County’s Obstetrical Program for the Poor Gets Record Grant

Written By Lisa Breslin

Since 1997, the Carroll County Health Department (CCHD) has partnered with Carroll Hospital Center and community obstetricians to ensure that poor, uninsured, pregnant women in Carroll County get prenatal care as well as labor and delivery services at an affordable cost.

The partnership, which is woven together through a local program called Best Beginnings, got a tremendous boost this year when the Maryland Community Health Resources Commission awarded the health department $237,000, the largest nursing grant ever awarded to CCHD, according to Dianna Davis, Director of Nursing.

The Best Beginnings pilot program had been thriving on approximately $45,000 before the award. The additional funding enables the health care team to reach out to more women: most notably those who are not eligible for state medical assistance programs.

“We saw an alarming trend before this program,” said Dr. Cristos Ballas, one of six obstetricians involved with the Best Beginnings program and also a partner with Carroll Ob-Gyn Associates – LTD. “These patients are uninsured; some have no citizenship, no Social Security numbers and, until this program, they felt they had no advocates and were not going to the doctor.”

“As a result, a host of complications were thrust in our laps,” Ballas added: “Gestational diabetes, increased risk of morbidity for the mothers and their babies. We had to ask ourselves, ÔHow does a civilized nation allow this to occur?”

The commission’s grant enabled the health care team to create a Best Beginnings Admissions Clinic supplemented with care coordination, transportation and, if needed, interpreters to help women navigate the prenatal health care process and facilitate access to additional health, financial and family resources.

Health care providers hope that Best Beginnings will inspire more pregnant women to tap health care resources earlier. This goal, as Tricia Supik, Executive Director and CEO of The Partnership for a Healthier Carroll County, Inc. explains, is difficult with a migratory population whose culture does not promote prenatal care as enthusiastically as does the local population.

Best Beginnings served approximately 41 patients during 2008, according to Laura Resh, Carroll Hospital Center’s Assistant Vice President of Business Development. She and the other members of the health care team anticipate Best Beginnings enrollment will at least quadruple by February 2012.

Dr. Ballas, Dr. Melvin Yeshnik, and other members of Advanced OBGYN Care and Carroll Ob-Gyn Associates- LTD are involved with the Best Beginnings partnership, but with the addition of interpreters, more doctors are also expected to join.

“The processing time – getting five pages of each patient’s comprehensive medical history – is time intensive, especially when patients speak little or no English,” said Cindy Marucci-Bosley, Women’s Health Program Manager for the CCHD. “Having interpreters and a care coordinator offers a consistent, nurturing environment that saves so much time, even for the doctors.”

“The program is a home run,” said Ballas.

“It is a successful collaborative approach,” said Supik. “Best Beginnings shows that when you bring all the right people together, you can successfully assemble all the different pieces in a difficult jigsaw puzzle.”
Best Beginnings’ first two admissions clinic sessions in late June and early July were filled, according to Marucci-Bosley.

“The patients trust usÉso there is less fear about going to the doctor,” Ballas said. “We offer an environment in which they feel safe and, as a result, the outcomes are better. The mothers’ health and their babies’ health is much, much better.”

Davis and Supik noted that patients often want to share in some of the expense of prenatal, labor and delivery care; an expense that often tops $10,000 without programs like Best Beginnings. Through the Hospital’s financial assistance program and obstetricians’ willingness to accept less reimbursement, that patient cost can be whittled down to approximately $900, an expense that is billed on a sliding scale.

“Our ideal,” said Supik, “is to have more women in prenatal care so that they arrive at the hospital fully informed and excited about a phenomenal milestone in their lives.” “We hope that when they arrive, the cultural and language barriers no longer exist and their delivery is a joyous time.”