title: Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina.
abstract: Objectives This study was undertaken to determine the cost savings of prevention of adverse birth outcomes for Medicaid women participating in the CenteringPregnancy group prenatal care program at a pilot program in South Carolina. Methods A retrospective five-year cohort study of Medicaid women was assessed for differences in birth outcomes among women involved in CenteringPregnancy group prenatal care (n = 1262) and those receiving individual prenatal care (n = 5066). The study outcomes examined were premature birth and the related outcomes of low birthweight (LBW) and neonatal intensive care unit (NICU) visits. Because women were not assigned to the CenteringPregnancy group, a propensity score analysis ensured that the inference of the estimated difference in birth outcomes between the treatment groups was adjusted for nonrandom assignment based on age, race, Clinical Risk Group, and plan type. A series of generalized linear models were run to estimate the difference between the proportions of individuals with adverse birth outcomes, or the risk differences, for CenteringPregnancy group prenatal care participation. Estimated risk differences, the coefficient on the CenteringPregnancy group indicator variable from identity-link binomial variance generalized linear models, were then used to calculate potential cost savings due to participation in the CenteringPregnancy group. Results This study estimated that CenteringPregnancy participation reduced the risk of premature birth (36 %, P < 0.05). For every premature birth prevented, there was an average savings of $22,667 in health expenditures. Participation in CenteringPregnancy reduced the incidence of delivering an infant that was LBW (44 %, P < 0.05, $29,627). Additionally, infants of CenteringPregnancy participants had a reduced risk of a NICU stay (28 %, P < 0.05, $27,249). After considering the state investment of $1.7 million, there was an estimated return on investment of nearly $2.3 million. Conclusions Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries.
authors.affiliation: Division of Medicaid Policy Research, Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC, 29208, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gareau
authors.affiliation: Division of Medicaid Policy Research, Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC, 29208, USA. adefede@mpr.sc.edu.
authors.forename: Ana
authors.initials: A
authors.lastname: Lòpez-De Fede
authors.affiliation: Division of Medicaid Policy Research, Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC, 29208, USA.
authors.forename: Brandon L
authors.initials: BL
authors.lastname: Loudermilk
authors.affiliation: Division of Medicaid Policy Research, Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC, 29208, USA.
authors.forename: Tammy H
authors.initials: TH
authors.lastname: Cummings
authors.affiliation: Division of Medicaid Policy Research, Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC, 29208, USA.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 948 Greene Street, Columbia, SC, 29208, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
authors.affiliation: Greenville Health System Department of Obstetrics and Gynecology, 890 W. Faris Road, Suite 470, Greenville, SC, 29605, USA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Picklesimer
authors.affiliation: Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 615 Greene Street, Columbia, SC, 29208, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Crouch
authors.affiliation: Greenville Health System Department of Obstetrics and Gynecology, 890 W. Faris Road, Suite 470, Greenville, SC, 29605, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Covington-Kolb
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D009035:Mothers; D009774:Obstetrics / Q000191:economics* / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care / Q000191:economics* / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013022:South Carolina / Q000453:epidemiology; D014481:United States
keywords: Birth outcomes; CenteringPregnancy; Cost savings; Low birthweight; Medicaid; Neonatal intensive care; Preterm birth