Insurer incentivizing prenatal care model

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The CenteringPregnancy model brings 8 to 10 pregnant women who are due around the same time together for routine prenatal care. Courtesy Spectrum Health

Priority Health is now providing incentives for health care providers that adopt a care model designed to improve mother and baby outcomes.

The Grand Rapids-based statewide health plan said last month it is now piloting incentives for providers that adopt the Boston-based Centering Healthcare Institute’s (CHI) CenteringPregnancy care model.

An evidence-based approach, CenteringPregnancy brings eight to 10 pregnant women who are due around the same time together for routine prenatal care.

The course of care begins with a health assessment, followed by the 10 prenatal visits that are recommended by the American College of Obstetrics and Gynecology and the American College of Nurse Midwives throughout a woman’s pregnancy. But instead of the 15- to 20-minute, one-on-one checkups with a provider that traditional care models offer, each visit is 90 minutes to two hours long.

The group component — in which providers cover CenteringPregnancy education topics including nutrition, common discomforts, stress management, labor and delivery, breastfeeding and infant care — provides education, dialogue and support in a comfortable and relaxed setting.

Moms-to-be in the program also get private time with their provider, in which they learn to record their own health data, including their weight and blood pressure.

According to CHI, studies have shown the CenteringPregnancy model lowers the risk of preterm birth by about 33% when compared to traditional care.

Additionally, Michigan Centering sites also have seen a reduction in the disparity gap in preterm birth rates between Black and Caucasian women, increases in breastfeeding rates, and improved visit adherence and patient satisfaction.

CHI says on its website that the cost of preterm birth and related conditions is more than 10 times that of a healthy baby, and the Centering model could save the health care system about $8 billion per year by preventing preterm births alone.

“Supporting a care model that not only improves health outcomes for members but also lowers overall health costs is a win-win,” said Marti Lolli, chief marketing officer and senior vice president, consumer and government markets at Priority Health. 

“We are proud to offer this new incentive to providers who transition to the CenteringPregnancy care model. We look forward to continuing our partnership with the Centering Healthcare Institute to help address racial health disparities within prenatal care here in Michigan.”

CHI confirmed Priority Health is the first insurer in Michigan to incentivize the CenteringPregnancy model, which has been adopted in 48 states across more than 600 licensed sites, serving more than 70,000 patients annually.

Priority Health currently covers CenteringPregnancy care for all Medicaid members free of cost.

Thus far, a few providers at CHI-accredited CenteringPregnancy sites in West Michigan will take advantage of the new incentives, including the Spectrum Health OB/GYN Residency Clinic in Kent County, which has been delivering the CenteringPregnancy model of care since 2015 and has served about 470 moms so far; the Hackley Community Care Center in Muskegon County; Grace Health in Calhoun County; and InterCare Community Health Network in Berrien County.

Shannon Wilson, director of Medicaid outreach and quality for Priority Health, said on top of the set amount Priority Health pays out to health providers to deliver prenatal care through Medicaid, the insurer will give providers an additional $50 per session to deliver the CenteringPregnancy model.

She said the Spectrum Health OB/GYN Residency Clinic in Kent County currently operates with an opt-out approach, meaning all of its patients are currently participating in the CenteringPregnancy model unless they have opted out. Other sites may use an opt-in model if they wish.

Wilson is encouraging any and all care centers that participate in Priority Health plans to become accredited in the CenteringPregnancy care model.

The Spectrum Health Pennock location in Hastings will become the fifth CHI-accredited West Michigan site in November, she said.

Wilson said she is encouraged by the data that shows CenteringPregnancy reduces racial disparities in the care of and birth outcomes for Black and Latina women.

“For Black women, their risk of maternal death is almost twice as high as it is for white women, and this CenteringPregnancy program really lowers that risk,” Wilson said. “We think it’s a great way to combat the disparities that we see in outcomes.”

She added nearly half the moms that went through the program at Spectrum Health OB/GYN Residency Clinic in Kent County were African Americans, and there was a “tremendous reduction” in low birth weights and preterm births over a five-year period.

“Across the state, our low birth weight rate is 14%, and so being able to see a reduction of 30% and even sometimes 40% is a really big deal,” Wilson said.

Erin Conklin, CHI’s state program manager for Michigan who is based in Genesee County, said the CenteringPregnancy model — which was developed by a group of midwives led by Sharon Rising in 1993 — was CHI’s flagship program when the nonprofit was established in 2001.

Since then, CHI has added more programs under the Centering model that are geared toward benefiting the whole family unit, including CenteringParenting, which is group care for well-child visits from birth through age 2, and CenteringHealthcare, a group model that helps patients manage asthma, diabetes, opioid recovery, cancer, chronic pain and other health issues.

She said while Priority Health is the first in Michigan to do so, payers across the country have begun offering “enhanced reimbursement” to support the CenteringPregnancy model as part of their strategy for improving birth outcomes.

Vandana Devgan, director of engagement for CHI, said one of the benefits of the Centering model is that it is flexible and adaptable for each group of participants and their needs.

“The two-hour format allows for providers to bring in experts, whether they’re lactation consultants or behavioral health experts, within the group discussion part, where they can then further go into detail about these topics the patients can benefit from.

“It’s created opportunities for pregnant women to experience care in a different way,” Devgan said. “There’s some magic to the Centering that happens, and some of these groups meet even after (delivery) and transition to CenteringParenting.”

Added Conklin: “We always say that ‘One person’s question is another person’s question,’ and so being able to learn from other people who may be going through the same experience as you or have gone through a similar experience is really powerful.”

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