An assessment of the use and impact of ancillary prenatal care services to Medicaid women in managed care.
OBJECTIVE
Managed care plans under Medicaid are becoming a usual source of care for low-income pregnant women. This study describes an ancillary prenatal care service intervention developed by one managed care organization (MCO) for Medicaid-enrolled women, assesses the extent to which the intervention services were used, and appraises the influence of the intervention on prenatal care participation.


METHODS
There were 226 intervention and 258 control women with a single live birth delivered between 28 and 44 weeks gestation who (1) were enrolled in the MCO's Medicaid program, (2) were high-risk based on a prenatal risk assessment, and (3) started prenatal care prior to 26 weeks gestation. Less than adequate and intensive prenatal care utilization were chosen as intervention outcomes measures.


RESULTS
Family planning, a 2-month postpartum baby visit, a maternal postpartum visit, and a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) referral were among the most self-selected intervention services for this population; home health aide and breast-feeding support were the least requested services. Over 90% of those needing family planning or breast-feeding services received the services, while over 20% of the intervention group refused child care, food assistance and family violence referrals, and home health aide and smoking cessation services. The intervention group had a significantly lower risk of less than adequate utilization of prenatal care (OR = .32; 95% CI: 0.17-0.60) and was more likely to have an intensive number of prenatal care visits (OR = 1.61; 95% CI: 1.05-2.48).


CONCLUSIONS
The ability of managed care organizations to provide ongoing prenatal care to Medicaid populations in a cost-effective manner depends partly on their development of packages of prenatal services that foster positive preventive health care utilization behaviors and good pregnancy outcomes. The results of this project suggest that the intervention was beneficial in the area of improving utilization of prenatal care.
Alexander
G R
GR
Department of Maternal and Child Health, University of Alabama at Birmingham 35294-0022, USA. GREG.ALEXANDER@UAB.EDU
Hulsey
T C
TC
Foley
K
K
Keller
E
E
Cairns
K
K
D000293:Adolescent; D000328:Adult; D000720:Ancillary Services, Hospital / Q000706:statistics & numerical data; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008430:Maternal-Child Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012016:Reference Values; D012307:Risk Factors; D014481:United States