“A doctor’s office that cares:” Improving outcomes and morale through flexible funding
The Camden Coalition’s perinatal health pilot program aims to connect pregnant people with prenatal and other appropriate care earlier in their pregnancy and support retention in care. As part of this pilot, partner sites — Obstetrician (OB) offices, federally qualified health centers (FQHCs), and community-based organizations (CBO) — are provided with a $10,000 patient cost fund, which can be disbursed at the site’s discretion as long the money supports patients with attending pregnancy-related care in some way. $10,000 may not be a consequential sum of money for an OB practice within a large health system or an FQHC, but in the settings the pilot targets, practice managers and providers rarely have access to this kind of flexible funding, making the program an attractive opportunity for local partners.
While it was expected that the funds would have an impact on patients, an unexpected outcome of the pilot has been its positive effect on providers. Given that more than half of frontline healthcare workers feel symptoms of burnout per a 2021 Kaiser Family Foundation survey, we consider this reported increase in provider satisfaction an additional metric of success for the program.
The funds disbursed through this pilot program serve as a simple intervention that benefits patients and staff alike. The benefit to the patients is tangible — they can use the funds to purchase baby supplies, maternity clothes, pay for childcare during their prenatal care appointments, or other necessities. Multiple sites have opted to directly provide patients with Visa gift cards so that they can use the funds to meet their unique needs. Sites intentionally chose to provide Visa cards rather than store-specific cards to maximize the flexibility of the funds. They have also directly purchased necessary supplies that are often unaffordable to patients even with insurance, such as blood pressure cuffs and diabetes testing strips, to ensure cost is not a barrier for these patients to receive necessary care.
The impact to staff morale is less tangible but equally notable. The outreach coordinator at one of the participating sites notes, “Staff like to be the one to hand the card over [to a patient] because [they’re] making someone happy and excited. It has been a great way to build staff relationships with the patient, and a feel-good intervention for staff.”
The same outreach coordinator also found that providing funds to patients makes them more likely to attend their follow-up appointments because “it changes from, ’I’m just going to a doctor’s appointment’ to ‘I’m going to a doctor’s office that cares.’” Partners within two other pilot sites have reported similar results. This improved retention has decreased staff workload as less time is dedicated to following up with patients who have missed appointments. This opens up time and capacity for staff to be fully present for their patients when they come in.
Healthcare workers often enter the field because they have a desire to improve patients’ health and lives. Once in the field, however, they are met with many barriers and restrictions that prevent them from being able to fully meet the needs of their patients.
Noted Jeey Moncayo, Service Coordinator at the Southern New Jersey Perinatal Cooperative, “The flexibility [of the funds] is key because the patients are then driving the needs… the client is the boss and I think that’s great.” She added that the funds allow her to offer a solution to the client’s problems, and being able to provide real help is fulfilling to staff. When doing outreach calls to pilot patients, Jeey commented on how offering potential sites the discretion for how to use the funds is “like coming with an invisible toolkit. You’re coming with something prepared to be able to actually do something. It’s comforting going into the calls… It feels good, somehow like I’m helping. It just makes it easier.”
A social worker at one of the participating sites meets with every new OB patient to discuss any barriers that might impact their pregnancy, such as lack of access to nutritious foods or unreliable transportation to their medical appointments. She commented, “I’ve been working here three years and we’ve been trying to figure out how to get patients to appointments the entire time. Now we’re able to [with the patient cost funds].”
A significant portion of the available funds disbursed at the site where she works were used to provide rides to and from appointments for patients without transportation, which significantly decreased the number of patients who do not attend their scheduled appointments. Early data shows that only 9% of patients engaged through the pilot did not attend their scheduled appointments compared with the same site’s general no-show rate of 27.8%, a reduction of approximately 68%. Seven months into the pilot, the site has provided 218 rides to more than 37 patients.
None of the patients that benefited from the covered transportation had significant problems with their pregnancy and/or delivery, despite them facing social barriers that are known to impact health outcomes such as homelessness or food insecurity. The social worker commented that being able to use these funds to provide transportation or address other needs has given her a lot of satisfaction in her work, and seeing her patients happy and succeeding makes her happy.
We believe we will continue to see significant return on investment from these funds. Beyond increasing patient retention in care and the associated improved health outcomes, we hypothesize that the improved staff morale that results from access to these flexible funds could translate into further positive returns for practices and health systems. Improved morale and lower burnout could contribute to improved staff retention and teamwork, which could increase efficiency and productivity. In the scheme of larger systems’ budgets, these flexible funds are a small investment. But the potential for positive change among patients and staff is clearly much greater.