BOOTHEEL PERINATAL NETWORK CLINICAL-COMMUNITY INTEGRATED CARE COORDINATION - ORGANIZATION NAME: ST. FRANCIS MEDICAL CENTER ORGANIZATION ADDRESS: 211 SAINT FRANCIS DRIVE, CAPE GIRARDEAU, MO 63703 FACILITY TYPE: HOSPITAL WEBSITE: HTTPS://WWW.SFMC.NET/ PROJECT DIRECTOR: BARB GLEASON, RN, MSN, CHW PHONE: 573-331-300 EMAIL: BGLEASON@SFMC.NET PROJECT TITLE: BOOTHEEL PERINATAL NETWORK: CLINICAL-COMMUNITY INTEGRATED CARE COORDINATION MODEL PROJECT GOALS AND OBJECTIVES: GOAL 1: IMPROVE BIRTH OUTCOMES FOR BIRTHING PEOPLE WHO LIVE IN THE 7-COUNTY REGION THROUGH CLINICAL-COMMUNITY INTEGRATED CARE COORDINATION OBJECTIVE 1:1: EXPAND BPN CLINICAL-COMMUNITY INTEGRATED CARE COORDINATION MODEL OBJECTIVE 1.2: EXPAND CURRENT NETWORK TO CREATE A STRONG UNITED COLLECTIVE OF BIRTHING SUPPORT PROFESSIONALS, WORKING IN CONCERT TO CREATE NETWORKING, EDUCATION, AND AWARENESS STRATEGIES. OBJECTIVE 1:3: INCREASE THE NUMBER OF DOULAS PROVIDING SERVICES IN THE REGION. OBJECTIVE 1:4 INTEGRATE DOULAS CARE INTO THE CLINICAL SETTING (DR VISITS AND DELIVERIES). OBJECTIVE 1.5: BY THE END OF THE GRANT PERIOD, INCREASE THE NUMBER OF MOTHERS AND INFANTS WHO ENGAGE WITH A CHW THROUGHOUT THE 12 MONTHS FOLLOWING DELIVERY BY 15% ABOVE BASELINE. GOAL 2: IMPLEMENT A PLAN FOR SUSTAINABILITY TO ENSURE THE PROGRAM'S CONTINUED OPERATION. 2.1: DELINEATE THE RELATIONSHIP BETWEEN ROI AND IMPROVED COMMUNITY-BASED MATERNAL SUPPORT SERVICES. 2.2: EXPLORE VALUE-BASED REIMBURSEMENT MODELS FOR PROVIDERS. 2:3: Z-CODE AND SDOH QUALITY IMPROVEMENT STRATEGIES TO GUIDE REIMBURSEMENT MODELS REQUESTED AWARD AMOUNT FOR EACH PROJECT YEAR: YEAR 1: $1,116,106; YEAR 2: $1,207,574; YEAR 3: $1,224,247; YEAR 4: $1,218,485. SAINT FRANCIS HEALTHCARE SYSTEM IS PROPOSING AN INNOVATIVE AND SUSTAINABLE PROJECT THAT WILL LINK ITS NUMEROUS EXISTING NETWORK MEMBERS, REGIONAL INITIATIVES, AND NEW COLLABORATORS IN SEVEN SOUTHEAST MISSOURI COUNTIES TO INTEGRATE COMMUNITY-BASED MATERNAL SUPPORT SERVICES (COMSS) INTO PERINATAL SYSTEMS OF CARE. THE INITIATIVE WILL FOCUS ON USING DOULAS AND COMMUNITY HEALTH WORKERS AS ACTIVE CLINICAL CARE TEAM MEMBERS TO EXPAND CARE COORDINATION AND LINKAGE TO COMMUNITY-BASED RESOURCES THAT HELP ADDRESS SOCIAL RISK FACTORS FOR PREGNANT AND POSTPARTUM PEOPLE. COLLABORATIVE NETWORK PARTNERS INCLUDE BOOTHEEL BABIES AND FAMILIES, BOOTHEEL NETWORK FOR HEALTH IMPROVEMENT, FRESH START SELF IMPROVEMENT, IT TAKES A VILLAGE (DOULA NETWORK), MISSOURI REGIONAL BOOTHEEL REGIONAL CONSORTIUM, MOHEALTH NET (MEDICAID AGENCY), M-BRACE BIRTHING ST. LOUIS, AND SEMO HEALTH NETWORK (COMMUNITY HEALTH CENTER). HOSPITAL PARTNERS INCLUDE SAINT FRANCIS MEDICAL CENTER, PEMISCOT MEMORIAL HOSPITAL, AND SSM HEALTH. MENTAL HEALTH SERVICE PROVIDERS INCLUDE BOOTHEEL COUNSELING SERVICES AND FAMILY COUNSELING CENTERS.