1. 1 Increasing Breastfeeding Among African American Women 2008 NCQA Recognizing Innovations in Multicultural Health Care Presented by Linda Hines, RN, MS July 15, 2009

2. 2 Understanding The Problem Breastfeeding rates differ substantially by race, socioeconomic level, and other demographic factors Racial Groups VPHP Population Mix Breastfeeding Mix Asian/Pacific Islander 2% African American 44%30% Hispanic5% White45%61% Unknown4%2% Total100%

3. 3 Challenges & Barriers Loss of Medicaid eligibility sixty (60) days postpartum 38% of pregnant eligible members are enrolled in VPHP in the last trimester of pregnancy which limits the time for prenatal breastfeeding education and encouragement Cultural barrier to breastfeeding in the Medicaid population – members feel that breastfeeding is for “poor people” without options Working mothers that do not have the support or time on their jobs to continue breastfeeding

4. 4 Goals and Rationale Increase the rate of breastfeeding among African American women in Richmond City and the county of Chesterfield from 22% (12/06) to 40% (4/30/07) Increase the length of breastfeeding efforts to at least four (4) weeks Educate members on the merits of breastfeeding such as improved health outcomes for their newborns Address barriers and the stigma of breastfeeding in the African American community

5. 5 Intervention and Implementation The Department of Medical Assistance Services (DMAS) sent letters to providers and hospitals introducing the initiative and requesting their support in educating and referring members for breastfeeding A universal breastfeeding referral form was developed to communicate service needs to community partners All African American women who chose to breastfeed received a home visit within several days of delivery for an initial assessment, support, education and possible community referral

6. 6 Intervention and Implementation Breast pumps were supplied to members at no cost to the participant to eliminate interruption to breastfeeding when separated from their infant A breastfeeding hotline was established that was linked to a RN nurse triage system so that after hours’ calls were routed to a nurse

7. 7 Intervention and Implementation Members were referred to lactation consultants as needed All members received a free breastfeeding video All members were offered to enroll in a breastfeeding class through their regional hospital

8. 8 Virginia Premier Health Plan Member Hospitals Resource Mothers Health Dep’t CHIP Department of Medical Assistance Services (DMAS) WIC Healthy Families Elizabeth Project

9. 9 Evaluation Methods Measures Breastfeeding Percentage All Virginia Premier African American mothers of live births in Richmond & Chesterfield who attempted to breastfeed All Virginia Premier mothers of live births in Richmond City & Chesterfield Length of time members breastfeed Evaluation of postpartum HEDIS rates Data Sources Medical Claims Medical record reviews Case Management System (CCMS) Member interviews/assessments

10. 10 Impact 37% sustained the effort >1month 54 % 56.69% 62.53% 48% 50% 52% 54% 56 % 58% 60% 62% 64% 200520062007 Postpartum HEDIS RatesBreastfeeding Results

11. 11 Moving Forward All interventions maintained and expanded to entire membership Community agencies continue to assist with efforts Initiated postpartum incentive Outreach visits to members in the hospital

12. 12 Sustained Efforts

13. 13 Sustained Efforts

14. 14 Questions Linda Hines, RN, MS Vice President, Medical Management Virginia Premier Health Plan, Inc. 600 East Broad Street, Suite 400 Richmond, Virginia 23219 lhines@vapremier.com (804) 819-5163