NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year

Objective 1: Increase the number of women returning for the postpartum visit from 88.0% in 2016-2019, 2021 to 96.0% in 2025.

OSDH and Oklahoma Health Care Authority (OHCA) will continue working together on data matching and analysis between Medicaid claims and birth certificate data. The joint OSDH/OHCA work group will work on determining the most effective use of the data and publications utilizing this information.

OSDH will continue to expand prenatal care services in the CHDs with the hopes of encouraging more women to attend the postpartum visit, either with the delivery provider or at the health department. Staff in the CHDs will continue providing postpartum care for those women scheduling a family planning visit that have chosen not to return to their delivering provider for a postpartum visit.

The home visitation programs will educate and encourage new moms to make and attend postpartum appointments and MCH staff will continue to assist in training new parentPro staff. The Healthy Start projects will continue to encourage attendance at the postpartum visit and prepare women for their postpartum/annual health care visits.

A new Pregnancy Resource Navigator program is being proposed and funding will be be requested from the 2023 Oklahoma Legislature. The goal of this program, if funded, will be to utilize Community Health Workers for visits to pregnant and postpartum women to identify potential risk factors and link them with appropriate resources.

MCH will continue to establish and expand projects with Maternal Health Innovation Grant funding to improve access to quality health care and reduce maternal and infant mortality. This grant is closely tied with Title V priorities utilizing the following baseline priorities: percentage of women covered by health insurance; percentage of women who receive an annual well woman visit; percent of pregnant women who receive prenatal care in the first trimester; percent of women attending a postpartum visit; percent of women screened for perinatal depression; rate of maternal mortality; and rate of severe maternal morbidity.

OSDH will continue work to expand prenatal care and child health services within the CHDs to additional districts and sites to improve access to care for pregnant women and infants. Some care will be provided on mobile units to address barriers to service including lack of transportation and lack of providers in rural areas. Memorandums of Understanding will be signed or agreements put in place for transfer of care for prenatal clients around 36 weeks gestation.

MCH will continue to collaborate with partners at the OHCA to monitor Medicaid expansion for enrollment statistics as well as utilization of services once individuals have enrolled. Enrollment does not always equal access to quality care and/or access to preventive health care. Managed care contracts should be awarded in early 2023 and MCH will stay engaged in setting quality measures and advocating for ways to more effectively monitor and report attendance at postpartum visits.

Objective 2: Improve birth intention by increasing the usage of the most effective methods of contraception among women on Medicaid and at risk for unintended pregnancy from 16.7% in 2022 to 20.0% in 2025.

The OSDH and OHCA will continue to work together to promote long-acting reversible contraception (LARC) utilization with public and private providers through the Focus Forward Initiative. A sustainable education model will provide skills training to current and future health care providers for LARC insertion utilizing staff from two major institutions of higher learning in partnership with the OHCA. Frontline staff and billing staff will continue to be trained to assist with provision of accurate information, assistance with scheduling, and education on accurate billing for maximum reimbursement. MCH staff will continue to train new OSDH staff and assist with the Focus Forward trainings for Nexplanon insertion.

MCH will continue to collaborate with partners at the OHCA to monitor Medicaid expansion for enrollment statistics as well as utilization of services once individuals have enrolled. OHCA benefits will maintain coverage for a broad range of contraceptives including the LARC methods. OSDH and OHCA will continue collaboration to increase access to LARCs for family planning clients.

Health Care Access Objective 1: Reduce the rate of unintended pregnancies (mistimed or unwanted) among mothers who have live births from 27.5% in 2021 to 25.0% by 2025.

The OSDH will continue to administer the family planning program through CHDs and contract clinics including assistance with SoonerCare and SoonerChoice enrollment, reproductive life planning, client-centered counseling, and provision of LARC methods. OSDH will maintain family planning services at all county health departments for both insured and uninsured clients. MCH will distribute LARCs purchased with additional funding to ensure same day access in CHDs.

The Family Planning Information and Education Committee continues to seek input from youth in reviewing reproductive health materials to ensure information is appropriate for adolescents and easy to understand in an effort to share information on preventing unintended pregnancies.

Public Health Youth Councils, facilitated by the Adolescent Health Specialists in rural areas of the state, will continue recruitment and begin meeting during the 2023-2024 school year.

MCH will work with community partners (OHCA, March of Dimes, OPQIC, Federally Qualified Health Centers, etc.) to identify ways to promote preconception health messages. Staff will work with the OSDH Chronic Disease Division and Office of Communications, as well as, Cox Media/OSDH Office of Communications to create preconception health messages to be disseminated through social media and/or streaming services. Through a contract with Southern Plains Tribal Health Board (SPTHB) and the Maternal Health Innovation Grant, MCH will work with SPTHB to create and disseminate culturally appropriate preconception and pregnancy related messages to improve quality of care and reduce infant and maternal morbidity and mortality.

SPM 1: Maternal mortality rate per 100,000 live births

MCH will continue to provide leadership and financial support for the Maternal Mortality Review Committee (MMRC) under the new statutory requirements. Staff will disseminate an annual report with data that is comparable to other states. As part of the Maternal Health Innovation Grant, MCH will continue leading the Maternal Health Task Force to assist with implementing recommendations from the MMRC. The MMRC facilitator is also working to incorporate informant interviews into the abstraction process to assist with gaps in medical information and assess barriers to care.

MCH will remain active in the Alliance for Innovation on Maternal Health (AIM) activities through the OPQI hospital level interventions to reduce maternal mortality and morbidity, addressing priority activities related to postpartum hemorrhage, hypertension, and opioid use/abuse. Based on recent maternal death data, OPQIC is planning to start work to implement the sepsis bundle. MCH will partner with the STAR (Substance Use, Treatment and Recovery) clinic through the Oklahoma Health Science Center to address the needs of pregnant women with substance use disorders.

MCH will analyze Pregnancy Risk Assessment Monitoring System (PRAMS) data and disseminate information through a Pregnancy PRAMS Brief or a PRAMSgram on some aspect of preconception health and counseling information. Women will be surveyed through PRAMS regarding utilization of postpartum visits and preconception health issues, especially those issues associated with maternal morbidity and mortality in Oklahoma.

NPM 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year

Objective 1: Increase the percent of county health department sites appropriately utilizing the PHQ-9 tool for screening and the new codes for positive and negative screening from 61 sites in February 2020 to 90 sites by 2025.

MCH will continue to conduct trainings and provide technical assistance at site visits to assist with the utilization of the PHQ-9 and new codes for screening.

Objective 2: Create culturally competent public service announcements (PSAs) and messages on maternal mental health that are representative of African-American, Native, and Latinx women and men impacted by Perinatal Mood and Anxiety Disorders (PMADs) by 2025.

Recruitment for representatives to assist with the PMADS PSAs will continue.