HJNO Mar/Apr 2024

58 MAR / APR 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS COLUMN  WOMEN’S HEALTH THE United States has a primary care problem. According to a report released by The Commonwealth Fund, when com- pared to other high-income nations, in- dividuals in the U.S. are the least likely to have a regular physician or place of care. There are countless reports on the corre- lation between established primary care and better health outcomes, particularly around key markers like infant and ma- ternal mortality. We know for certain that when people are seeing a primary care provider more regularly, they are more likely to lead a healthier, longer life. Access to primary care is stagnated because of a fragmented and expensive healthcare system, primary care provider shortages, and a lack of paid family leave policies or affordable childcare. One solu- tion that is not being deployed enough for families with social drivers of poor health is home visiting. Many of us have seen in movies or recall a grandparent talking about a family doctor who would come to the home to check on a pregnant mother or young child. Home visiting has the pow- er to deliver healthcare to families on their terms but has largely only been accessible to wealthy individuals for concierge care, elder adults, or those with severe chronic conditions. There is clear evidence for home visit- ing improving family health outcomes, particularly as it applies to early child- hood and maternal health. The recently launched HRSA Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program provides annual grants to states for evidence-based home visiting models to improve maternal and child health, in- crease family education levels, promote children’s development, and more. The program provides funding to states spe- cifically for home visiting programmodels serving at-risk pregnant women and chil- dren from birth to age 5. In 2022, the pro- gram served 138,000 parents and children, providing more than 840,000 home visits resulting in 81% of caregivers screened for depression, 79%of children in the program deemed school ready, 70% of mothers in the program having received a postpar- tum visit within 8 weeks of delivery, and 70% of children in the program having re- ceived a well-child visit in accordance with the AAP schedule. Despite existing home visiting programs, we know that access to home visits or after-hours care is the low- est in the U.S., with countries like France, the Netherlands, Germany, Sweden, and the United Kingdom reporting nearly all PCPs as offering home visits. The scaling of home visiting programs is gaining traction in the U.S., however, and interest is growing. There have also been state- and city-led program initiatives. In March of 2023, the Illinois Senate passed a bill to approve a program called “Start Ear- ly” to grow the home visiting program for early childhood. The New Orleans Health Department has piloted a home visit- ing program called “Family Connects” for families in Orleans Parish. The program provides one to three home visits free of charge to parents of newborns up to 12 weeks who gave birth at Ochsner Baptist or Touro Hospital. Additionally, in 2021, the New York City Health Department an- nounced home visiting services for first- time parents and infants living in public housing. The program focuses on under- served families to help “reduce persistent inequities in maternal and infant health.”1 Even with these examples, the bulk of pri- mary care home visiting programs remain solely government-funded and are not funded by the private sector. The State of Primary Care Is Failing American Families