Guidelines for Grant Applications to CareFirst BlueCross BlueShield -for- Addressing Disparities: Improving Maternal and Birth Outcomes

Transcription

1 .+ Guidelines for Grant Applications to CareFirst BlueCross BlueShield -for- Addressing Disparities: Improving Maternal and Birth Outcomes Issue Date: December 10, 2018 Submission Deadline: January 14, 2019 by 11:59 p.m. EST

2 Addressing Disparities: Improving Maternal and Birth Outcomes This document describes the purpose of the CareFirst BlueCross BlueShield (CareFirst) Addressing Disparities in Maternal and Child Health: Improving Birth Outcomes request for proposals (RFP) for up to $2 million over 2 years, eligibility criteria, and the procedures to follow in submitting a proposal. Please review these guidelines carefully, provide all requested information and submit your proposal in the requested format. All proposals must be submitted using the online application at Background Infant mortality rate (IMR) is a barometer for the health and wellbeing of a population. In 2016, the IMR of the United States (U.S.) was 5.9 deaths per 1,000 live births, which was far greater when compared to other industrialized nations [1] and especially pronounced in marginalized communities. While, integrated efforts to reduce the infant mortality have improved health outcomes, we have far to go. Between 2000 to 2014, the 16% improvement in U.S. IMR was half that of comparable countries [1]. The CareFirst region, including Maryland, District of Columbia (D.C.), and Northern Virginia, has reduced their IMRs to historic lows, yet rates continue to outpace the national average. In 2016, Maryland s IMR was 6.7 deaths per 1,000 live births. The Maryland Department of Health has seen a statistically significant decline in infant mortality led by Baltimore Metro Area and the National Capital Area. Maryland Vital Statistics states that Prince George s County alone experienced a 20% drop over the 5-year periods between [2]. According to the 2018 report on Perinatal Health and Infant Mortality Report, the DC IMR in 2016 was 7.1 deaths per 1,000 live births, almost half the IMR in 2007 of 13.1 deaths per 1,000 live births [3]. While the CareFirst Northern Virginia region generally has a lower IMR (3.7deaths per 1,000 live births) than the Virginia Department of Health s state-wide targets of 5.2 deaths per 1,000 live births, there remain areas of need especially when we consider racial disparities in birth outcomes [4]. According to the Centers for Disease Control and Prevention, the top 10 leading causes of infant mortality include low birth weight (<2500 grams) and pre-term birth (<37 weeks of pregnancy), accounting for about 17% of infant deaths, nationally [5]. Factors contributing to the low birth weights and pre-term births include tobacco, alcohol, and substance use during pregnancy; socio-economic position, age, and racism; as well as behavioral health conditions, somatic disorders (obesity, asthma, diabetes), and pregnancy history [5]. Table 1: National Capital Area Regional Maternal and Child Health Statistics (2016) Maryland District of Columbia Northern VA (District 8)* Infant Mortality Rate (per 1,000) Percent Pre-term birth 10.1% 10.8% 9.6%** Percent Low birthweight 8.5% 10.1% 7.1% *Please note that while we reference Virginia Planning District 8 generally, CareFirst funding is only designated to Maryland, D.C., and counties/cities in Virginia within our service area east of Route 123. Baltimore City is currently receiving funding therefore will be excluded from this grant. **Data were unavailable for District 8, therefore 9.6% is represented for all of Virginia Sources: [2] [3] [6] [7] [8] [9]

3 Purpose Under its CareFirst Commitment Initiative, CareFirst dedicates resources to initiatives that expand access to health care and public health services and catalyze change through improvements in the health delivery system. In addition to financially supporting private and public programs that provide access for marginalized populations, CareFirst also invests in innovative programs and other initiatives that stimulate productive, long-term improvements in health care and public health systems. CareFirst is providing up to $2.0 million over two years to improve maternal and birth outcomes in our service regions: Maryland, D.C., and Northern Virginia (areas east of Route 123). No applicant should request more than $500,000 total in funding over 2 years. Please note that Baltimore City is currently receiving funding through the B more for Healthy Babies initiative and therefore we will not accept applications impacting Baltimore City. The ideal project is one that achieves significant improvement in outcomes for a targeted population group. A project which is collaborative and can be expanded or replicated in nearby communities and that includes a plan for sustainability beyond the period of funding is strongly preferred. Target Population Addressing birth outcomes such as IMR requires a deeper understanding of communities that face disparities in outcomes. IMRs vary by geography and the disparity between non-white mothers to white mothers is high. Across Maryland, D.C., and Northern Virginia, marginalized communities experience higher rates of infant mortality and its associated causes, including social determinants of health. (Table 2) In D.C. alone, the IMR among black mothers is nearly 5 times higher and Hispanic mothers is 1.6 times higher than of white mothers [3]. This trend has maintained over time. Table 2: Disparities in Infant Mortality Rates by Region (2016) Maryland District of Columbia Northern VA (District 8**) White Black Hispanic/Latinx Not Available Other 2.0 **Please note that while we reference Virginia Planning District 8 generally, CareFirst funding is only designated to Maryland, D.C., and counties/cities in Virginia within our service area east of Route 123. Baltimore City is currently receiving funding therefore will be excluded from this grant. Sources: [2] [3] [6] While the primary outcomes of this RFP focus on enhancing systems and strategies to address infant mortality, we are also interested in initiatives addressing maternal health outcomes. In 2015, the United States (US) had a higher maternal mortality rate than Russia, Costa Rica, Kazakhstan, China among others [10]. While maternal mortality rates (MMR) decreased in all other developed countries, MMR has more than doubled in the US from 7.2 deaths per 100,000 live births 1987 to 18.0 deaths per 100,000 live births in 2014 according to the Centers for Disease Control and Prevention [11]. According to a report from the CDC Foundation, 60% of pregnancy related deaths from three maternal mortality review committees were found to be preventable [12]. Additionally, black women were 3.22 times more likely to die due to pregnancy-related deaths, compared to white women; similar unacceptable rates have

4 persisted in Maryland since the 1940s (figure 2 from Maryland Maternal Mortality Review 2017 Annual Report) [11, 13]. Outcomes At minimum, the project must address one of the seven key areas identified for the maternal and child health initiatives and provide specific means for measuring how the program/service will improve outcomes. CareFirst is especially interested in promoting creative initiatives that address factors that contribute to poor birth outcomes including but not limited to: Birth Spacing Breastfeeding Adoption Implicit bias/racism Prenatal Care Initiation in First Trimester Maternal Depression Maternal Obesity Safe Sleep Smoking and Substance Use Treatment Eligibility Criteria Eligible applicants include qualified 501(c)3 non-profit organizations or public (governmental) health entities in our service region of Maryland D.C. and Northern Virginia (east of route 123). We support partnerships, including but not limited to nonprofits and government agencies (e.g. public health departments) and/or other community-based organizations both within and outside the health sector. Proposal Content and Preferences The ideal proposal will present promising changes to enhance capacity and delivery systems on a sustainable basis. It will also propose to align well with regional perinatal strategies and provide a detailed plan for developing, implementing, and evaluating a maternal and child health initiative or service within a public or non-profit setting, with a focus on evidence-based interventions. Proposal are required to: Describe the applying organization, experience, and need Describe the grant project, target population, expected reach (number of people served), and project staffing Provide a sustainability plan beyond the grant period, particularly if any portion is proposed to support staffing Provide an implementation plan (or work plan) Include a budget and budget justification for project needs Include an evaluation plan with measurable goals, outcomes, as well as a plan to incorporate evaluation early in the initiative The grant proposal must be completed and submitted using the dedicated on-line Maternal and Child RFP Application by Monday, January 14 at 11:59 p.m. (EST). In addition to describing how your proposed project would satisfy the requirements as set forth in this document, the on-line application will prompt you to include other components in your proposal to assist CareFirst to better understand your

5 organization and your proposal. Please access the on-line application and link to the work plan by going Selection Criteria Proposals for addressing substance misuse and substance use disorders are limited to organizations serving the CareFirst Maryland, District Columbia, and areas of Northern Virginia (located north and east of route 123, including portions of Fairfax, Alexandria, and Arlington Counties). Baltimore City is currently receiving funding therefore will be excluded from this grant. CareFirst will consider requests that include activities that address the following but not limited to: safe sleep, smoking cessation, prenatal care, birth spacing, breastfeeding adoption, maternal depression, and maternal obesity. Reminder The grant proposal must be completed and submitted using the dedicated online RFP application by Monday, January 14 at 11:59 p.m. (EST). Please access the on-line application and link to the work plan by going to Evaluation Criteria The following section describes CareFirst s criteria for evaluating the applications and the expectations of your organization should you be selected to receive a grant. A portion of funds may be used for the evaluation process, not to exceed 10% of the overall budget. The overall proposal and work plan will be evaluated on the following criteria: 1. Organizational Background, Commitment, and Financial Viability a. The applicant will: i. be committed to improving quality of life and health outcomes for the targeted population, ii. demonstrate how its proposed project will contribute to this goal(s), iii. demonstrate sound financial standing, iv. have sufficient financial management systems, v. demonstrate the capability of managing grant funds, 2. Community Need a. The proposal should demonstrate an understanding of the community it seeks to serve. It should clearly define the geographic location and targeted population to be served. b. The number of unique individuals must be reliably quantified, and the needs of this population documented through qualitative and quantitative data, such as demographics, rates of insurance coverage, service utilization statistics, and health risk factors including social service needs. c. Baseline numbers for the targeted population must be clearly stated and supported. 3. Program Development and Project Description a. Proposals should describe the purpose of the project, what activities the project will conduct, and who is included in the target population. b. Proposals should provide clear and succinct program theory of change. c. Proposals should describe how the program or project will improve birth outcomes/services in Maryland, the D.C., and/or Northern Virginia d. Strategies to increase access, improve quality, and enhance systems to achieve improved outcomes for the program s target population should be based in evidence. Proposals should describe the rationale and evidence for program.

6 e. Program or project implementation including but not limited to recruitment, enrollment, service provision, and follow up should be outlined in detail. f. If applicable, proposals should describe how program partners will support activities and goals in detail. 4. Participation of Stakeholders and Partners a. Proposals should include a list of key participants and relevant stakeholders, including health or non-health sector stakeholders, and their roles/responsibilities. b. Any project partners/collaborators should be actively engaged by participating in the planning and implementation process and allocating staff or other resources, contributing facilities or equipment, or providing free or discounted health care services to the project. c. Proposals must provide Memorandums of Understanding (MOUs) for all project partner organizations or agencies as attachments. Any MOU should clearly delineate partner/collaborator s contribution to the project. 5. Data collection and Evaluation a. Proposals should describe how data for the project or program will be collected and how that data will be used to manage, monitor, and/or enhance services. b. The grantee should have a demonstrated ability to measure output, outcome, and goal measures to show progress through quantitative measures, such as the number, demographics, characteristics, and service utilization of the targeted population, both at baseline and as the project proceeds. c. The grantee must be able to comply with the monitoring and evaluation requirements inherent in this grant program. 6. Sustainability a. Proposals should demonstrate the benefits to the specific population and the larger community, particularly alignment with regional maternal and child health strategies. b. Proposals should identify likely revenue sources or non-traditional partnership to sustain the program and/or its effects beyond the term of the grant. c. Evidence of past accomplishments will help demonstrate the grantee s capacity to successfully maintain the program. d. Strong preference will be given to proposals that demonstrate community support for their programs or services by the magnitude of funds an organization generates internally and/or through community matching support. Potential Metrics for Measuring Impact Below, we provide a list of metrics for measuring effects of services. A small portion of this list will be required; other measures are illustrative. Measures can focus on both services provided and longer-term program goals, however all proposal should provide baseline metrics and targets. Preferred are programs that establish baseline and outcome data, which can be used to leverage new funding streams for program replication, and/or sustainability.

7 All proposals Metrics of Interest Required Measures Time period for reporting Number of unique patients to be served over the life of the grant Patient demographics: age, race, insurance status (commercially insured, publicly insured through Medicare or Medicaid, or uninsured) Potential Measures Output Number of paraprofessional and/or professional providers trained (by type of provider and/or and training) Objective Number of paraprofessional and/or professional providers certified (by type of Measures provider and training) Number of patients screened Number of patients linked to appropriate care/services (examples include but are not limited to: prenatal care, home visiting, behavioral health, tobacco cessation, substance use disorder treatment, housing, food, transportation) Number of patients enrolled in programs and receiving services Number of patients exposed to health education messaging Number of health centers/hospitals implementing program/practice Number of patients counseled on family planning practices Days or weeks clients/patients participate in services Goal Measures Safe Sleep Infant Mortality Rate from sudden unexpected infant deaths (includes SIDS, Unknown Cause, Accidental Suffocation and Strangulation in Bed) Proportion of infants placed on back to sleep Proportion of infants placed alone to sleep Smoking and Substance Use Cessation Proportion of women who used tobacco during pregnancy Proportion of women who used tobacco post-partum Proportion of mothers who tested positive for hospital drug toxicology screen at birth Prenatal Care Proportion of women who initiated prenatal care in first trimester Proportion of women who have no prenatal care Proportion of women who receive early and adequate prenatal care Birth Spacing Proportion of women with >18 months birth to pregnancy Proportion of women who used contraception to plan pregnancy Proportion of women who received post-partum family planning counseling Proportion of women using birth control (aggregated by type)

8 Breastfeeding Adoption Proportion of infants who were ever breastfed Proportion of infants who are breastfed at six months Proportion of infants exclusively breast fed through six months Maternal Mental Health Proportion of women with post-partum depression Proportion of women with pre-pregnancy depression Proportion of women with anxiety during pregnancy Proportion of women who experience IPV during pregnancy Maternal Obesity Proportion of women with pre-pregnancy BMI>=30 Proportion of women with pre-pregnancy hypertension Proportion of women with pre-pregnancy diabetes If the proposals are accepted, grantees will be asked to submit periodic progress and expenditure reports; deliverables committed to under the grant; a final written report describing quantitatively how the project has affected the target population served and the community overall. As a condition of receiving grant funds, the grantee may be asked to: attend grantee convenings, participate in site visits, interviews with evaluators, and/or deliver progress reports and accomplishments to CareFirst, its staff and advisers, and other grantees.

9 References [1] B. Sawyer and S. Gonzales, "How does infant mortality in the U.S. compare to other countries?," Peterson-Kaiser Health System Tracker, [2] Maryland Department of Health, "Maryland Vital Statistics Infant Mortality in Maryland 2016," Vital Statistics Administration, Baltimore, MD, [3] District of Columbia Department of Health, "Perinatal Health and Infant Mortality Report," DC Health Government of the District of Columbia, Washington, D.C., [4] Virgina Department of Health, "Virginia's Plan for Well Being ," Richmond, VA, [5] Centers for Disease Control and Prevention, "Premature Births," 6 November [Online]. Available: [Accessed 1 August 2018]. [6] Virginia Department of Health, "Total Infant Deaths by Place of Occurrence and Place of Residence by Race," Virginia Department of Health, Office of Information Management, Data Management Team, [7] KFF, Henry J Kaiser Family Foundation, "Preterm Births as a Percent of All Births by Race/Ethnicity," [Online]. Available: %22asc%22%7D. [Accessed 13 August 2018]. [8] KFF, Henry J Kaiser Family Foundation, "Births of Low Birthweight as a Percent of All Births by Race/Ethnicity," [Online]. Available: [9] Virginia Department of Health, "Resident Low Weight Live Births and Very Low Weight Births by Race," [Online]. Available: birth_1-10.pdf. [Accessed 13 August 2018]. [10] GBD 2015 Maternal Mortality Collaborators, "Global, regional, and national levels of maternal mortality, : a systematic analysis for the Global Burden of Disease Study 2015," The Lancet, vol. 388, [11] CDC, "Pregnancy Mortality Surveillance System," 7 August [Online]. Available: [Accessed 1 September 2018]. [12] Building U.S. Capacity to Review and Prevent Maternal Deaths, "Report from maternal mortality review committees: a view into their critical role," CDC Foundation, Atlanta, GA, 2017.

10 [13] Maryland Department of Health Prevention and Health Promotion Administration, "Maryland Maternal Mortality Review 2017 Annual Report," Maryland Department of Health, Baltimore, MD, 2017.