Association for Public Policy Analysis & Management

Many maternity practices have shown interest in implementing Group Prenatal Care (GPC), a transformative model that combines clinical care in a group setting with education and support. Overall, studies of GPC have generally shown high patient satisfaction and neutral or positive outcomes relative to typical care. Strong Start for Mothers and Newborns, a federal initiative to prevent preterm birth, demonstrated some better birth outcomes for GPC participants compared to Medicaid participants in typical care, including lower costs and lower rates of prenatal and postpartum hospitalization for mothers and newborns and postpartum emergency department visits. While these positive findings suggest potential advantages to continuing to expand GPC, it can be difficult to implement and sustain. This research investigates GPC implementation in Strong Start.

We report qualitative analysis on group care implementation. Data collection using triangulated case study methods included interviews with 441 key informants and focus groups with 428 women. Researchers conducted additional semi-structured interviews with Medicaid officials and other stakeholders.

Participants expressed high satisfaction with prenatal care. Barriers to implementing GPC occurred at the practice, patient, provider/administrator and system levels, including meeting the requirements of graduate medical education (GME) programs, serving high-risk women, attitudes of prenatal care providers, and payment policies (e.g. of state Medicaid programs). Sites newly implementing GPC had varying success sustaining their programs. Both new and established sites identified critical strategies for maintaining buy-in and model commitment such as establishing steering committees to engage leadership and guide GPC implementation, utilizing provider champions to persuade and motivate other providers and staff, and inviting prenatal care providers to participate in a session to see how GPC worked.

While other parts of the Strong Start evaluation found that group prenatal care shows promise for improving outcomes and reducing costs among both high and low risk Medicaid beneficiaries, barriers to implementing and sustaining the model are multifaceted. Varying sites, including birth centers, private medical practices, and academic high-risk medical centers identified broadly applicable strategies for overcoming challenges.

For GPC to be successfully implemented and sustained, systematic strategies can be employed at the practice, payer, provider, patient and policy levels. Best practices can help interested maternity care sites implement and sustain this transformative approach.