Strong Start for Mothers and Newborns: Final Evaluation, Volume 1

Hill I, Dubay L, Courtot B, Benatar S, Garrett B, Balvin F, Howell E, Johnston E, Allen E, Thornburgh S, Markell J, Morgan J, Silow-Carroll S, Bitterman J, Robin D, Odenhal R, Paez K, Thompson L, Lucado J, Firminger K, Sinnarajah B, Paquin L, Rouse M
Publication Year: 2018
Patient Need Addressed: Maternal/perinatal
Population Focus: Medicaid beneficiaries
Demographic Group: Women
Intervention Type: Service redesign, Staff design and care management
Study Design: Mixed-Methods
Type of Literature: Grey

The Strong Start for Mothers and Newborns initiative, funded under Section 3021 of the Affordable Care Act (ACA), aimed to improve maternal and infant outcomes for women covered by Medicaid and the Children’s Health Insurance Program (CHIP) during pregnancy. The initiative funded enhanced services through three evidence-based prenatal care models—Birth Centers, Group Prenatal Care, and Maternity Care Homes—and supported the delivery of these services through 27 awardees and 211 provider sites across 32 states, the District of Columbia, and Puerto Rico. Four-year cooperative agreements were awarded on February 15, 2013 by the Center for Medicare and Medicaid Innovation (CMMI) of the Centers for Medicare and Medicaid Services (CMS). The Strong Start awardees comprised a wide variety of organizations, including hospital and health systems, health plans, and community-based providers and agencies; only one award directly contracted with a state.

Insights Results

Overview of report

  • Strong Start participants faced a large number of social and medical challenges that placed them at risk of experiencing poor birth outcomes. Nearly half of women enrolled in Strong Start were neither employed nor in school, more than a quarter had not completed high school or a GED, and just 15% possessed a college degree. A fifth experienced food insecurity, and more than one-third reported barriers to accessing prenatal care
    Care Outcomes
  • Birth Center participants had dramatically lower rates of preterm birth (4.5%) than women served by either Group Prenatal Care (12%) or Maternity Care
    Homes (12.9%). Similarly, rates of low birthweight among Birth Center participants were much lower (3.6%) than for Group Prenatal Care and Maternity Care Home participants (10% and 10.5%, respectively)
  • Cesarean section deliveries for Strong Start participants were, by far, lowest for women in Birth Centers (13%). In contrast, approximately 30% of Group
    Prenatal Care and Maternity Care Home participants had C-sections
  • Regressions of participant data show that Birth Center participants experienced significantly better outcomes than their counterparts in Maternity Care Homes, but Group Prenatal Care enrollees (overall) did not
  • Regardless of whether women gave birth at the Birth Center or in a hospital, infants born to Birth Center participants had an average clinical estimate of gestation that was almost half a week longer than that of infants born to comparison group women, were significantly less likely to be preterm than comparison group infants (6.3% vs. 8.5%), and were less likely to be born at low birthweight (5.9% vs. 7.4%). Rates of C-section deliveries were 17.5% for Strong Start women who received care in a Birth Center compared to 29.0% for matched women in typical care
  • Delivery expenditures were, on average, 21% lower and total expenditures from delivery until the infant’s first birthday were 16% less for women enrolled in Birth Centers than for women and infants in the comparison group
  • Expenditures in the 8 months prior to delivery for women enrolled in Group Prenatal Care were about 15% lower than the average for women in the comparison group