INDIANAPOLIS--(BUSINESS WIRE)--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.
Medicaid is the largest payer of maternity health benefits in the U.S., and inpatient costs associated with preterm births exceed $6 billion per year – representing half of all costs associated with infant births. One in 10 American babies is born prematurely, placing the newborn at increased risk of death, medical complications and lifelong health challenges.
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.
“Anthem is dedicated to the health of American families, which is why our Foundation is a longtime champion of CenteringPregnancy through financial support of the March of Dimes and the Centering Healthcare Institute,” said Karen Shea, Anthem’s vice president of maternal child health and one of the co-authors of the paper. “This study demonstrates that designing payment programs that sustain CenteringPregnancy at the ob/gyn practice level are a potentially sound investment for payers to reduce inpatient costs and help more babies get a healthy start in life.”
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.
“The value of the group model is that it engages patients in their own health, enhances the care experience for both patient and provider, and creates a community of support,” says Angie Truesdale, CEO of Centering Healthcare Institute. “All of these components contribute to cost savings and healthier moms and babies.”
In addition to Anthem, representatives from BlueChoice Health Plan South Carolina Medicaid, Greenville Health System and the Department of Obstetrics and Gynecology at Greenville Health System co-authored the paper.
About Anthem Inc.
Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 73 million people served by its affiliated companies, including approximately 40 million within in its family of health plans, Anthem is one of the nation’s leading health benefits companies. For more information about Anthem’s family of companies, please visit www.antheminc.com/companies.
About the Centering Healthcare Institute
Centering Healthcare Institute is improving health by transforming care through Centering groups. It has developed and sustained the Centering model in more than 450 practice sites and in some of the largest health systems in the world. They have partnered with many dedicated individuals and organizations to build a future where group healthcare becomes the standard of care. For more information on Centering Healthcare Institute and the Centering models of group care, visit www.centeringhealthcare.org.