Mississippi
Mississippi’s maternity program is extremely insufficient
Since January 2011, the state of Mississippi has contracted a NY based company, ActiveHealthⓇ Management, a former subsidiary of Aetna and currently owned by CVS Health.
ActiveHealth Management purportedly provides comprehensive health and wellness management services to the State and School Employees Health Insurance Plan to improve health among more than 197,000 active employees, dependents, spouses and retirees.
The company has received four consecutive contracts valued at a nearly $64,000,000. Yet, it has not produced one evaluation report on its efficacy because the Department of Finance Administration does not require it to assess employees’ health outcomes.
According to Cindy Bradshaw, former State Insurance Administrator, DFA administers patient satisfaction surveys about their experiences within the ActiveHealth Management program. Patient satisfaction surveys are designed to determine how a person feels about or perceives her/his experience with something or someone; it does not determine whether the experience was effective and to what degree.
This is particularly concerning for pregnant state employees who are at risk for pre-term births and Cesarean deliveries, the No. 1 surgery in the state of MS and the nation.
Annually, Mississippi pays for over 90% of prenatal care and births in the state through Mississippi Medicaid and Blue Cross Blue Shield of Mississippi plans. In 2022, members in both plans experienced comparable Cesarean delivery rates. About 39% of BCBS of MS members experienced a Cesarean delivery and 37% Medicaid members, according to data from the Mississippi State Department of Health. Also, 20% of BCBS members and 21% of Medicaid members, whose labor was induced, subsequently delivered via a Cesarean. The State paid an estimated average of $27.4 million for Medicaid-members and $30.6 million for BCBS-members who had Cesarean deliveries.
Furthermore, those members who had a first-time Cesarean delivery have a 90% probability of experiencing a repeat procedure because only a handful of providers in Mississippi will attempt to deliver a vaginal birth after a Cesarean delivery.
Liz Welch, DFA’s executive director, said she wasn’t aware of the birth outcomes of state employees and would request a report from BCBS of MS, the state’s plan administrator. I am almost certain she did not.
Since 2019, I have administered a community health worker program that provides preventive based services to pregnant residents, including state employees. I have found ActiveHealth Management’s maternity program to be extremely insufficient and ineffective as it does not address the complex underlying risk factors influencing common negative birth outcomes in Mississippi.
Underlying preventable risk factors affecting most pregnant women in Mississippi are maternal obesity and smoking that can lead to gestational hypertension, preeclampsia, gestational diabetes, Cesarean deliveries, preterm babies, low birth weight babies, NICU babies, and maternal and infant mortality. Annually Mississippi residents experience the highest rates of maternal obesity (37.6%), fetal deaths (9.5), Cesarean deliveries (39%), preterm births (15), low birth weight (13), maternal mortality (43) and infant mortality (9.2) in the nation.
ActiveHealth Management’s maternity intervention involves nurses making three phone calls to pregnant state employees and one call after the baby is born.
The nurse asks a list of general questions such as, “how’s your overall health,” “how’s your pregnancy going so far,” “any medical concerns,” “are you taking prenatal vitamins,” “what you know about pre-eclampsia,” etc.
There is no face-to-face engagement between the employee and nurse, including no home visits and no birth support. The nurse doesn’t assist the employee with developing a prenatal dietary and exercise plan, a birth plan, healthy birth practices to prevent medically unnecessary labor inductions, and Cesarean deliveries. She does not provide crucial childbirth education and breastfeeding and postpartum support, which is needed in the home.
Providing exclusive phone support during pregnancy has been shown to reduce risk for depression, but it does not improve risky health behaviors, e.g. smoking, sedentary, unhealthy foods or birth outcomes. Data show that neither phone nor short message support are effective at reducing prenatal smoking, improving prenatal body mass index, reducing preterm births, and Cesarean deliveries.
In contrast, there is considerable evidence showing that community health worker programs, which provide in-personal maternal health education and birth assistance, are significantly effective at changing risky behaviors and improving healthcare decisions that lead to better prenatal health and birth outcomes.
Community health workers can provide a supportive social network, motivate and drive pregnant patients at risk to make healthy lifestyle changes that reduce maternal obesity, stress and anxiety and improve physical health, which subsequently reduces maternal morbidities associated with pre-eclampsia, preterm births, and Cesarean deliveries.
In 2021, I initiated a dialogue with ActiveHealth Management’s medical leadership about enhancing its program through the integration of community health workers. My suggestion was met with resentment and rejection. They stated they would do no more than their contract requires.
The State will issue a new RFP in 2025 and likely renew ActiveHealth Management’s contract. It should seriously consider reducing the value of the contract and redirecting a substantial amount of funding to the Mississippi Department of Health’s Community Health Worker Program.
The MS Department of Health could train, certify, and strategically deploy community health workers across the State to deliver evidence based, maternity services, which would be more feasible and effective than ActiveHealth Management’s telephonic/virtual program.
— Getty Israel, MPH, is a population health specialist in the Jackson area.
Mississippi
Along the Mississippi River, an acorn-collecting ‘legend’ works to save struggling forests
Jerry Boardman doesn’t remember exactly when he started collecting acorns in the fall.
But the thousands upon thousands of them he gathers to share with people working to improve habitat along the Mississippi River makes the 81-year-old resident of De Soto, a village of about 300 between La Crosse and Prairie du Chien, a pretty big deal.
“It’s like a myth or a legend,” Andy Meier, a forester for the U.S. Army Corps of Engineers who receives a portion of Boardman’s bounty, said of the integral role it plays in his work. “It just has always been that way.”
In reality, Boardman began collecting around the time that the need for acorns — a nut that contains the seed that grows oak trees — was becoming critical. For the past few decades, the trees that grow in the Mississippi River floodplain, known as floodplain forests, have been struggling. Although they’re named for their ability to withstand the river’s seasonal flooding, they’ve recently been overwhelmed by higher water and longer-lasting floods.
Overall, forest cover along the stretch of the river from Minnesota down to Clinton, Iowa, decreased by roughly 6% between 1989 and 2010, according to a 2022 report on ecological trends on the upper Mississippi. In the years since, losses in some places have neared 20% — and were particularly acute following a massive flood event in 2019.
What exactly is driving the excess water isn’t fully fleshed out, but climate change and changes in land use that cause water to run off the landscape faster are likely factors.
The result is mass stretches of dead trees that can no longer perform their functions of providing wildlife habitat, sucking up pollutants that would otherwise run downriver, and slowing water during floods. Reno Bottoms, a sprawling wetland habitat on the river near Boardman’s hometown of De Soto, is one such example of the dispiriting phenomenon.
Boardman, who has been a commercial fisherman, hunter and trapper on the river for most of his life, called the change in forest cover in recent years “shocking.” To combat it, he puts in about 100 hours a year between August and October gathering acorns from the floodplain in De Soto, Prairie du Chien and La Crosse. The idea is that if the trees that produced the acorns were successful enough at warding off flood damage to drop seeds, those seeds might be similarly resilient if replanted.
He looks for acorns from the bur oak, pin oak and swamp white oak, the latter of which is particularly well-suited to the floodplain forest. And the numbers he puts up are impressive — last year, he collected about 130,000; this year, 65,000.
He splits up the total to give to the Army Corps and the U.S. Fish and Wildlife Service, both of which have foresters planting trees to restore floodplain habitat.
“Pretty much everything that Jerry collects, in one way or another, will return to the river,” said Meier, with the Corps.
Last fall, for example, they scattered between 20,000 and 30,000 of Boardman’s swamp white oak acorns near McGregor Lake, a river backwater near Prairie du Chien where the Corps is piloting an effort to protect trees from flood inundation by raising the forest floor a few inches.
This spring, Meier said, he was “blown away” by the approximately 1,000 seedlings that had taken root there and begun to sprout.
Having access to Boardman’s acorns is important because it gives foresters the chance to experiment with direct seeding, instead of buying young trees and planting them. Direct seeding is both cheaper and more likely to result in a viable tree, because the seed is local.
“When we have an opportunity to get something we know came from the river, we know that it’s adapted to growing there,” Meier said.
To maximize his time, Boardman uses a contraption not unlike ones used to pick up tennis balls to scoop up the acorns. One small variety, though, requires collectors to “get down on your hiney or your knees” to pick them up, he said. For those, he relies on a little grunt work.
Ev Wick, a fifth grade teacher at De Soto’s Prairie View Elementary, has taken his students out for an acorn-gathering day with Boardman for the past several years. Boardman scouts the best trees ahead of time, Wick said, then the kids get to work. They can pick up between 5,000 and 6,000 in a day, propelled by friendly competitions to see who can collect the most or fill their bucket quickest.
They’re interested when Boardman tells them all the acorns they collect will eventually be planted on the islands they see in the river, Wick said. But most of all, they do it to thank Boardman for taking them out fishing and ice fishing in the winter and spring.
Acorn-gathering is just one of Boardman’s talents. Along with other members of Friends of Pool 9, a group of area residents who work to protect natural resources, he hosts fishing days, runs river cleanups and counts bald eagle nests to report to the Fish and Wildlife Service.
Whether it’s acorn-related or otherwise, Meier said it’s amazing to see the commitment Boardman has to ensuring the river continues to thrive.
To Boardman, the chance to donate acorns or otherwise help out is a no brainer.
“That river has given me so much,” he said. “I’ve just got to give back all I can give.”
Madeline Heim is a Report for America corps reporter who writes about environmental issues in the Mississippi River watershed and across Wisconsin. Contact her at 920-996-7266 or mheim@gannett.com.
Mississippi
Women’s Basketball: Mississippi State shows no mercy on Mercer in blowout win
STARKVILLE — Former Mississippi State assistant coach Michelle Clark-Heard returned to Humphrey Coliseum on Wednesday night as the head coach at Mercer, and her ex-boss, Sam Purcell, made sure it was a rude welcome home.
The Bulldogs limited their fourth straight opponent to under 50 points and have held all five teams they’ve played to under 30 percent shooting, defeating the Bears 81-44.
“We’re watching film, we’re trying to find every advantage we can,” Purcell said. “That stuff matters to us. That’s culture, that’s DNA. We train hard, we work hard, and we’re a multiple defensive team. I always say there’s bad coaches out there if you only play one style, and that’s not who we’re going to be. We can press, we can trap, so it makes it a nightmare for our opponents.”
Mercer did not make a 3-pointer until there were less than two minutes left in the fourth quarter, finishing 1-for-17 from behind the arc. MSU (5-0) made more than half of its field goals and was 10-for-22 from deep, outscoring the Bears 44-14 in the paint.
Fifth-year senior guard Jerkaila Jordan entered the game having made just one 3-pointer on 15 attempts so far this season, but she made her first shot of the night from distance behind a screen in the final minute of the opening quarter. Jordan then blocked Hanna Knoll’s 3-point attempt on the other end, and Eniya Russell connected from long range to beat the buzzer and put the Bulldogs ahead by double digits.
Jordan recorded a double-double with 15 points and 11 rebounds, and she was 3-for-4 from 3-point range, nailing a triple from each corner 33 seconds apart in the third quarter.
“She just needs to relax. That’s it,” Purcell said. “The kid’s a pro. She trains hard, she’s in the gym every single day. She knows what’s up. I haven’t said one thing to her. I knew it was going to finally end, I’m just glad it happened before we head on the road.”
Madina Okot had another big night in the post, tallying 15 points, eight boards, two blocks and two steals. The Kenyan is shooting 65 percent through five games in the maroon and white and is pulling down nearly 10 boards per contest.
“This has been my dream, and I just feel happy,” Okot said. “I’m just grateful for the team and for this coaching staff. They’re really doing great, I’m putting in work and they’re ready to support me to get everything I desire to get here.”
MSU already led by 20 at the half before winning the third quarter 32-7, finishing the period on an 18-2 run. The Bulldogs’ last four opponents have scored a total of 24 points in the third quarter.
Junior sharpshooter Debreasha Powe was also in double figures with 13 points, going 5-for-7 from the floor and 3-for-5 from behind the 3-point line. Destiny McPhaul had an efficient night as well, and Quanirah Montague had eight points in just 13 minutes of action. MSU shared the ball extremely well, with 26 assists on 33 made field goals.
“I was just locked in,” Montague said. “I was ready to get in the game, ready to have energy and bring energy to my team.”
The Bulldogs will not play in Starkville again until Dec. 29, following eight straight games away from The Hump. They are back in action Sunday against Jacksonville in Orlando, Florida, a neutral-site game that is part of the inaugural WBCA Showcase.
Wednesday’s win was No. 50 for Purcell in 73 games at MSU, making him the fastest coach in program history to reach that milestone.
“It’s all about the young women who step on the floor and sacrifice night in and night out,” Purcell said. “I’ve never scored a point here at Mississippi State. I’m fortunate to have a university that gave a first-time head coach an opportunity. You need one school to believe in you, so it means the world that Mississippi State believed in me.”
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Mississippi
Court says it's ending dispute over control of airport in Mississippi's capital city
FILE – Sen. Josh Harkins, R-Flowood, right, reacts as Sen. John Horhn, D-Jackson, left, purposes amendments that would affect Harkins’ proposed legislation that would shift control of the Jackson-Medgar Wiley Evers International Airport to state officials and surrounding counties, March 3, 2016, in Senate chambers at the Capitol in Jackson, Miss. (AP Photo/Rogelio V. Solis, File)
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