Winners helped people, saved $$
By David Gulliver
4/9/2009 © Health News Florida
The woman -- a girl, really -- was just 15, about 24 weeks pregnant. No longer able to conceal her swelling belly, she had to tell her parents, which led to a feud. As delivery neared, her blood pressure soared.
It's the kind of scene that can lead to a tragedy. Instead, four months later, the girl delivered a healthy, 7-pound baby boy after a quick and uncomplicated labor, surrounded by parents, siblings and friends.
Midwife Terrie Watkins made it happen by counseling the girl and her family, helping her keep her blood pressure under control and persuading the scared mother-to-be that she could actually excel at caring for her baby.
“You get this strong sense of satisfaction when you see that light go on in their eyes,” Watkins said. Her employer, Lake County Health Department, has been named a winner of a $1,500 prize from a private program that rewards state workers for innovations that improve services and save money.
Florida’s health-related agencies led the pack in the 21st year of the Prudential-Davis awards, racking up 192 of the 568 awards, as judged by the nonpartisan group Florida Tax Watch.
Other health teams that won top innovation awards were affiliated with Sarasota County Health Department, Family Support Services of North Florida and the general counsel’s office of the Department of Children and Families. (DETAILS)
Lake County’s program grew out of discussions between Florida Hospital Waterman and the health department in 2002.
More and more pregnant women were seeing a doctor for the first time in the emergency room, with complications like high blood pressure, or even already in labor. Most were uninsured. That meant complicated, often premature deliveries, and longer hospital stays to resolve health problems for mother and child.
Meanwhile, obstetricians were leaving the county, even the speciality, over the rising costs of liability insurance -- in some part because of the more difficult births.
Donna Gregory, the assistant administrator and director of nursing for Lake County, said the answer was reaching out to people who thought they could not afford care. “If you didn’t have a team program that saw the uninsured in the community, what you would have is the patients reporting to the ER with no prenatal care,” she said.
Watkins, the midwife, met the young mother-to-be at the 24-week mark and counseled the girl and her family on how she could stay fit and healthy, on what pain to expect and how to relieve it, and how to keep her blood pressure under control.
Midwives are the core of the program. The county pays for four midwives and two OB/GYNs. Together, they care for the mothers-to-be and deliver the babies. The midwives also care for the mothers in early stages of labor, reducing demands on hospital staff.
The program also helps the department get the soon-to-be mothers signed up for Medicaid, slashing the amount of written-off costs. Meanwhile, having the OB/GYNs on the county payroll provides them with sovereign immunity, resolving the liability issue and stemming the loss of obstetric care.
The program started in mid-2002 and has grown to handle 450 to 500 births a year. A study found the program’s midwife and OB/GYN care resulted in fewer Caesarean section deliveries compared to the rest of the county, cutting the average post-partum stay in half, Gregory said. In turn, that reduced how long mothers had to stay in the hospital after delivery, saving money for the patients and the hospital.
The prenatal care also probably reduced expensive premature births, Gregory said. The Heath Department estimates the program saved about $1 million for the hospital and the county in 2007-08, when it handled some 1,400 cases and 700 deliveries.
--Contact free-lance reporter David Gulliver.