Limits of prenatal care coordination for improving birth outcomes among Medicaid participants.

Maternity Care Homes (MCHs) intend to address clinical and psychosocial needs for perinatal patients and are commonly implemented for Medicaid beneficiaries. Rigorous evidence supporting MCHs' effectiveness for improving birth outcomes is thin, but most studies consider only clinical and demographic factors from administrative data. To assess birth outcomes with controls for psychosocial variables known to affect them, this paper considers quantitative participant-level data from the Strong Start for Mothers and Newborns prenatal care initiative, with qualitative case study data to further contextualize results.

Preeclampsia Risk and Prevention among Pregnant Medicaid Beneficiaries.

Pregnancy-related hypertensive disorders can cause morbidity and mortality. Low-dose aspirin (LDA) reduces risk. This paper aims to assess Medicaid beneficiaries' risk factors for preeclampsia and their providers' clinical use of LDA in the federal Strong Start for Mothers and Newborns II initiative.

Intensive Approaches to Prenatal Care May Reduce Risk of Gestational Diabetes.

To observe gestational diabetes mellitus (GDM) prevalence among participants receiving enhanced prenatal care through one of three care models: Birth Centers, Group Prenatal Care, and Maternity Care Homes. This study draws upon data collected from 2014 to 2017 as part of the Strong Start II evaluation and includes data from nearly 46,000 women enrolled across 27 awardees with more than 200 sites throughout the United States. Descriptive and statistical analyses utilized data from participant surveys completed upon entry to the program and a limited chart review.

Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High-Value Model of Care.

Unlabelled: Policy Points Birth center services must be covered under Medicaid per federal mandate, but reimbursement and other policy barriers prevent birth centers from serving more Medicaid patients. Midwifery care provided through birth centers improves maternal and infant outcomes and lowers costs for Medicaid beneficiaries. Birth centers offer an array of birth options and have resources to care for patients with medical and psychosocial risks.

Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of 'Strong Start For Mothers And Newborns'.

The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups.

Prenatal Depression: Assessment and Outcomes among Medicaid Participants.

This study used bivariate and regression-adjusted analyses of participant-level survey and medical data to investigate prevalence of depression among pregnant Medicaid participants, correlates of depression, and the relationship between depression and pregnancy outcomes. The sample included Medicaid participants with a single gestation and valid depression data who were enrolled in Strong Start for Mothers and Newborns 2, a national preterm birth prevention program, from 2013 to 2017 (N = 37,287; 85% of total enrollment). Depression rates in Strong Start were high (27.

Twin Births in Medicaid: Prevalence, Outcomes, Utilization, and Cost in Four States, 2014-2015.

Objectives: Twin births have increased in prevalence. Twin births are more likely to have poorer outcomes than singleton births and are more costly. However, although Medicaid paid for approximately half of U.

Key Considerations for Implementing Group Prenatal Care: Lessons from 60 Practices.

Introduction: Group prenatal care combines clinical care with peer support and education. Research has indicated neutral or positive results for group care when compared with traditional individual prenatal visits. A national initiative, Strong Start II, was implemented to determine if specific prenatal care interventions such as group prenatal care can reduce the rate of preterm birth, improve health outcomes, and lower costs.

Strategies to Promote Postpartum Visit Attendance Among Medicaid Participants.

Postpartum care is important for promoting maternal and infant health and well-being. Nationally, less than 60% of Medicaid-enrolled women attend their postpartum visit. The Strong Start for Mothers and Newborns II Initiative, an enhanced prenatal care program, intended to improve birth outcomes among Medicaid beneficiaries, enrolled 45,599 women, and included a variety of approaches to increasing engagement in postpartum care.

What do women in Medicaid say about enhanced prenatal care? Findings from the national Strong Start evaluation.

Background: Medicaid pays for approximately half of United States births, yet little research has explored Medicaid beneficiaries' perspectives on their maternity care. Typical maternity care in the United States has been criticized as too medically focused while insufficiently addressing psychosocial risks and patient education. Enhanced care strives for a more holistic approach.

Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013-2016.

Background: Maternal opioid use disorder (OUD) has serious consequences for maternal and infant health. Analysis of Medicaid enrollee data is critical, since Medicaid bears a disproportionate share of costs.

Methods: This study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after a delivery in 2014-2015 (2013-2016) examining health, health care use, treatment, and neonatal outcomes.

Barriers and facilitators to depression screening in older adults: a qualitative study.

The objective of this qualitative study was to better understand facilitators and barriers to depression screening for older adults. We conducted 43 focus groups with 102 providers and 247 beneficiaries or proxies: 13 focus groups with Medicare providers, 28 with older Medicare beneficiaries, and 2 with caregivers of older Medicare beneficiaries. Each focus group was recorded, transcribed, and analyzed using principles of grounded theory.

Correction to: Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants.

The original version of this article unfortunately contained a mistake in the order of authors. The co-author "Sarah Benatar" should be the second author and "Brigette Courtot" should be the third author of the article.

A Framework for Rigorous Qualitative Research as a Component of Mixed Method Rapid-Cycle Evaluation.

As federal, state, and local governments continue to test innovative approaches to health care delivery, the ability to produce timely and reliable evidence of what works and why it works is crucial. There is limited literature on methodological approaches to rapid-cycle qualitative research. The purpose of this article is to describe the advantages and limitations of a broadly applicable framework for in-depth qualitative analysis placed within a larger rapid-cycle, multisite, mixed-method evaluation.

Facilitators and barriers to optimal preventive service use among providers and older patients.

Preventive service use remains low among Medicare beneficiaries despite the Affordable Care Act's waiver of coinsurance. This study sought to understand barriers and facilitators to preventive service provision, access, and uptake. We used a mixed methods approach synthesizing quantitative survey and qualitative focus group data.

Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants.

Objectives Strategies to prevent preterm birth are limited. 17 Alpha-Hydroxyprogesterone Caproate (17P) injections have been shown to be effective, but the intervention is under-used. This mixed methods study investigates barriers and facilitators to 17P administration among Medicaid and CHIP participants enrolled in Strong Start for Mothers and Newborns, a federal preterm birth prevention program.

Prescription Drug Use and Cost Trends Among Medicaid-Enrolled Children with Disruptive Behavioral Disorders.

Disruptive behavior disorders (DBDs) are the most common mental health conditions in children. These conditions profoundly affect healthcare utilization and costs. Service use, costs, and diagnostic trends among pediatric Medicaid beneficiaries provide information regarding healthcare quality and potential for smarter spending.

Facilitators and Barriers to Healthy Pregnancy Spacing among Medicaid Beneficiaries: Findings from the National Strong Start Initiative.

Background: Closely spaced, unintended pregnancies are common among Medicaid beneficiaries and create avoidable risks for women and infants, including preterm birth. The Strong Start for Mothers and Newborns Initiative, a program of the Center for Medicare and Medicaid Innovation, intended to prevent preterm birth through psychosocially based enhanced prenatal care in maternity care homes, group prenatal care, and birth centers. Comprehensive care offers the opportunity for education and family planning to promote healthy pregnancy spacing.

Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending.

Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively).

Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.

While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits.

Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services' Health Care Innovation Awards Program.

Objective: To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs.

Data Sources: Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations.

Study Design: NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews.

Long-term breastfeeding support: failing mothers in need.

This qualitative study analyzes mothers' reports of breastfeeding care experiences from pregnancy through infancy. Most research on medical support for breastfeeding examines a specific practice or intervention during an isolated phase of care. Little is know about how mothers experience breastfeeding education and support from the prenatal period through their child's first year.

Bound by Children: Intermittent Cohabitation and Living Together Apart.

In this article, we examine variations in low-income mothers' patterns of intermittent cohabitation and the voluntary and involuntary nature of these unions. Intermittent cohabitation involves couples living together and separating in repeating cycles. Using Three-City Study ethnographic data, we identified 45 low-income mothers involved in these arrangements, 18 of whom resided with their children's fathers occasionally while saying that they were not in a cohabiting relationship.

Living Together Apart in France and the United States.

Union formation involves a number of stages, as does union dissolution, and new couples often spend an initial period in a non-cohabiting intimate relationship. Yet while certain couples never share the same dwelling, "living apart together" has not developed widely as a long-term lifestyle option. Claude Martin in France, and Andrew Cherlin and Caitlin Cross-Barnet in the United States have studied a symmetrical phenomenon, that of couples who continue to live together while considering themselves to be separated.