Original Research

Peer-viewed studies and review articles on managed care.

Effects of a Pregnancy Management Program On Birth Outcomes in Managed Medicaid

Mary V. Mason MD, MBA, FACP
Senior vice president, chief medical officer, Centene Corp.
Amy Poole-Yaeger MD, FAAP
Vice president of medical affairs, Centene Corp.
Brad Lucas MD, MBA, FACOG
National medical director, Centene Corp.
Cathie R. Krueger, RN, BSN
Director of quality improvement, Centene Corp.
Tamim Ahmed, Ph.D, MBA
Vice president, Solucia Consulting
Ian Duncan, FSA, FIA, FCIA, MAAA
Department of probability and applied statistics, University of California-Santa Barbara


Objective: Examine the effect of a prenatal program on birth outcomes, specifically birth weight, in a managed Medicaid pregnant population, and identify the potential barriers to obtaining the risk screening information required for successful interventions.

Design: Retrospective propensity-adjusted cohort comparison.

Methods: Retrospective propensity-adjusted comparison of pregnant women in a managed Medicaid plan enrolled in a prenatal program and pregnant women who were not enrolled. Program enrollment was initiated by receipt of a Notification of Pregnancy (NOP) risk screening assessment.

Results: We demonstrate a statistically significant improvement in delivery outcomes in the women who participate in the pregnancy management program (NOP group) compared with those who do not (non-NOP group). The incidence of low-birth-weight infants was lower in the NOP group compared to the non-NOP group. Odds ratio estimates indicate that the NOP participants are likely to have 7.9% lower adverse event frequency for delivery weights <2500 g; 20% lower adverse event frequency for delivery weights <1500 g; and 31.2% lower adverse event frequency for delivery weights <1000 g. All p values are statistically significant.

Conclusion: Participation in a pregnancy management program improves birth outcomes in women who are at risk of low-birth-weight deliveries. Early identification of pregnant women and their risk factors for the purpose of enrollment in a managed Medicaid prenatal program is an important factor in improving birth outcomes, specifically birth weight. Our results indicate that this is an important area for investment if birth outcomes are to be improved.

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