Since it began in 2011, the South Carolina Birth Outcomes Initiative (SCBOI), based at SCDHHS, has been a bright spot in our state’s healthcare landscape, bringing together more than 100 stakeholders each month to make a difference in the lives of newborns and mothers. Its tremendous success has become a national model for how to make a difference on longstanding public health issues and to improve cost savings, both which have proven difficult to tackle in the past.
Last week, the initiative celebrated its fifth anniversary, marking a milestone in efforts to improve the health outcomes for moms and babies throughout the state. The moment also provided an opportunity for the group to take a step back and recognize how much they have accomplished over the last half-decade. By targeting specific areas that could lead to a reduction in the infant mortality rate and the disparities between white and black patients, South Carolina has seen the needle move on the highest level. In 2011, the state’s infant mortality rate was 7.4 per 1000 live births, with African-American rates at 12.6 per 1000. Five years later, the overall number has dropped to 6.5 per 1000, with African-American rates down even more dramatically at 9.3 per 1000.
The story of the initiative begins with the South Carolina Department of Health and Human Services (SC DHHS), the South Carolina Hospital Association (SCHA), March of Dimes and BlueCross BlueShield of South Carolina (BCBSSC) agreeing to work alongside healthcare providers throughout the state to impact one of the most important aspects of population health: birth. The collective found early success in campaigning against non-medically necessary early elective deliveries (EEDs) between 37-38 weeks gestation. By October 2012, the CEOs of all 44 birthing hospital in South Carolina had signed a written commitment to stop the practice, and four years later 76% of those hospitals boast a 0% rate of EEDs.
That inaugural year also saw South Carolina become the first state in the nation to revise its Medicaid policy to cover inpatient insertion of LARCs immediately after delivery, a move which dramatically reduces the rate of unintended pregnancies for new mothers and leads to healthier outcomes. As of June 2016, 11 hospitals are doing inpatient LARC insertions immediate after delivery, with the three largest hospitals doing this for up to 30% of new mothers.
The initiative also announced the Race to the Date program in 2012, a $1 million incentive program to encourage hospitals to achieve baby-friendly certification. That designation is built around strict criteria and given to providers who have built a culture that supports breastfeeding and breast milk as the standard in neonatal care. By September 2013, four hospitals were rewarded $200,000 for achieving the designation; as of this writing, 11 out of 44 birthing hospitals in the state now qualify as baby-friendly, with 36% of all births and 34% of SC Medicaid births occurring in a baby-friendly hospital.
Other projects that grew out of SCBOI include the introduction of the CenteringPregnancy model, which is designed to provide prenatal care to patients in a group setting and has been shown to dramatically reduce the odds of a preterm birth as well as the racial disparity gap; and The Mother’s Milk Bank of South Carolina, a non-profit milk bank that helps collect, pasteurize and distribute breast milk to hospitals throughout the state. SCBOI also championed the SimCOACH™, a fully-equipped mobile simulation training center which provides training on best birthing practices to clinical professionals onsite at each South Carolina birthing hospital.
SCHA is proud of the work SCBOI has accomplished and looks forward confidently to what the initiative can accomplish in the next five years.