Study Examines Savings from Value-Based Care Reimbursement of Prenatal Care Program to Medicaid Payers
Increased reimbursement to doctors who offer group prenatal care improves birth outcomes and significantly reduces Medicaid plan costs, according to a new study co-authored by Anthem, Inc, BlueChoice Health Plan South Carolina Medicaid, Greenville Health System and the Department of Obstetrics and Gynecology at Greenville Health System.
The study, published in the January-February 2017 edition of Women’s Health Issues Journal , is the first to examine the newborn intensive care unit (NICU) cost savings from the group prenatal care program, CenteringPregnancy, to payers when a managed care organization provided enhanced reimbursement to doctors to defray the costs and reward providers for encouraging patient participation in the program.
The CenteringPregnancy model requires significant upfront and continuing investment from practices, including patient education materials, annual certification fees and office support staff training. Although increased costs to the practices may be small in comparison with the potential savings for payers and the overall health care system, it often remains a barrier to implementation and few payers have developed enhanced reimbursement policies to cover the cost of CenteringPregnancy.
The study examined an enhanced reimbursement pilot project from the South Carolina Department of Health and Human Services to BlueChoice Health Plan South Carolina Medicaid, which in turn passed the additional incentive payments along to participating prenatal care practices.
The study compared a group of 85 pregnant women enrolled in Medicaid who attended at least four CenteringPregnancy sessions with a similar group of expectant mothers who instead saw their doctor individually. The pregnant women participating in the CenteringPregnancy program had a 3.5 percent NICU admission rate, while 12 percent of the matched control group had babies needing NICU care. The lower rate of hospital admissions resulted in an estimated net cost savings of $67,293 for the Medicaid managed care organization covering the 85 women.
The typical care model for women in the U.S. with uncomplicated pregnancies involves brief individual doctor appointments focused on identifying medical risks, with limited opportunity for counseling and support. In the Centering Pregnancy model, groups of eight to 12 pregnant women due within the same month attend sessions with an individual medical assessment followed by a 90-minute group discussion on topics including stress management, labor and nutrition. The open discussion format promotes information sharing among women, social support and the involvement of significant others.