Innovations in Maternity Care forum by National Coalition on Health Care (www.nchc.org)

1. The CenteringPregnancy® Model
Sharon Schindler Rising, CNM, MSN, FACNM
Innovations in Maternity Care:
Better Outcomes, Lower Costs
NCHC Briefing
May 10, 2017
“Improving health by transforming care through
Centering groups”

2. WHY GROUP CARE ?
“It’s what you imagine when having a
baby. It’s personal, loving, relaxing,
and an amazing community.”(Centering mom)
“It’s the one thing in my week that
brings me joy.” (Centering provider)

4. Who is Centering?
450+ sites
50,000+ moms

5. Components of Centering Healthcare

6. ASSESSMENT

8. Community Building
Evaluation

9. “It’s what you imagine when
having a baby. It’s personal,
loving, relaxing and an
amazing community.”

10. Centering Meets the
Goal
of the Triple Aim

11. District of Columbia - 5 CenteringPregnancy + 1 CenteringParenting
Florida - 10 CenteringPregnancy + 1 CenteringParenting
Louisiana - 6 Strong Start CenteringPregnancy sites; LDH enthusiasm for
expansion, Medicaid supportive
Michigan - 14 CenteringPregnancy + 2 CenteringParenting; MI Primary Care
Assoc. & March of Dimes led consortia, Spectrum Health supportive, exploring
enhanced reimbursement
Pennsylvania - 17 CenteringPregnancy + 3 CenteringParenting; March of
Dimes led consortium, Dept. of Health supportive
Ohio – 31 CenteringPregnancy + 8 CenteringParenting. Funding included in
current budget plan
South Carolina - 19 CenteringPregnancy + 1 CenteringParenting
Centering State Snapshot

12. Milestones in South Carolina

16. Picklesimer, 2016
Using Blue Choice / Anthem claims data - Investing in
CenteringPregnancy for 85 patients ($14,875) yielded
a net savings for the MCO of $67,293.
Gareau, 2016
CenteringPregnancy reduced risk of PTB
(36 %, p < 0.05). For every PTB prevented there was
an average savings of $22,667. Also reduced the
incidence of delivering an infant that was LBW (44 %,
p < 0.05, $29,627). Additionally, infants of
CenteringPregnancy participants had a reduced risk of
a NICU stay (28 %, p < 0.05, $27,249).
South Carolina Case Study

18. Evidence to Action
Effectiveness Translation Dissemination
Cluster RCT, 14 Community Health Centers
and Hospitals New York City
(NIH R01MH/HD61175)

19. POST-HOC ANALYSES
50 % of visits attended
Less likely to have:
Preterm birth
Low birth weight
baby
Rapid repeat
pregnancy
Babies spent fewer
days in the NICU
More condom
use/less unprotected
intercourse
Greater care
satisfaction
N=1148 All p < .001 Ickovics et al. AJPH. 2016;106:359-365.

20. What are the Centering Outcomes?
33%-47% decrease in preterm birth
Increased breastfeeding rates
Decreased sexually transmitted infections
Longer interconceptional period
Increased immunization rates
Better attendance
More appropriate weight gain/loss
Improved coping strategies
High satisfaction of patients with group care

21. • Incentivizes model adoption for new practices;
expands access for patients
• Mitigates risk for practices associated with
business model change
• Incentivizes scaling of Centering at existing
Centering practices
• Tracks Centering claims data
• Enhanced payments scale in proportion to # of
patients in Centering
VALUE OF ENHANCED PAYMENTS

22. CHI data based on practice sites reporting on 10,800 women through CenteringCounts as of 12.31.15 and US data source: March of Dimes PeriStats 2013, CDC and HP2020
Low Birth
Weight
HP2020 GOAL 7.8%
CHI 6%
US 8%
Breastfeeding
HP2020 GOAL 82%
CHI 86%
US 80%
Preterm Birth
MOD GOAL 5.5%
CHI RATE 6.8%
US RATE 11.4%
97% patient
satisfaction

23. Looking Ahead
• Enhanced reimbursement
– Continuing essential benefits
• Robust research and evaluation
• Regional centers of excellence
• Government, foundation, and community
partnerships
• Large system adoption
• Kaiser
• Army

24. Building healthy communities
one group at a time

25. References
Ickovics JR, Kershaw T, Westdahl C, Magriples U, Massey Z, Reynolds H, Rising, S. (2007)
Group Prenatal Care and Perinatal Outcomes: A randomized controlled trial. Obstetrics and
Gynecology,110(2), Part 1: 330-39.
Picklesimer A., Billings D., Hale J., Blackhurst, D., and Covington-Kolb, S. (2012) The effect
of CenteringPregnancy group prenatal care on preterm birth in a low income population.
American Journal of Obstetrics & Gynecology Vol 206: 415. e1-7.
Picklesimer A, Herberlein E, Covington-Kolb S. (2015) Group Prenatal Care: Has its time
come? Clinical Obstetrics and Gynecology, 58(2): 380-391.
Gareau, S., Lòpez-De Fede, A., Loudermilk, B. L., Cummings, T. H., Hardin, J. W.,
Picklesimer, A. H., ... & Covington-Kolb, S. (2016). Group Prenatal Care Results in Medicaid
Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy
Participation in South Carolina. Maternal and child health journal, 1-10.

26. References
Crockett A, Heberlein E, Glasscock L, Khan I. (2016) Investing in CenteringPregnancy
group prenatal care reduces newborn hospitalization costs. Women’s Health Issues, 27-
1:60-66.
Ickovics, J. R., Kershaw, T., Westdahl, C., Rising, S. S., Klima, C., Reynolds, H., &
Magriples, U. (2003). Group prenatal care and preterm birth weight: Results from a
matched cohort study at public clinics. Obstetrics & Gynecology, 102 (5, Pt. 1), 1051–
1057.
Rising SS, Quimby CH. (2017) The CenteringPregnancy® Model: the power of group
health care. NY: Springer Pub.