Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina
- 1.5k Downloads
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.
KeywordsCenteringPregnancy Medicaid Cost savings Birth outcomes Preterm birth Low birthweight Neonatal intensive care
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.
- 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.Centers for Medicare and Medicaid Services. (2015). Strong start for mothers and newborns: General information. Retrieved from https://innovation.cms.gov/initiatives/strong-start/.
- 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.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
- 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
- 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.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
- 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
- 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
- 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.
- 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.
- 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.
- 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.
- 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.United Health Foundation. (2016). America’s health rankings: South Carolina. Retrieved from http://www.americashealthrankings.org/SC.