficult to locate.

You really had to be somebody who worked in that field to be able to find the information and interpret it.

So what we did is we followed an informatics approach to talk to stakeholders about maternal health in Arkansas.

What's the data that you need?

What would lay users also need to understand about this data to help with raising awareness and increasing advocacy for maternal health?

So the site has data from birth records, from the Maternal Mortality Review Committee, from hospital data that health researchers use to understand outcomes for hospital births, and also from some surveys of new mothers about some of their health behaviors and health care access.

So how does this information help?

Give us an example of the type of information you're getting and what you're doing with the information?

So the purpose of the scorecard is really to make it available really broadly to people in Arkansas so that they can understand and promote advocacy and awareness raising.

For example, one of the pieces of data that's on the site that's actually, I think I haven't seen anywhere else is we're tracking closures of labor and delivery units at Arkansas hospitals.

So we have a birthing hospital map where our hospitals the worst that available and that links to information on the Arkansas Perinatal Quality Collaborative site about what services are offered at each hospital.

But we're also tracking closures because in the past four years there have been at least five hospitals that have closed or paused labor and delivery services in Arkansas.

And so we're tracking that and showing what are the reasons that the hospital stated that they had to close labor and delivery.

And so those are the types of things that I think if there's more public awareness about and, you know, for all the stakeholders involved, we can take action on preventing more closures and addressing some of those issues.

We know we have health care deserts in our state, which limits access, and that's something I know you are working on as well.

Dr. Kenneth McGill.

You have a $2.4 million grant, which is incredible.

Tell us what this is being used for, about what it's being what what you're studying.

Yes, of course.

So this is a grant that's funded by the Office of Minority Health under Health and Human Services.

And it's through their grant mechanism that's entitled Community Health Innovations for Improving Health Outcomes.

And we have ventures and aims.

We like to support innovative solutions to improve health care, particularly in the state of Arkansas.

And as we have discussed and there has been a lot of focus on in the state, maternal and infant mortality and morbidity is a huge problem in the state, especially compared to the rest of the country.

And it's a very complex issue.

A lot of different factors.

You know, there's no one answer for what's going to work, but things like hospital closures or, you know, labor and delivery closures at hospitals, particular really in the Delta area are really exacerbating the problem.

And so, you know, our project is focused on figuring out innovative ways to reduce maternal and infant mortality, particularly among black women in the Arkansas Delta.

These women, unfortunately, are almost twice as likely to die in the first year of birth or after the first year of birth, compared to their white non-Hispanic counterparts in the state.

So there's obviously a big problem, and we are trying to take an all encompassing approach to attack this problem from different sides.

So so one is the community facing aspect.

So going into the communities, we have some wonderful partners and satellite sites in Helena, West Helena Lake Village and Pine Bluff that will allow us to go into the communities and reach the mothers where they are, reach the families where they are, provide them with access to resources, education, preventative health screenings and things like that.

Another part of it is working with providers to help them understand how to better reach these women.

So this is the work is also being done in partnership with the UMass Institute of Digital Health and Innovation, which is very big on telehealth, telemedicine, figuring out ways that people who are not, that providers who are not in the physical region can still help these women.

So working with providers to train them more on telemedicine, but also on things like health inequities and cultural considerations for reaching these patients.

And the third part of the program that I'm particularly excited about is because I feel like this is really innovative and is working with each year five students from HBCU's to have them identify a problem related to maternal health in the Delta region come up with the solution, and then we will equip them with entrepreneurial training and skills to turn that solution into something real.

So whether it's a nonprofit or a small startup or something like that, but something that's going to be a sustainable solution beyond the period of the grant, because that's kind of a big a big issue, you know, with these grant funded programs, you go in and you help and then when the grants, then what happens?

So well, you mentioned the racial component to this.

There's a socioeconomic component to this as well.

Do you have a firm reason why this is why there's such a stark contrast between an African-American woman and a white woman going for the same care?

I like I said, there is no one reason there are a lot of different factors that are going into this.

So one of the is one of the reasons is that there's physically not a lot of resources, there are physically not a lot of resources in this region.

So women having to go multiple counties over to get prenatal health care or to deliver their babies, obviously that's yeah, Yeah.

And so there's that there are different socioeconomic factors.

There is a higher rate of, you know, specific preexisting conditions like diabetes or even, you know, environmental issues like more exposure to second hand smoke and things like that.

There's transportation issues.

There's just the fact that a lot of these areas are very rural.

So it's hard for the women to to get to where they need to be.

There's nutrition issues, lots of different things.

Well, you mentioned just a multifaceted approach to this.

And so there's the Primrose project, which I want to hear more about, and then also the Arkansas Perinatal Quality Collaborative.

But let's start with the Primrose Project.

What is the Primrose Project doing?

What's the goal?

So the Primrose Project is a project funded by hers, a program called State Maternal Health Innovation Grants.

And so those grants are given to states to try to come up with innovations that will help address what are some of the root causes of poor maternal health outcomes in that state.

So one of the factors that that we're trying to address is maternal complications that end up at the emergency department.

So we know, particularly in the postpartum period and in areas where there's less access to maternity care, women who experience a complication can end up at the emergency department.

And emergency departments aren't always very prepared to recognize that it's an obstetric complication and then to manage that complication appropriately.

And so and that's one of the recommendations that came out of the reviews of maternal deaths in Arkansas by the maternal Mortality Review Committee is that emergency departments need to be trained to identify obstetric complications and address them.

So we do a simulation training and that's led by some of the faculty in obstetrics and gynecology at UMass, including Dr. Lillian Richer and Dr. Leslie Odom.

And we go in and teach the emergency departments about the differences between hypertension that's pregnancy related, and that's a real emergency and the hypertension that they're typically more used to seeing and how to recognize when it's an obstetric complication.

So there's a real education component to this.

Even within the health care community.

Yes.

So a lot of the work is around ensuring that we have the highest quality health care and that both our birthing hospitals are prepared to address any obstetric emergencies or complications that come their way or to prevent them.

And also emergency departments and across the spectrum are continuum of care.

Well, you also mentioned and we mentioned earlier, the Arkansas Perinatal Quality Collaborative as well.

Tell us about this.

So the Arkansas Perinatal Quality Collaborative, it's a network of health care facilities and providers and experts that work together to try and improve the quality of care we usually organize our work around initiatives.

So we've been doing an initiative for the past 18 months on preventing primary C-sections.

One thing we know is that if women have multiple C-sections, then they have much higher risk for some severe obstetric complications.

And if we can prevent that first C-section, then the that woman is set up for a much better trajectory in terms of her risks for complications in future pregnancies.

And so we've been working with the birthing hospitals.

All but one in Arkansas are signed up to participate.

They commit to implementing different practice changes on their unit to help reduce the chance of a C-section.

And that one's been going incredibly well.

There's been a great response, and we're about to start one on congenital syphilis prevention, because congenital syphilis, there's a syphilis epidemic nationally.

And in Arkansas, the rate of congenital syphilis has gone up, I think, 500% in the last five years.

And it's very preventable.

So these are the types of things we're raising awareness when these there are emerging problems coming up and working together to come up with strategies that can solve it.

Well, one thing that our state representative that was on just before you mentioned was there's no care for a number of these women prior to their becoming pregnant.

And so is that part of what you're working on, too, as well?

And so that's a great question.

So pre-pregnancy pre-conception.

Sure.

So I think that that's a really important thing to bring up because, you know, poor maternal outcomes aren't happening in isolation.

And especially if you want to understand Arkansas rates being among the highest for poor maternal outcomes, Arkansas is also among the highest for just poor general health status as well.

So, you know, a big contributing factor is population health generally and our women going into pregnancy healthy so that they're best set up to have a healthy pregnancy and healthy pregnancy outcome.

That's not something that we're currently directly addressing.

But I would say that on the scorecard, it's something that you can kind of monitor and see.

How is Arkansas comparing for protecting U.S. health like obesity, for example, among pregnant patients, how this Arkansas compare to other states in terms of moms co-morbidities going into pregnancy?

We have about 30 seconds, and I want to hear from you.

Just any final thoughts you may have.

And, you know, I think that this is I mean, as evident here just today, I think that there are a lot of people in the state who are doing a lot of amazing things.

And so and part of our project is to try and bring all of those things together and to help, you know, the specific women we're trying to reach.

But I am very hopeful.

I think that that by working together as a as a big collaborative, that this could actually make a significant impact.

We are certainly making headway, but there's a lot of work to be done.

And this is a topic we will continue here on this program and in our communities.

We thank you both.

Dr. Jennifer Callahan, Kuru and Dr. Stephanie Cannon.

McGill, thanks for being with me.

And that wraps up this week's edition of Arkansas Week.

I'm Don Scott.

Thank you so much for being here for this half hour.

And support for Arkansas week provided by the Arkansas Democrat-Gazette, The Arkansas Times and Little Rock Public Radio.