Reducing Infant Mortality in Baltimore City

Baltimore City officials recently announced that the infant mortality rate in Baltimore reached an all-time low in 2015, due in large part to the success of the B’More for Healthy Babies Initiative. B’More for Healthy Babies (BHB) is a citywide public-private partnership led by the Baltimore City Health Department with more than 100 partners that seeks to ensure that all babies are born at a healthy weight, full-term and ready to thrive in healthy families.BHB is a comprehensive strategy that includes 12 components designed to address the social determinants of health that so strongly influence birth outcomes in Baltimore. BHB focuses on providing high-quality, coordinated maternal and infant health services and support to first-time and high-risk mothers during pregnancy and often for up to two years after the baby is born.Key BHB services include:

• Promoting access to prenatal care;

• Providing care coordination and referrals to medical and social services;

• Home visiting for first-time and high-risk mothers;

• Post-partum depression screenings and counseling following infant deaths;

• Safe sleep education and free cribs;

• Breast feeding promotion; and

• Anti-smoking and obesity efforts.

The key to this approach is that the women are supported through multiple venues directly in their communities. There are neighborhood Mom’s Clubs (in English and Spanish), breast feeding support groups and B’More Fit exercise classes for mothers where child care is available. Community outreach workers answer questions, make connections to available services and programs, and reinforce the BHB core messaging.ResultsSince the implementation of BHB in 2009, the city’s infant mortality rate has declined by 38 percent – from 13.5 deaths per 1,000 live births in 2009 to 8.4 in 2015 (Figure 1). This decline was most pronounced for African Americans, whose infant mortality rate decreased by 50 percent. The teen birth rate also dropped by 36 percent.Figure 1. Baltimore City Infant Mortality Rate, 2009 – 2015Financing BHB is primarily funded by federal public health and Baltimore City general funds, and has historically received a significant amount of local philanthropic support. Federal and state Medicaid funding supports some of the care coordination and triage/referral activities that help the women navigate the health and social service system. However, many of the services provided through the initiative are not billed to Medicaid, even though the vast majority of families are enrolled in the program and Medicaid pays for nearly two-thirds of all births in Baltimore City.

For the past 18 months, Harbage Consulting has been working with Baltimore to identify opportunities for long-term financial sustainability of B’More for Healthy Babies. We were pleased that the Maryland Department of Health and Mental Hygiene agreed to include a Medicaid-funded Home Visiting Pilot program in their Section 1115 waiver renewal request to the Centers for Medicare & Medicaid Services (CMS). This competitive pilot program would provide Medicaid funding to local Health Departments to support and enhance evidence-based home visiting services that meet the needs of the whole family and promote improved health outcomes and community integration. Federal Medicaid support for home visiting services in Baltimore could play a key role in ensuring BHB’s future. The waiver is currently pending approval with CMS.