STRONG START FOR MOTHERS AND NEWBORNS: TESTING APPROACHES TO PRENATAL CARE

STRONG START FOR MOTHERS AND NEWBORNS: TESTING APPROACHES TO PRENATAL CARE

The Strong Start for Mothers and Newborns initiative, an effort by the Department of Health and Human Services, aims to reduce preterm births and improve outcomes for newborns and pregnant women.  On February 8, 2012, the Centers for Medicare & Medicaid Services announced the two strategies of this initiative to achieve these goals. The first is a public-private partnership and awareness campaign to reduce the rate of early elective deliveries prior to 39 weeks for all populations. The other component is a funding opportunity to test the effectiveness of specific enhanced prenatal care approaches to reduce the frequency of premature births among pregnant Medicaid or Children’s Health Insurance Program (CHIP) beneficiaries at high risk for preterm births. 

The Strong Start effort to test new approaches to prenatal care is a four-year initiative to test and evaluate enhanced prenatal care interventions for women enrolled in Medicaid or CHIP who are at risk for having a preterm birth.   The goal of the initiative is to determine if these approaches to care can reduce the rate of preterm births, improve the health outcomes of pregnant women and newborns, and decrease the anticipated total cost of medical care during pregnancy, delivery, and over the first year of life for children born to mothers in Medicaid or CHIP.

Three approaches to enhanced prenatal care

This initiative will test three evidence-based maternity care service approaches that enhance the current care delivery and address the medical, behavioral, and psychosocial factors that may be present during pregnancy and contribute to preterm-related poor birth outcomes.  Awardees will test one of the three following interventions but cannot use funds to supplement or supplant any funding sources, including Medicaid and CHIP reimbursement:

1. – group prenatal care that incorporates peer-to-peer interaction in a facilitated setting for health assessment, education, and psycho-social support.  

1. – comprehensive prenatal care facilitated by teams of health professionals, including peer counselors.  Services include collaborative practice, intensive case management, counseling, and psycho-social support. 

1. – enhanced prenatal care including psychosocial support, education, and health promotion in addition to traditional prenatal care.   Services provided will expand access to care, improve care coordination, and provide a broader array of health services. 

Strong Start Award Recipients

Awardee	Enhanced Prenatal Care Approaches	Awardee State	Location of the Enhanced Prenatal Care Services	Award Amount (Year 1)
Access Community Health Network	Maternity Care Home	IL	Chicago	$459,511
Albert Einstein Healthcare Network	Group/Centering	PA	Philadelphia	$239,980
American Association of Birth Centers, Inc.	Birth Centers	PA	Anchorage, AK; Juneau, AK; Wasilla, AK; Rogers, AR; Tucson, AZ; San Diego, CA; Sacramento, CA;	$1,585,122
			Santa Rosa, CA; Danbury, CT; Grandin, FL; Gainesville, FL;  Largo, FL; Sanford, FL; Dunedin, FL; Sarasota, FL;
			Winter Garden, FL; Chicago, IL; Oak Park, IL; Overland Park, KS; Long Prairie, MN; St. Louis Park, MN;
			St. Paul, MN; Missoula, MT; Chapel Hill, NC; Bellevue, NE; Los Ranchos, NM; Taos, NM;
			Brooklyn, NY; Springfield, OR; Medford, OR; Bart, PA; Reading, PA; Pittsburgh, PA;
			Charleston, SC; Cookeville, TN; Waynesboro, TN; Knoxville, TN; Madisonville, TN; Pasadena, TX;
			Weslaco, TX; Richardson, TX; Houston, TX; Pearland, TX; Richmond, VA; Chantilly, VA; Black River Falls, WI; and Hurricane, WV
Amerigroup Corporation	Group/Centering	VA	Baton Rouge, LA; New Orleans, LA; and Shreveport, LA	$608,742
Central Jersey Family Health Consortium, Inc.	Group/Centering	NJ	Lakewood, Long Branch, Neptune , Newark, New Brunswick,   Pennington, and Perth Amboy	$466,046
Florida Association of Healthy Start Coalitions	Maternity Care Home	FL	Tampa, St. Petersburg, and Lakeland	$618,334
Grady Memorial Hospital Corporation DBA Grady Health System	Group/Centering	GA	Albany, Athens, Atlanta, Roswell, and Savannah	$243,207
Harris County Hospital District	Group/Centering	TX	Harris County	$355,822
HealthInsight of Nevada	Group/Centering	NV	Las Vegas and Reno	$544,126
Johns Hopkins University	Maternity Care Home	MD	Baltimore	$590,904
Los Angeles County Department of Health Services	Maternity Care Home	CA	Los Angeles County	$664,390
Maricopa Special Health Care District	Maternity Care Home	AZ	Phoenix	$190,176
Medical University of South Carolina	Maternity Care Home	SC	Columbia, Florence, Mount Pleasant, Sumter, and Walterboro	$557,848
Meridian Health Plan	Maternity Care Home	MI	Jackson	$249,939
Mississippi Primary Health Care Association, Inc.	Maternity Care Home	MS	Brandon, Canton, Hattiesburg,  Jackson, Laurel, Lexington, Meridian, and Mound Bayou	$614,909
Oklahoma Health Care Authority	Group/Centering	OK	Talihina, Oklahoma, and Tulsa	$320,269
Providence Health Foundation of Providence Hospital	Group/Centering, Maternity Care Home, & Birth Center	DC	District of Columbia	$488,476
Signature Medical Group	Maternity Care Home	MO	St. Louis	$361,463
St. John Community Health Investment Corp.	Group/Centering	MI	Detroit and Southfield	$262,731
Texas Tech University Health Sciences Center	Maternity Care Home & Group/Centering	TX	Lubbock	$260,670
United Neighborhood Health Services, Inc.	Maternity Care Home	TN	Nashville	$206,332
University of Alabama at Birmingham	Maternity Care Home	AL	Birmingham	$215,734
University of Kentucky Research Foundation	Group/Centering	KY	Frankfort, Hazard, Lexington, and Morehead	$587,038
University of Puerto Rico Medical Sciences Campus	Group/Centering	PR	San Juan	$219,473
University of South Alabama	Group/Centering & Maternity Care Home	AL	Mobile	$322,367
University of Tennessee Medical Group	Group/Centering & Maternity Care Home	TN	Memphis	$259,336
Virginia Commonwealth University	Group/Centering	VA	Manassas, Richmond, Shenandoah, and Woodbridge	$281,278

Awardees receiving Strong Start funds can administer more than one approach to enhanced prenatal care at multiple provider sites; however, individual provider sites can administer only one of the three enhanced approaches.

Strong Start awardees will be serving women in the areas with the highest preterm birth rates in the country, including areas that are among the top ten prematurity and infant mortality counties according to the Centers for Disease Control and Prevention. 

The Center for Medicare & Medicaid Innovation (CMS Innovation Center), in partnership with the Health Resources and Services Administration (HRSA) and Administration on Children and Families (ACF), is also evaluating a fourth approach to preventing preterm births, enhanced prenatal care through home visiting, as part of the evaluation of two evidence-based models under the Maternal, Infant, and Early Childhood Home Visiting program, Nurse Family Partnership, and Healthy Families America.   The Strong Start evaluation of these two models builds on the Maternal and Infants and Early Childhood Home Visiting Program Evaluation.

Length of awards

Program participants will receive an initial award for the first year of program implementation to pursue the goals and objectives of the Strong Start initiative.  After the initial award, non-competing continuation awards may be awarded for up to two additional years contingent upon availability of funding, participant performance, and demonstrated progress toward the goal of reducing premature births.  Participants may also be awarded funds in the fourth year for data collection.  CMS is under no obligation to make additional awards as part of this program. 

Eligibility criteria

To be eligible to participate in the Strong Start initiative, applicants had to be:

1. Providers of obstetric care (for example, provider groups or affiliated providers and facilities);
2. State Medicaid Agencies, in partnership with providers;
3. Medicaid managed care organizations (MCOs), in partnership with providers; or
4. Conveners in partnership with other applicants.  The convener could be a direct applicant or could convene and support other organizations to become applicants.  Examples of conveners include professional trade associations or other health service related organizations.

Funds were awarded with consideration to:

• Available funding;
• Geographic diversity; and
• Quality of each application and the ability to meet the goals of the initiative.

Program requirements

Strong Start awardees will participate in monitoring and evaluation activities to ensure that quality care is being delivered.  Participants will be expected to provide the CMS Innovation Center performance metrics consistent with the goals of the initiative on a quarterly basis.  Among other measures, awardees will report information on gestational age and birth weight for the infants of the mothers participating in one of the three approaches to enhanced prenatal care.  Participants will also provide the gestational age and birth weight data on births from a historical baseline period that spans at least two years prior to the start of the intervention.    

Participants also submit quarterly progress reports on the specific uses of the cooperative agreement funds, assessment of the overall project implementation, and other specific information.  They must also submit quarterly data reporting on operations, utilization, and outcomes.

CMS will provide technical assistance, analytic support, and coordination to help participants launch their interventions to reduce premature births.  As with all Innovation Center initiatives, participants will participate in opportunities for shared learning and dissemination with others. 

State data linkages for intervention and comparison mothers and infants

CMS will be working with states or other entities to link vital statistics with Medicaid and CHIP claims and encounter data as part of the national program evaluation.  This linked data will supplement the data reported by awardees on the intervention participants and a comparison population. 

About the Innovation Center

The CMS Innovation Center was created by the Affordable Care Act to test new innovative payment and service delivery models.  The Center is committed to testing models to help the Medicare, Medicaid, and CHIP programs deliver better care for beneficiaries while reducing costs. 

For more information

Additional information on the Strong Start initiative is available on the Strong Start website at: innovation.cms.gov/initiatives/strong-start.