A team of HMA consultants have authored a peer-reviewed journal article drawing on data from the recently completed five-year evaluation of the Strong Start for Mothers and Newborns II Initiative to discuss key considerations for implementing a group prenatal care model, including barriers to implementation and sustainability as well as strategies for overcoming barriers and sustaining the model.
Group prenatal care offers a transformative approach to perinatal care, combining a clinical prenatal visit, education, and peer support into one session generally lasting 90 to 120 minutes in lieu of individual appointments.
Studies of CenteringPregnancy, the most commonly employed group prenatal care program which has been implemented in hundreds of sites, have generally shown either neutral or positive clinical outcomes relative to traditional individual prenatal care. Group prenatal care participants in Strong Start were found to have lower Medicaid prenatal expenditures as well as lower rates of prenatal and postpartum hospitalizations and emergency department visits. Group prenatal care participants also expressed high satisfaction with their care. Given that group prenatal care has potential benefits and does not appear to have unintended negative effects, many prenatal care practices want to implement the model. Implementation, however, can be challenging as it requires practitioners and other clinic staff to rethink how care is provided and adjust practices accordingly.
Barriers to implementing and sustaining the model are multifaceted, and included inflexible appointment times, lack of childcare, lack of appropriate meeting space, new scheduling and training needs, meeting requirements of graduate medical education programs, prenatal care provider and administrator reluctance to adopt new practices, and Medicaid payment policies. Both new and established sites identified provider champions and opt-out enrollment approaches as critical for maintaining buy-in.
Successful implementation of group prenatal care depends on systematic strategies at the practice, payer, provider, patient, and policy levels to implement, reimburse for, and sustain the model. Strategies for overcoming barriers can assist practices in offering this transformative approach, including practices serving women with clinical, demographic, or psychosocial risk factors for preterm birth.
The evaluation was completed by HMA Senior Consultant Jodi Pekkala, Principal Margaret Kirkegaard and Managing Principal Sharon Silow-Carroll and supported by a team from the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services and the Urban Institute. It appears in the Journal of Midwifery & Women’s Health.