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Interview with JoAnne Fischer
Joanne is the Executive Director, Maternity Care Coalition, Philadelphia, PA. Interviewed by Michael Feagans on 07.14.00.
4npo: Tell me a little about Maternity Care Coalition.
JoAnne: MCC was formed in 1980 by volunteers. I'm the first full-time director and I came on board about 11 years ago.  It was initially formed as a coalition of health professionals and poor peoples' organizations like Welfare Rights, women's organizations, and consumer organizations that were concerned about infant mortality particularly in low income communities with people of color.
4npo: Does your organization cover the entire city?
JoAnne: It is state-wide. About 5 years ago we merged with Pennsylvania Healthy Mothers, Healthy Babies. Our education and advocacy programs are state-wide, and our direct services programs are regional. They are located in Philadelphia, Montgomery and Delaware counties.
4npo: How many employees do you have?
JoAnne: Currently we have about 55.
4npo: How many clients do you serve?
JoAnne: Within the momobile program, actual participants are about 3,000 per year. We provide a less intensive service for an even larger number. And, we have another subgroup for whom we provide educational services.
4npo Tell me about the momobile?
JoAnne: The momobile is our signature program. It's an outreach and family support program where we use brightly colored mini-vans to get peoples' attention and provide outreach services. We get women linked with prenatal care and all of the services and support that they need to have healthy pregnancies and a healthy babies.
4npo: How old is that program?
JoAnne: About 10 years. We started 11 years ago when we had a staff of 3 and a budget of $117,000. Now we have a budget of close to $3 million and a staff of close to 60. We have 12 momobile sites in the region. The program has been extremely successful. We recently figured out we've served over 30,000 families during these years. There have been a number of studies of our program's outcomes. In the areas where we have done outreach, more people have gotten into care and linked to things like WIC and childcare. While our birth outcomes don't seem to be tremendously different from people who have not had the intervention, we have found that the people entering our program have had more drug, alcohol and mental health problems to start with. So, the fact that the birth outcomes were the same is in fact good.
We are also doing a lot of HIV prevention, welfare-to-work support, and a healthy start program where we do a much more intensive 90 minute home visit every week where we do some early intervention and early childhood education.
4npo: Your organization has developed its own software. How did that come about?
JoAnne: We needed to track not only who our clients were, but what interventions we were engaged in. It was a long process, but we learned that we needed to track client characteristics, interventions and outcomes. When we investigated what was out there, we didn't find anything that really met our needs. The available products were much more clinically oriented, with a medical orientation, but our program is really geared towards social support. So, we wound up developing a client data management system. At first we did our own using Microsoft Access. Then a number of years ago we really had a need to convert that system into a billing system for managed care. We got an infrastructure support grant from the William Penn Foundation that enabled us to convert our old system and build a much more sophisticated system on an Oracle platform. We could use this to track client activity, process billing, assist in our case management, and to report to our numerous funders.
4npo: It sounds like you had to go through a pretty sophisticated process. How long did it take from the time you made the decision to get rid of the old system to the implementation of the new one?
JoAnne: We were funded for 2 years but it probably took 3 years. After having had a full year or two of using the system, we are now engaged in a major revision in which we are now converting to a web-based system.
4npo: How much was the initial grant from the William Penn Foundation?
JoAnne: It was $465,000. That wasn't just for IS but for infrastructure as well.
4npo: William Penn must have been pretty impressed with the organization in order to invest that kind of money in its information infrastructure?
JoAnne: We certainly saw it as a vote of confidence.
4npo: Your original reason for developing the software was for tracking purposes?
JoAnne: For tracking and billing. We really thought it was important in terms of doing business with managed care. At that point, it looked like that was where things were headed. Looking back it never added up to very much revenue. So, I would say our original motivation is no longer our motivation. But the reporting requirements have gotten increasingly complex and demanding. Even for very small government grants the level of detail is amazing. So this has helped us a lot.
4npo: That must have required quite a bit of training and change in your organization.
JoAnne: It did, and I want to give my consultant credit that their first step was to really learn about our business and service delivery processes. One of the things that they identified in their initial survey was that there was a lot of consistency from site-to-site and we did have some standard operating procedures. That was a good base to build a program on. Then, compared to a lot of agencies where people are really entrenched, we are lean and mean and not so entrenched in the old ways of doing business. There was an openness here on all levels. The way we have done business has been transformed, not only in the developing of our client data management system but the networking of all our sites, the use of e-mail and the Internet and common scheduling system. All of those things have made a tremendous difference in how we do business. Our staff has been pretty good in the transition. Now, we did lose some people who weren't really all that excited about communicating by e-mail. But I would say my line staff, our lay community health workers, are using the system. Some of them had never turned a computer on in their lives but find this change very exciting. I remember in a meeting they were saying "finally now I can do what my kids can do." I think we have upgraded our staff skills dramatically and they are grateful for that.
4npo: You said that government agencies, even for small grants require a tremendous amount of information. How easy is it for you to track all of their requirements and how often do these requirements change?
JoAnne: It depends on what the they are and what the outcomes are. I have 46 different funders. It's pretty burdensome when they all want different things. For instance, different divisions of the Health Department may require a different age breakdowns. There's a tremendous amount of programming for reports. I would say that if anything, this wound up being more cumbersome, time consuming and expensive than I had anticipated. For example, the Feds changed their requirements, which meant the city had to change their requirements, but it wound up being very expensive and time consuming for us to change too.
4npo: When you say funders are you speaking mainly about government funders?
JoAnne: Yes, their the ones who are fickle.
4npo: Have you made your software available to other organizations?
JoAnne: We've begun. An article in a Robert Wood Johnson Foundation publication mentioned that we had the software. We've done a couple of presentations at professional meetings. As a result, we've really had some interest. We did put in one bid and we learned that we really don't have the staff to do the marketing and follow-up that we needed. We did develop a business plan and concluded that as an organization that provides technical assistance to other maternal child health organizations, like a Healthy Start, or through an organization that is doing IT for non-profits it would make sense for us to partner with a marketing and distribution organization. The good part about following-up with the leads that we had was that it turned out to be a market research project. We identified some of the needs of the folks in the field and as a result, we learned a few things. One was that we were way ahead of a lot of people. We thought that our market would be grassroots community organizations who had reporting requirements, like community health workers. Most of them can't afford this type of product and in many cases were just beginning to purchase computers. What we found was that our potential market was actually much more sophisticated where there were the people who appreciated the value of an Oracle database. We did learn that there is a market out there. We also learned that people want a web based product, which is why we went in that direction. If they have remote sites it makes it easier to support them.
4npo: Do you have concerns about privacy and the security of a web based application?
JoAnne: Yes and no. We're working with our consultants on that. It means that they have to do the kinds of encryption they need to do, passwords to enter the system. I'm not terribly worried about that.
4npo: You talked about the lack of reporting standards earlier. Are there any efforts being made to create broad reporting standards?
JoAnne: If you find out, let me know! The AIDS stuff is unbelievable. For $25,000 they want you to spend $20,000 on reporting.
4npo: JoAnne thanks so much for taking the time to speak with me.
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