Marin General Hospital Will Help Maintain Full Service Maternity Care for Publicly-Insured Patients

GREENBRAE, CA — A partnership between Marin General Hospital, Prima Medical Foundation, Marin Community Clinics and Marin County will insure that patients without private insurance can continue to receive high quality maternity care.

Cash-strapped Marin County has been running a full service OB/GYN program in partnership with Marin General Hospital but recently had to slash funding by 40 percent, leaving 600 uninsured and under-insured women potentially without prenatal care.

“As a community hospital, we recognized that we have a responsibility to make sure that all members of the community have access to care,” said Lee Domanico, Marin General Hospital CEO. “So we explored ways that we could merge staff and resources to be able to fill the gap left by decreased funding. Happily, we realized that we also had an opportunity for across-the-board enhancement of our maternity care by merging and consolidating resources. We have been able to augment the round-the-clock availability of physicians for all deliveries at the hospital—as well as provide the only 24/7 midwifery services accessible to all women, regardless of insurance status, anywhere in Marin or San Francisco counties. Every woman in Marin who wants more control and choice over her delivery will benefit from this program.”

Reaching out to local providers, the Hospital was able to structure a partnership—more than a year in the making—that not only meets the County’s needs but significantly improves the hospital’s maternity offering for privately insured women. It works as follows:

• Marin Community Clinics, a Federally Qualified Health Center, has assumed responsibility for the prenatal care that was previously provided by Marin County, including routine, high risk, diabetes and psychosocial care.
• Prima, a locally owned nonprofit medical foundation, provides both Certified Nurse Midwives and fully qualified OB/GYN physicians to Marin Community Clinics as well as to the Hospital’s inpatient program.
• When patients arrive at Marin General Hospital to deliver, regardless of insurance status they will have the option of round-the-clock midwifery services as well as physician directed deliveries. This program extends to privately insured patients the same option for midwifery care that has been available to publically insured patients. The OB/GYN and midwife “hospitalist” team are also available to support those private physicians who are not currently part of this system, should the need arise.

“My colleagues and I have been involved with the planning and implementation of this new OB program for over a year with the goal of not only meeting the county’s need, but improving the maternity services the hospital offers,” said Dr. Malini Nijagal, an obstetrician with the County of Marin and Marin Community Clinics. “One of our goals was to fill a niche that is not often met by maternity programs—making sure that patients have choices. By ensuring the availability of both physician and midwifery care at all times on the Labor and Delivery Unit, and providing round-the-clock support services such as anesthesia and pediatrics, a birthing tub, and specialized nursing, we are able to provide women with a personalized birth experience according to their preferences and needs.”

“It’s all about patient choice,” said Melanie Wice-Perkoff, Director of Midwifery Services at Prima and one of the providers who helped design the new maternity program. “This approach emphasizes patient-centered care that takes into account the beliefs, needs and cultural requirements of the mother and her family without sacrificing the all important safety for more complex situations.”

Dr. Nijagal pointed out the range of patient choices. “There are anesthesiologists available at all times, but Marin General Hospital also offers great support for ‘natural’ births,” she said.

“We’re pleased that the program emphasizes equal access to quality care for all women in Marin, regardless of their insurance status,” said Dr. K. Jennifer Voss, a Prima OB/GYN and chairman of the Department of OB/GYN at Marin General Hospital. “Our goal is to improve safety and satisfaction for both patients and physicians,” said Dr. Voss.

“By combining the best of traditional medicine with more alternative approaches, we believe we can both advance quality and the patient experience. A program like this—which gives women more say in choosing the kind of delivery with which they are most comfortable and ensures a safe setting should things get complicated—is a step toward a better system. And we will be tracking metrics of quality and safety as well as satisfaction levels moving forward” said Domanico.