A review of CMS’ Strong Start initiative showed some success in three evidence-based maternity care service approaches.
Strong Start funded 27 awardees between 2013 and 2017 and included 26,007 enrollees at 112 maternity care homes, 10,508 enrollees at 60 group parental care sites and 8,806 enrollees at 47 birth centers.
The report found that women who received prenatal care in Strong Start birth centers had better outcomes and lower costs than Medicaid beneficiaries not enrolled in the program. Rates of preteen birth, low birthweight and cesarean section were lower among birth center participants and costs were more than $2,000 lower per mother-infant pair during birth and the following year.
The four-year Strong Start program sought to enhance care delivery and address medical, behavioral and psychosocial factors for at-risk moms and babies enrolled in Medicaid. The program sought to study how those issues, faced during pregnancy, contributed to poor birth outcomes. The goal was to reduce preterm births, improve health outcomes and decrease total cost of medical care through the first year of the child’s life.
All of the programs analyzed can improve access to care, care coordination and offer a full range of health services. The initiatives couldn’t use other funds to supplement or replace funding sources like Medicaid.
The analysis found that 42% of women in the program showed symptoms of depression, anxiety or both and 21% had a prior preterm birth. The demographic groups were split 40% black, 30% Hispanic and 26% white.
Birth centers, midwives models of care enhanced with peer counseling for additional support and referrals, created the most savings and better outcomes. Maternity care homes, which focused on care coordination, experienced higher costs but fewer prenatal hospitalizations. Maternity care homes also saw a higher rate of low birth weight and more weekend deliveries. Weekend deliveries point to the fact that there were more fewer scheduled inductions and scheduled C-sections.
Meanwhile, the group prenatal initiative, which provided health education and facilitates discussion, saw $427 lower per woman costs during the eight months before birth. The program also had fewer emergency room visits and hospitalizations. However, group prenatal led to very low birthweight, more weekend deliveries and more vaginal births after cesarean.
CMS said the positive birth center results can help state Medicaid programs looking for ways to improve health outcomes. Risky pregnancies can reach into the hundreds of thousands or even millions of dollars depending on the complications and outcomes. Efforts that look to help women with at-risk pregnancies before they reach a crisis has the potential to bring significant savings and improve long-term health outcomes. For states, they could also contain Medicaid costs, which state leaders say are taking up more of their state budgets.