Description of Interventions Used in Medicaid Reimbursed Prenatal Case Management

Home visiting of high-risk, low income pregnant women, also called prenatal case management (PCM), is a community-based, health-related service for medically or socially high-risk pregnant women for the purpose of improving birth and early infancy outcomes. Very little is known about the types of interventions used to address client problems and needs. This research describes the dosage and types of interventions used with clients receiving PCM.

A national survey of Medicaid reimbursed PCM programs yielded data from 188 programs. Case managers (n=339) were asked to record over 2 weeks, the number of minutes spent on each intervention provided per encounter. A standardized measure of intervention dosage was calculated by averaging the number of interventions types and quintiles of the intervention time (minutes) and of case open duration (weeks); dosage ranged from 0 to 9.

Of the 4980 encounters, 26% were with adolescents. Among the prenatal encounters, the median gestational age was 24 weeks. Per prenatal encounter, women received an average of 4.4 types of interventions during 51.8 minutes, yielding an average dosage of 3.4 (SD=.96). Among infants (post-partum encounters), the median age was 17.8 weeks, with an average case open duration of 28.8 weeks during which time they received an mean of 4.5 types of interventions per encounter, yielding a dosage total of 3.8 (SD=.95).

Measuring dosage of interventions delivered is feasible with three key variables. National home visiting policy, like that created under the Affordable Care Act, ought to require reporting of these variables for more nuanced outcome evaluations.