HHS Strong Start Initiative, Part 2: Reducing Premature Births Through Improved Prenatal Care

On February 8, 2012, HHS announced the Strong Start initiative, the goal of which is two-fold: (1) to reduce the number of preterm births that occur among high-risk women and those covered by Medicaid in the U.S., and (2) to campaign for a reduction in the number of early elective deliveries occuring before 39 weeks.  HHS cited that the number of premature births, those occuring prior to 37 weeks, has increased by 36 percent in the last 20 years.  Those premature babies that are covered by Medicaid have health care costs on average of $20,000 during their first year of life, compare to $2,100 for full-term babies.

This part of the initiative aims to improve the prenatal care of Medicaid beneficiaries, and to that end the Center for Medicare and Medicaid Innovation will award $43 million in grants through a competitive process to providers, states, managed care plans and other organizations to provide better care, improve health and reduce costs for Medicaid beneficiaries who are pregnant and at-risk of preterm births and their infants.  The grants, a four-year initiative to test and evaluate the effect improved prenatal care has on prematurity rates, will evaluate three approaches to achieving the objectives of enhancing prenatal care:

  • Group visits:  Group prenatal care will be used, that includes peer-to-peer interaction, in a facilitated setting to assess health and provide both education and psycho-social support.
  • Birth centers:  Teams of health professionals, including peer counselors and doulas, will provide collaborative, comprehensive care which includes case management, counseling, and psych-social support.
  • Maternity care homes:  Along with traditional prenatal care, women will be provided with an array of health services, including psycho-social support, education, and health promotion.  Such services will improve access to care and improve care coordination.

Organizations can only implement one of these options at their individual practice. A fourth approach, home visits, will be evaluated specifically by the Innovation Center, along with the Health Resources and Services Administration and the Administration on Children and Families, as part of the ongoing Maternal, Infant, and Early Childhood Home Visiting program.

The Strong Start initiative will actually operate for three years, and an additional year will be provided beyond the last birth for data collection and submission.  The intention is to fund enhanced prenatal care for around 30,000 pregnant Medicaid beneficiaries each year the program is in operation, or about 90,000 in total.  The number of grants provided will depend on the number of applicants, and awards will be made in consideration of the funding available, geographic diversity, and the quality of the application and the organization’s ability to meet the goals.   Applicants should have the capacity to serve at least 500 pregnant at-risk beneficiaries per year.

Grant recipients will be required to participate in monitoring and evaluation to track the quality of the care provided.  Monthly figures related to gestational age at delivery, birth weight, and use of neonatal intensive care units (NICUs) will be requried, for example.  Semi-annually, the organizations will have to report regarding the use of the grant funding and overall program implementation.

Eligible to participate in the initiative are obstetric care providers, state Medicaid agencies, Medicaid managed care organizations, and conveners in partnership with other applicants (such as states, associations of providers, or health service-related organizations).  Non-state organizations must provide a letter of intent from the state Medicaid agency agreeing to co-sign the agreement between the organization and CMS.  Letters of intent and applications are due on March 21 and June 13, 2012, respectively, and the grants are expected to be awarded on September 10, 2012.  Applications must be submitted electronically at http://www.grants.gov.

The first part of this article, published last week, addressed the other goal of the Strong Start Initiative, which was to campaign for the reduction of early elective deliveries occurring prior to 39 weeks of gestation.