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

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.

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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.

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Correspondence to Ana Lòpez-De Fede.

Appendix of Codes

Appendix of Codes

Preterm Birth

ICD-9 Codes

  • 765.01–765.09: Disorders relating to extreme immaturity of an infant

  • 765.11–765.19: Disorders relating to other preterm infants

  • 765.21–765.28: 36 weeks or less of gestation

Low Birthweight

ICD-9 Codes

  • 764.00–764.08: Light for dates without fetal malnutrition, <2500 g

  • 764.10–764.18: Light for dates with fetal malnutrition, <2500 g

  • 764.91–764.98: Fetal growth retardation, <2500 g

  • V21.3-V21.34: Low birthweight status

Neonatal Intensive Care Unit Visit

Revenue Codes

0173, 0174: Special care or Neonatal Intensive Care Unit

CPT Codes

99291–99296, 99298, 99300, 99468–99469, 99477–99482: Pediatric or neonate critical care

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Gareau, S., Lòpez-De Fede, A., Loudermilk, B.L. et al. Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina. Matern Child Health J 20, 1384–1393 (2016). https://doi.org/10.1007/s10995-016-1935-y

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Keywords

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