Strong Start for Mothers and Newborns: implications for prenatal care delivery.

Abstract

In February 2012, the Centers for Medicare and Medicaid Services announced a 4-year initiative to test new approaches to prenatal care delivery to improve rates of preterm birth for women enrolled in Medicaid. The Strong Start for Mothers and Newborns initiative was designed to achieve this goal through two strategies: first, a public awareness campaign designed to reduce the rate of elective deliveries prior to 39-week gestation, and second, a funding opportunity to test the effectiveness of enhanced prenatal care models designed to reduce the incidence of low-birth-weight infants among pregnant Medicaid beneficiaries. This article reviews previous prenatal care expansion efforts and provides insights into the alternative prenatal care delivery models currently being tested for low-income patient populations at high risk for adverse birth outcomes. Alternative prenatal care models, such as prenatal home visitation and group prenatal care for patients at high risk for adverse birth outcomes, may provide more efficient and effective care than the traditional, predominantly medical model of prenatal care delivery. The authors discuss the relationship between prenatal care utilization and adverse birth outcomes, such as low birth weight, and current efforts to reinvent prenatal care content, structure and delivery.