November 11, 2016

Reversing Racial Disparities in Health

by Amy Crockett | McNulty Prize Winner
How one model can drastically cut costs, eliminate racial disparities, and improve health for women and children

Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

— Martin Luther King, Jr.

The United States has a long and striking history of racial disparities in health and access to healthcare. Within my specialty of women’s health, we know that black women have a higher incidence of breast, endometrial and cervical cancer, and lower survival rates after diagnoses are made. Black women experience higher rates of unintended pregnancy, and, during pregnancy, higher rates of maternal mortality and preterm birth.

Racial disparities in health are a particularly daunting challenge for physicians because race is a social — not biologic — construct, and over time the cumulative effects of social and racial inequalities contribute to poor health outcomes. Poor health outcomes, in turn, exacerbate these inequities. Babies born preterm, for example, can suffer from neurosensory and cognitive disabilities, and experience lifelong disparities in their education, health and employment prospects.

As a physician, it is hard to imagine how a traditional, 15-minute encounter with a patient can begin to undo the influence of years and even generations of social, economic, physical and environmental hardship. It’s impossible to fix with the usual tools of surgery or prescription medications. As much as I care about my patients and their health, it is sometimes tempting to despair that racial disparities and other social determinants of health are too complex for me to tackle.

The CenteringPregnancy model of group prenatal care turns this assumption on its head. The model improves so many aspects of the physician-patient relationship, and changes the way women feel about their healthcare, themselves and their pregnancies. Most notably, CenteringPregnancy has shown promise in reducing racial disparities in a number of birth outcomes.

Something as simple as women connecting with each other in a group impacts gene expression in the placenta in such a way that can lead to radically improved health outcomes for women and babies over the course of their lives.

For women from low-income and immigrant backgrounds, or who are teenage or single mothers without access to cars, family support or a steady income, Centering provides a level of social support that they otherwise wouldn’t have. Despite these hardships, something as simple as women connecting with each other in a group impacts gene expression in the placenta in such a way that can lead to radically improved health outcomes for women and babies over the course of their lives.

A short documentary featuring Dr. Amy Crockett & CenteringPregnancy South Carolina

The Centering Healthcare Institute, a nonprofit based in Boston, maintains the curriculum and evaluates and approves sites that offer this trademarked model of group prenatal care. The model brings together groups of pregnant women 10 times over six months, combining traditional physical assessment and health education within the group space, with women actively participating in their own medical care.

In my practice, we have seen a 47 percent reduction in the odds of preterm birth for women who participated in CenteringPregnancy. We have also seen higher rates of breastfeeding, lower rates of gestational diabetes, and lower rates of cesarean delivery. Most notably, the gap in health outcomes between black and white women has narrowed for all of these outcomes.

Good health is also good business. The state’s two largest insurers, Medicaid and BlueCross BlueShield, now offer enhanced reimbursement for the coverage.

Because good health is also good business, the South Carolina Department of Health and Human Services and the South Carolina Chapter of the March of Dimes have supported expansion of this model to 17 other obstetric practices in South Carolina. Furthermore, the state’s two largest insurers, Medicaid and BlueCross BlueShield, now offer enhanced reimbursement for the coverage. For every 30 patients in CenteringPregnancy (approximate cost — $6,000), one neonatal intensive care unit admission is averted ($27,000), generating more than $2 million in savings from this health outcome alone.

The impact we are making on preterm birth, and in lowering racial health disparities, is influencing healthcare in new ways. The success of this approach has catalyzed health systems to think about how group models of care can be adapted to other health areas, for patients dealing with diabetes or obesity, for example.

If we want to reduce further disparities in health outcomes, it’s clear that healthcare methods must innovate and adapt to address the complex social determinants of health that patients face.

Dr. Amy Crockett is a maternal fetal medicine specialist and founder of CenteringPregnancy South Carolina. She is the winner of the 2016 John P. McNulty Prize and a Liberty Fellow of the Aspen Global Leadership Network.

view all ideas