Variable Uptake of Medicaid-Covered Prenatal Care Coordination: The Relevance of Treatment Level and Service Context (original) (raw)
Related papers
Maternal and Child Health Journal, 2011
Objectives Community-based prenatal case management (PCM) is a means to improve birth outcomes for medically or socially high-risk pregnant women. To conduct national surveys of PCM programs, a useful sampling frame of existing programs is needed. However, as a relatively small optional Medicaid reimbursed program, PCM programs are hard to reach. Methodological approaches are needed to address issues arising when attempting to access and survey hard-to-reach participants, including programs. Methods State Medicaid offices were contacted to determine whether they reimbursed for PCM, and lists of Medicaid providers were obtained from those states. Most providers on the lists were contacted to confirm that they provide PCM and to verify the program director contact information. Findings Multiple attempts, using different modes of communication, were required to identify states reimbursing for PCM through Medicaid (n = 33). Of providers on the lists obtained from 29 of the 33 states, 34% of those listed provided PCM, suggesting over coverage rather than omissions. Provider contact information was outdated, duplicative, or not specific to PCM. The final count was 1,184 PCM programs in 29 states. Conclusion Identifying hard-to-reach programs requires persistence and creativity, as well as a rigorous approach to generating a census of programs.
Prenatal, delivery, and infant care under Medicaid in three states
Health care financing review, 1989
Medicaid services and expenditures were analyzed for care during the prenatal, delivery, and post-delivery periods in three States--California, Georgia, and Michigan. Uniform data were used from the Health Care Financing Administration's Medicaid Tape-to-Tape project, 1983-84. Results indicate that from 16 to 24 percent of all births in the States of the study, during the study period, were financed by Medicaid. Overall, the study showed that more than one-half of expenditures for the study population were for the delivery hospitalization, and less than 12 percent were for prenatal care. As expected, a substantial portion of expenditures were for high-cost deliveries, up to 41 percent of total delivery payments. From 33 to 41 percent of total Medicaid expenditures for Aid to Families with Dependent Children were for pregnancy, delivery, and newborn care in 1983.
An Examination of the Association Between State Medicaid Perinatal Services and Birth Outcomes
2020
This thesis investigated the connection between socioeconomic status, healthcare coverage, and birth outcomes. The research question that was posed specifically looked at twenty perinatal services that states covered under Medicaid to varying degrees to see their association, if any, with premature birth rates and low birthweight rates. State-level and Mississippi county-level data were compiled regarding preterm birth rates, low birthweight rates, presumptive eligibility adoption, and coverage of twenty different perinatal services. Using these data, the correlation between state Medicaid expansion status and birth outcomes was first calculated in order to determine if variation in birth outcomes was associated with expanded Medicaid coverage. After this, the relationship between birth outcomes and poverty was determined at both the state level and the Mississippi county level. The research found that poverty had a very positive correlation with high rates of poor birth outcomes and that state-level coverage was minimally correlated with birth outcomes. This study concluded by calling for further research into the Medicaid system, preventative care models for Medicaid, or systemic reform to the healthcare delivery system. AN EXAMINATION OF […] PERINATAL SERVICES AND BIRTH OUTCOMES iv ACKNOWLEDGEMENTS I would first like to thank Dr. John Green for all of the time and effort he has poured into my writing process throughout my undergraduate career. I would also like to thank my committee of readers, Dr. Lefmann and Dr. Dellinger for all of the editing advice and for being willing to take on another thesis defense. I would lastly like to thank my family for teaching me the importance of education and for supporting me wholeheartedly in my college endeavors.
Health services research, 2017
To examine effects of maternity care coordination (MCC) on perinatal health care utilization among low-income women. North Carolina Center for Health Statistics Baby Love files that include birth certificates, maternity care coordination records, WIC records, and Medicaid claims. Causal effects of MCC participation on health care outcomes were estimated in a sample of 7,124 singleton Medicaid-covered births using multiple linear regressions with inverse probability of treatment weighting (IPTW). Maternity care coordination recipients were more likely to receive first-trimester prenatal care (p < .01) and averaged three more prenatal visits and two additional primary care visits during pregnancy; they were also more likely to participate in WIC and to receive postpartum family planning services (p < .01). Medicaid expenditures were greater among mothers receiving MCC. Maternity care coordination facilitates access to health care and supportive services among Medicaid-covered wo...
Effects of a pregnancy management program on birth outcomes in managed Medicaid
Managed care (Langhorne, Pa.), 2011
Examine the effect of a prenatal program on birth outcomes, specifically birth weight, in a managed Medicaid pregnant population, and identify the potential barriers to obtaining the risk screening information required for successful interventions. Retrospective propensity-adjusted cohort comparison. Retrospective propensity-adjusted comparison of pregnant women in a managed Medicaid plan enrolled in a prenatal program and pregnant women who were not enrolled. Program enrollment was initiated by receipt of a Notification of Pregnancy (NOP) risk screening assessment. We demonstrate a statistically significant improvement in delivery outcomes in the women who participate in the pregnancy management program (NOP group) compared with those who do not (non-NOP group). The incidence of low-birth-weight infants was lower in the NOP group compared to the non-NOP group. Odds ratio estimates indicate that the NOP participants are likely to have 7.9% lower adverse event frequency for delivery ...
Prenatal and Postpartum Care Disparities in a Large Medicaid Program
Maternal and child health journal, 2017
Objectives Pennsylvania's maternal mortality, infant mortality, and preterm birth rates rank 24th, 35th, and 25th in the country, and are higher among racial and ethnic minorities. Provision of prenatal and postpartum care represents one way to improve these outcomes. We assessed the extent of disparities in the provision and timeliness of prenatal and postpartum care for women enrolled in Pennsylvania Medicaid. Methods We performed a cross-sectional evaluation of representative samples of women who delivered live births from November 2011 to 2015. Our outcomes were three binary effectiveness-of-care measures: prenatal care timeliness, frequency of prenatal care, and postpartum care timeliness. Pennsylvania's Managed Care Organizations (MCOs) were required to submit these outcomes to the state after reviewing administrative and medical records through a standardized, validated sampling process. We assessed for differences in outcomes by race, ethnicity, region, year, and MCO...
Birth, 2017
Background: Variations in care for pregnant women have been reported to affect pregnancy outcomes. Methods: This study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio-behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored. Results: Medicaid beneficiaries enrolled at AABC sites had diverse socio-behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low-risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery-led prenatal care, and 84% with midwifery-attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4-times greater risk of cesarean birth among medically low-risk childbearing Medicaid beneficiaries. Conclusions: The birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value. K E Y W O R D S birthing centers, cesarean birth, Medicaid 1 | INTRODUCTION The birth center model has been recognized as a high quality alternative to hospitalization for healthy, childbearing women. 1-5 Recently, there has been renewed interest in birth settings and risk appropriate levels of care. 6-9 In 2015, risk appropriate care and birth settings were the topic of the American College of Obstetricians and Gynecologists
Health Affairs, 2020
The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups. Improved outcomes were achieved at lower costs. There were few improvements in outcomes for participants who received group prenatal care, although their costs were lower in the prenatal period, and no improvements in outcomes for participants in maternity care homes.
Implementation of mandatory Medicaid managed care in Missouri: impacts for pregnant women
The American journal of managed care, 2005
To assess the impact of mandatory Medicaid managed care in Missouri on prenatal care, maternal behavior, and low birth weight among pregnant women enrolled in Medicaid. Pre-post design using a comparison group with birth certificate and Medicaid enrollment data in 1995 and 2000. Pregnant women delivering in 38 counties that implemented managed care in Medicaid were compared preimplementation and postimplementation with pregnant women delivering under Medicaid in 78 counties that remained fee-for-service (FFS) for separate samples of white (37,561) and black (13,640) non-Hispanic women. We calculated difference-in-difference estimates using linear probability regression models that controlled for maternal characteristics and time-invariant county differences. Analyses were stratified based on Medicaid enrollment before and after conception, managed care region, and marital status. Both managed care and FFS counties showed large improvements in prenatal care measures over time for bot...
The Impact of Medicaid Managed Care on Pregnant Women in Ohio: A Cohort Analysis
Health Services Research, 2004
Objective. To examine the impact of mandatory HMO enrollment for Medicaidcovered pregnant women on prenatal care use, smoking, Cesarean section (C-section) use, and birth weight. in 10 Ohio counties, 6 that implemented mandatory HMO enrollment, and 4 with low levels of voluntary enrollment (under 15 percent). Cuyahoga County (Cleveland) is analyzed separately; the other mandatory counties and the voluntary counties are grouped for analysis, due to small sample sizes. Study Design. Women serve as their own controls, which helps to overcome the bias from unmeasured variables such as health beliefs and behavior. Changes in key outcomes between the first and second birth are compared between women who reside in mandatory HMO enrollment counties and those in voluntary enrollment counties. County of residence is the primary indicator of managed care status, since, in Ohio, women are allowed to ''opt out'' of HMO enrollment in mandatory counties in certain circumstances, leading to selection. As a secondary analysis, we compare women according to their HMO enrollment status at the first and second birth. Data Collection/Extraction Methods. Linked birth certificate/enrollment data were used to identify 4,917 women with two deliveries covered by Medicaid, one prior to the implementation of mandatory HMO enrollment (mid-1996) and one following implementation. Data for individual births were linked over time using a scrambled maternal Medicaid identification number. Principal Findings. The effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county. In Cuyahoga, the implementation of mandatory enrollment was related to a significant deterioration in the timing of initiation of care, but an improvement in the number of prenatal visits. In that county also, women who smoked in their first pregnancy were less likely to smoke during the second pregnancy, compared to women in voluntary counties. Women residing in all the mandatory counties were less likely to have a repeat C-section. There were no effects on infant birth weight. The effects of women's own managed care status were inconsistent depending on the outcome examined; an interpretation of these results is hampered by selection issues. Changes over time in outcomes, both positive and negative, were more pronounced for African American women. Conclusions. With careful implementation and attention to women's individual differences as in Ohio, outcomes for pregnant women may improve with Medicaid