New health care programs are launching, thanks to $1.5 billion promise from the feds

Sade Booth was roughly seven months pregnant, on bed rest and living in a car with her husband when she was connected to a new pilot program in Pierce County earlier this year.

Doctors were worried Booth would have her baby early, and added stress from her living situation was not helping. At one point, she was forced to sleep with her legs above the steering wheel of her Volkswagen to help alleviate painfully swollen feet.

After Booth met Elizabeth Clark, a community health worker for the program, her situation changed drastically. Clark helped Booth coordinate medical appointments, found her family an apartment in downtown Tacoma and helped get Booth’s husband a temporary job.

Booth delivered the baby after a full term.

“Now it’s like we are moving forward, and we’re not just stuck at a dead end,” Booth, 25, said in a recent interview. “We are actually looking at the brighter things in life (rather) than, ‘Oh, we’re homeless, and we’re sleeping in our car.’ ”

Booth is an early beneficiary of the Pathways Passage2Motherhood program, an innovative project launched in March as part of a multifaceted initiative by state lawmakers and health officials to improve Washington’s health care system for low-income residents on Medicaid.

Much of that work — backed by a long-sought federal waiver promising up to $1.5 billion over five years — is in its early stages.

It includes a broad set of goals for new reforms and government programs, overseen by nine regional organizations called Accountable Communities of Health. Improvements to the elder-care system, merging physical and behavioral health treatment for Medicaid patients and helping people on Medicaid find jobs and housing are among top priorities.

Pierce County’s Pathways program is one early and tangible result.

The pilot project seeks to connect women from under-served communities — many of whom are at risk of delivering low birth-weight babies or have had past pregnancy complications — with services typically spread around various government and nonprofit groups. That includes housing, transportation, employment and more. Instead of women and families trying find each need separately, the Pathways crew acts as a fixer to bring all the needs directly to clients.

“When you go to the doctor they say, ‘We can’t help you with housing, this is the doctor,’ ” Clark said, drawing a contrast to current systems.

The Pathways program currently has eight community health workers and hopes to enroll 250 pregnant women by the end of the year.

Alisha Fehrenbacher, CEO of the Pierce County ACH, said other states, including Alaska and Ohio, have had success with similar programs. The ACH hopes to expand the model to fit other people in need beyond pregnant women in the future.

Teresa McCallion, a spokeswoman for the Pierce County ACH, said the program was chosen in part because it has had success elsewhere but also because of troubling inequities in infant health locally and in Washington state.

Black and Native American babies die twice as often as white infants in the state, and Pierce County is one of three counties in the state with higher than average mortality rates, according to the state Department of Health.

While Pierce County fits the state and national average for low birth weight babies at 6 percent, black women in the county give birth to low-weight babies at an 11 percent rate, according to county data compiled by countyhealthrankings.org.

The program is a small part of the large tasks remaining for the nine ACHs. For example, with the aid of the federal money, they’re overseeing the impending integration of physical and behavioral health care in the state, which is a huge logistical effort. Many lawmakers and health officials contend merging the two practices will create a more comprehensive system easier for patients to navigate.

While the programs have attracted relatively wide support, some at the Legislature have been wary the undertaking could leave the state on the hook for extra costs. After Washington’s Health Care Authority successfully secured the federal waiver, Republicans in the state Senate rejected it in their 2017 budget proposal.

Sen. John Braun, a Centralia Republican and the top GOP budget writer, told media at the time he was concerned the state would create new programs only to feel obligated to shell out money to continue them — or be forced to shut them down — once the federal money ends.

Braun was unavailable to talk late last week about the waiver programs as he was on duty with the U.S. Navy Reserve, a legislative spokesman said. But he said in March 2017 that Republicans were “very cautious about walking into additional federal funding without fully understanding the long-term costs.”

In the end, Republicans, who then controlled the state Senate, accepted the waiver in the two-year budget.

Health officials have tried to tamp down concerns of rising costs.

Robbi Kay Norman, the co-founder of health care reform company Uncommon Solutions, said the federal waiver is not a grant; it comes with strings attached. The state and the ACHs must demonstrate success and savings along the way to continue to get money, she said. The goal is to make the projects sustainable and not require new state dollars.

Norman is working with the Pierce County ACH as a consultant.

Sustainability will in part come from the streamlining of fragmented government processes for providing care, officials say.

“If we create enough efficiencies across care settings, and we actually reduce duplication within those settings, those efficiencies or cost savings or cost avoidance ... would then be realigned and reinvested back into the system,” Norman said.

While it’s too early to tell if those savings will pan out, there is evidence such cost-cutting and health care improvement is possible with the Pathways project.

A program in Mansfield, Ohio, that Pathways is modeled after has realized significant savings, according to a report in The (Cleveland) Plain Dealer. Women with full-term babies delivered at a healthy weight typically need less hospital care, such as stays in neonatal intensive units and emergency rooms.

For Booth, the program was successful. She has three other children, and all of them were delivered prematurely. two of them were underweight, she said. But her new baby, born on time in July, was 8 pounds and 4 ounces. Booth’s family is living safely in an apartment, and her husband recently began a full-time job.

“I know we’re not near done with our issues and problems that we have in life,” Booth said. “But right now we are in a way better position than what we were in a few months ago.”

This story was originally published August 19, 2018 at 10:16 AM.