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Maternal and Child Health Journal

, Volume 20, Issue 7, pp 1384–1393 | Cite as

Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina

  • Sarah Gareau
  • Ana Lòpez-De Fede
  • Brandon L. Loudermilk
  • Tammy H. Cummings
  • James W. Hardin
  • Amy H. Picklesimer
  • Elizabeth Crouch
  • Sarah Covington-Kolb
Article

Abstract

Objectives This study was undertaken to determine the cost savings of prevention of adverse birth outcomes for Medicaid women participating in the CenteringPregnancy group prenatal care program at a pilot program in South Carolina. Methods A retrospective five-year cohort study of Medicaid women was assessed for differences in birth outcomes among women involved in CenteringPregnancy group prenatal care (n = 1262) and those receiving individual prenatal care (n = 5066). The study outcomes examined were premature birth and the related outcomes of low birthweight (LBW) and neonatal intensive care unit (NICU) visits. Because women were not assigned to the CenteringPregnancy group, a propensity score analysis ensured that the inference of the estimated difference in birth outcomes between the treatment groups was adjusted for nonrandom assignment based on age, race, Clinical Risk Group, and plan type. A series of generalized linear models were run to estimate the difference between the proportions of individuals with adverse birth outcomes, or the risk differences, for CenteringPregnancy group prenatal care participation. Estimated risk differences, the coefficient on the CenteringPregnancy group indicator variable from identity-link binomial variance generalized linear models, were then used to calculate potential cost savings due to participation in the CenteringPregnancy group. Results This study estimated that CenteringPregnancy participation reduced the risk of premature birth (36 %, P < 0.05). For every premature birth prevented, there was an average savings of $22,667 in health expenditures. Participation in CenteringPregnancy reduced the incidence of delivering an infant that was LBW (44 %, P < 0.05, $29,627). Additionally, infants of CenteringPregnancy participants had a reduced risk of a NICU stay (28 %, P < 0.05, $27,249). After considering the state investment of $1.7 million, there was an estimated return on investment of nearly $2.3 million. Conclusions Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries.

Keywords

CenteringPregnancy Medicaid Cost savings Birth outcomes Preterm birth Low birthweight Neonatal intensive care 

Notes

Acknowledgments

This work was done under the contract between the Institute for Families in Society, University of South Carolina, and the SC Department of Health and Human Services, Medicaid Program. The Institute for Families in Society at the University of South Carolina also receives funding through the U.S. Centers for Medicare and Medicaid Services. The views expressed in this article are solely the responsibility of the authors and do not necessarily represent the views of the SC Department of Health and Human Services, Medicaid Program, nor those of the U.S. Centers for Medicare and Medicaid Services. The authors thank staff at Greenville Health System and the Institute for Families in Society for their technical assistance and the SC DHHS Birth Outcomes Initiative for its support of this study.

References

  1. 1.
    Barr, W. B., Aslam, S., & Levin, M. (2011). Evaluation of a group prenatal care-based curriculum in a family medicine residency. Family Medicine, 43(10), 712–717.PubMedGoogle Scholar
  2. 2.
    Blackstone, E. H. (2002). Comparing apples and oranges. Journal of Thoracic and Cardiovascular Surgery, 123(1), 8–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2015). Preterm birth. Retrieved from http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm.
  4. 4.
    Centers for Medicare and Medicaid Services. (2015). Strong start for mothers and newborns: General information. Retrieved from https://innovation.cms.gov/initiatives/strong-start/.
  5. 5.
    Cook, R. J., & Sackett, D. L. (1995). The number needed to treat: A clinically useful measure of treatment effect. British Medical Journal, 310(6977), 452–454.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Garg, V., Shen, X., Cheng, Y., Nawarskas, J. J., & Raisch, D. W. (2013). Use of number needed to treat in cost-effectiveness analyses. Annals of Pharmacotherapy, 47(3), 380–387.CrossRefPubMedGoogle Scholar
  7. 7.
    Gaudion, A., Menka, Y., Demilew, J., Yiannouzis, K., Schindler, S., & Bick, D. (2011). Findings from a UK feasibility study of the Centering Pregnancy® model. British Journal of Midwifery, 19(12), 796–803.CrossRefGoogle Scholar
  8. 8.
    Grady, M. A., & Bloom, K. C. (2004). Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy® program. Journal of Midwifery and Women’s Health, 49(5), 12–420. doi: 10.1016/j.jmwh.2004.05.009.Google Scholar
  9. 9.
    Hale, N., Picklesimer, A. H., Billings, D. L., & Covington-Kolb, S. (2014). The impact of Centering Pregnancy Group Prenatal Care on postpartum family planning. American Journal of Obstetrics and Gynecology, 210(1), 50.e1-7. doi: 10.1016/j.ajog.2013.09.001.
  10. 10.
    Ickovics, J. R., Earnshaw, V., Lewis, J., Kershaw, T. S., Magriples, U., Stasko, E., et al. (2016). Cluster randomized controlled trial of group prenatal care: Perinatal outcomes among adolescents in New York City health centers. American Journal of Public Health, 106(2), 359–365.CrossRefPubMedGoogle Scholar
  11. 11.
    Ickovics, J. R., Reed, E., Magriples, U., Westdahl, C., Rising, S. S., & Kershaw, T. S. (2011). Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomised controlled trial. Psychology and Health, 26(2), 235–250.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S. S. (2007). Group prenatal care and perinatal outcomes. Obstetrics and Gynecology, 110(2 Pt 1), 330–339.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ickovics, J. R., Kershaw, T. S., Westdahl, C., Rising, S. S., Klima, C., Reynolds, H., & Magriples, U. (2004). Group prenatal care and preterm birth weight: Results from a matched cohort study at public clinics. Obstetrics and Gynecology, 102(5), 1051–1057. doi: 10.1016/S00297844(03)00765-8.Google Scholar
  14. 14.
    Kornhauser, M., & Schneiderman, R. (2010). How plans can improve outcomes and cut costs for preterm infant care. Managed Care, 19(1), 28–30.PubMedGoogle Scholar
  15. 15.
    Kowlessar, N. M., Jiang, J., & Steiner, C. (2013). Hospital stays for newborns, 2011. Healthcare Cost and Utilization Project, Statistical Brief, 163. Retrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb163.pdf.
  16. 16.
    Kurth, T., Walker, A. M., Glynn, R. J., Chan, K. A., Gaziano, J. M., Berger, K., & Robins, J. M. (2006). Results of multivariable logistic regression, propensity matching, propensity adjustment, and propensity-based weighting under conditions of nonuniform effect. American Journal of Epidemiology, 163(3), 262–270.CrossRefPubMedGoogle Scholar
  17. 17.
    McDonald, S., Sword, W., Eryuzlu, L., Neupane, B., Beyene, J., & Biringer, A. (2016). Why are half of women interested in participating in group prenatal care? Maternal and Child Health Journal, 20(1), 97–105.CrossRefPubMedGoogle Scholar
  18. 18.
    Mooney, S. E., Russell, M. A., Prairie, B., Savage, C., & Weeks, W. B. (2008). Group prenatal care: An analysis of cost. Journal Health Care Finance, 34(4), 31–41.Google Scholar
  19. 19.
    Muraskas, J., & Parsi, K. (2008). October). The cost of saving the tiniest lives: NICUs versus prevention. American Medical Association Journal of Ethics, 10(10), 655–658.PubMedGoogle Scholar
  20. 20.
    Nguyen, N., Allen, A., Gorman, M., Hersh, S., Frias, A., Cooper, A., & Caughney, A. (2014). Group prenatal care for women with pre-gestational type II diabetes mellitus: A cost-effectiveness analysis. American Journal of Obstetrics and Gynecology, 210(1), D290. doi: 10.1016/j.ajog.2013.10.408.Google Scholar
  21. 21.
    Novick, G., Reid, A. E., Lewis, J., Kershaw, T. S., Rising, S. S., & Ickovics, J. R. (2013). Group prenatal care: Model fidelity and outcomes. American Journal of Obstetrics and Gynecology, 206, 112e1–112e6.CrossRefGoogle Scholar
  22. 22.
    Ohno, M., Rodriguez, M. I., Wiener. S., & Caughey, A. B. (2012, October). CenteringPregnancy ® for the prevention of preterm birth: A cost effectiveness analysis. Presented at the 34th Annual Meeting of the Society for Medical Decision Making Phoenix, AZ. Retrieved from https://smdm.confex.com/smdm/2012az/webprogram/Paper6929.html23.
  23. 23.
    Petrou, S., Sach, T., & Davidson, L. (2001). The long-term costs of preterm birth and low birth weight: Results of a systematic review. Child Care Health Development, 27(2), 97–115.CrossRefGoogle Scholar
  24. 24.
    Picklesimer, A. H. & Craine, J. (2015, November 12) Centering outcomes and payment reform: Shifting resources to prevention. Presented at the Northeast Centering Symposium at the Massachusetts Medical Society. Retrieved from http://www.marchofdimes.org/massachusetts/news_13422.html.
  25. 25.
    Picklesimer, A. H., Billings, D., Hale, N., Blackhurst, D., & Covington-Kolb, S. (2012). The effect of CenteringPregnancy® group prenatal care on preterm birth in a low-income population. American Journal of Obstetrics and Gynecology, 206, 415e1–415e7.CrossRefGoogle Scholar
  26. 26.
    Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55.CrossRefGoogle Scholar
  27. 27.
    Rowley, R., Phillips, L., O’Dell, L., Husseini, R., Carpino, S., & Hartman, S. (2016). Group prenatal care: A financial perspective. Maternal and Child Health Journal, 20(1), 1–10.CrossRefPubMedGoogle Scholar
  28. 28.
    Sheeder, J., Yorga, K. W., & Kabir-Greher, K. (2010). A review of prenatal group literature: The need for a structured theoretical framework and systematic evaluation. Maternal and Child Health Journal, 16(1), 177–187. doi: 10.1007/s10995-010-0709-1.CrossRefGoogle Scholar
  29. 29.
    South Carolina Department of Health & Human Services. (2015). CenteringPregnancy: A successful model for group prenatal care. South Carolina Birth Outcomes Initiative Webinar. Retrieved from https://www.scdhhs.gov/organizations/boi.
  30. 30.
    Tandon, D. S., Cluxton-Keller, F., Colon, L., Vega, P., & Alonso, A. (2013). Improved adequacy of prenatal care and healthcare utilization among low-income Latinas receiving group prenatal care. Journal of Women’s Health, 22(12), 1056–1061. doi: 10.1089/jwh.2013.4352.CrossRefPubMedGoogle Scholar
  31. 31.
    Tanner-Smith, E. E., Steinak-Fry, K. T., & Lipsey, M. W. (2013). Effects of CenteringPregnancy® group prenatal care on breastfeeding outcomes. Journal of Midwifery and Women’s Health, 58(4), 389–395. doi: 10.1111/jmwh.12008.CrossRefPubMedGoogle Scholar
  32. 32.
    Tanner-Smith, E. E., Steinka-Fry, K., & Lipsey, M. W. (2012). A multi-site evaluation of the CenteringPregnancy® programs in Tennessee: Final report presented to the Tennessee Department of Health. Nashville, TN: Peabody Research Institute, Vanderbilt University. Retrieved from https://my.vanderbilt.edu/emilytannersmith/files/2012/02/Contract19199-GR1030830-Final-Report.pdf.
  33. 33.
    Tanner-Smith, E. E., Steinak-Fry, K. T., & Lipsey, M. W. (2014). The effects of CenteringPregnancy® group prenatal care on gestational age, birth weight, and fetal demise. Maternal Child Health Journal, 18(4), 801–809. doi: 10.1007/s10995-013-1304-z.CrossRefPubMedGoogle Scholar
  34. 34.
    Trotman, G., Chhatre, G., Darolia, R., Tefera, E., Damle, L., & Gomez-Lobo, V. (2015). The effect of Centering Pregnancy versus traditional prenatal care models on improved adolescent health behaviors in the perinatal period. Journal of Pediatric and Adolescent Gynecology, 28(5), 395–401.CrossRefPubMedGoogle Scholar
  35. 35.
    United Health Foundation. (2016). America’s health rankings: South Carolina. Retrieved from http://www.americashealthrankings.org/SC.

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sarah Gareau
    • 1
  • Ana Lòpez-De Fede
    • 1
  • Brandon L. Loudermilk
    • 1
  • Tammy H. Cummings
    • 1
  • James W. Hardin
    • 1
    • 2
  • Amy H. Picklesimer
    • 3
  • Elizabeth Crouch
    • 4
  • Sarah Covington-Kolb
    • 3
  1. 1.Division of Medicaid Policy Research, Institute for Families in SocietyUniversity of South CarolinaColumbiaUSA
  2. 2.Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  3. 3.Greenville Health System Department of Obstetrics and GynecologyGreenvilleUSA
  4. 4.Health Services Policy and Management, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA

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