Panel: Programs to Improve Maternity Care

Thursday, November 7, 2019: 8:30 AM-10:00 AM
I.M Pei Tower: Terrace Level, Terrace (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Organizer:  Ian Hill, Urban Institute
Panel Chair:  Caitlin Cross-Barnet, Centers for Medicare & Medicaid Services
Discussant:  Gretchen Hammer, Public Leadership Group

The Strong Start for Mothers and Newborns initiative aimed to improve maternal and infant outcomes for women covered by Medicaid and the Children’s Health Insurance Program (CHIP) during pregnancy. The initiative funded enhanced prenatal care services through three evidence-based models—Birth Centers, Group Prenatal Care, and Maternity Care Homes—and supported the delivery of these services through 27 awardees and 211 provider sites across 32 states, the District of Columbia, and Puerto Rico. The five-year national evaluation of Strong Start used mixed methods to study the implementation and impacts of the initiative on rates of preterm birth, low birthweight, and cost of care, among other outcomes.

Using linked birth certificate and Medicaid data, the evaluation’s impact analysis compared birth and cost outcomes for women participating in Strong Start to outcomes for comparable, non-participating Medicaid-enrolled women receiving “typical” Medicaid prenatal care.   The analysis produced many important findings, including:  infants born to women in Birth Centers were 26 percent less likely to be born preterm, and 20 percent less likely to be born low birthweight, than infants born to women receiving typical prenatal care.  Rates of cesarean section were 40 percent lower and rates of vaginal birth after cesarean 93 percent higher for women receiving Birth Center care.  Finally, expenditures for mothers and infants during the prenatal care and delivery period were $1759 (or 21 percent) lower for women in Birth Centers compared to those receiving typical care. Meanwhile, women receiving Group Prenatal Care experienced few improvements in outcomes, but their prenatal care costs were lower than those of women receiving typical care, and women cared for in Maternity Care Homes experienced neither improved outcomes nor lower costs.   

This panel will review the key elements of the three evidence-based models implemented under Strong Start – with individual papers focusing on design, implementation, and patients' experiences with Birth Center care, Group Prenatal Care, and Maternity Care Homes – and discuss the key features of these models that explain why some had impacts and others did not.  The federal project officer for the Strong Start evaluation will serve as panel chair; evaluation leaders will present each of the panel’s three papers, and a maternal and child health expert and former Medicaid Director from the State of Colorado will serve as discussant and will interpret the evaluation’s findings and comment on their implications for prenatal care delivery both nationally and under Medicaid.

Participant-Level Data Suggest That More Intensive Approaches to Prenatal Care May Reduce the Risk of Developing Adverse Pregnancy Conditions
Sarah Benatar1, Emily M. Johnston1, Caitlin Cross-Barnet2 and Ian Hill1, (1)Urban Institute, (2)Centers for Medicare & Medicaid Services

Birth Center Care Improves Outcomes Under Strong Start: What Features Explain Their Success?
Brigette Courtot1, Caitlin Cross-Barnet2 and Ian Hill1, (1)Urban Institute, (2)Centers for Medicare & Medicaid Services

Key Considerations for Implementing Group Prenatal Care: Lessons from 60 Practices
Jodi Pekkala1, Caitlin Cross-Barnet2, Margaret Kirkegaard1, Sharon Silow-Carroll1, Brigette Courtot3 and Ian Hill3, (1)Health Management Associates, (2)Centers for Medicare & Medicaid Services, (3)Urban Institute

Moving the Needle on Birth Outcomes in Medicaid: Challenges to Improving the Medical Model of Care
Caitlin Cross-Barnet1, Sarah Benatar2, Brigette Courtot2, Ian Hill2, Lisa Dubay2, Emily M. Johnston2, Fredric Blavin2, Bowen Garrett2 and Embry Howell2, (1)Centers for Medicare & Medicaid Services, (2)Urban Institute

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