North Carolina's pregnancy medical home: An innovative approach to improving maternity care and birth outcomes

Background: Southern states have struggled to address rates of preterm birth and low birth weight that are consistently above national averages. In 2011, Community Care of North Carolina implemented an innovative Pregnancy Medical Home model in collaboration with the State Divisions of Medical Assistance and Public Health to improve birth outcomes in the Medicaid population. This population management approach builds on existing primary care infrastructure to improve the quality of maternity care and reduce costs.

Methods: Maternity providers were recruited to join existing Community Care networks as Pregnancy Medical Homes. Participation requires committing to key performance expectations, including standardized risk screening and avoidance of early term elective delivery, and entitles practices to financial incentives from Medicaid. Patients at elevated risk for preterm birth receive care management through local health department pregnancy care managers working in collaboration with Pregnancy Medical Home clinicians.

Results: More than 80% of North Carolina maternity providers serving Medicaid patients joined the initiative in the first 18 months. By June 2012, 81% of Medicaid deliveries were to patients receiving care from a Pregnancy Medical Home. 75% of patients received risk screening; nearly 70% had at least one priority risk factor. Preliminary analysis found a 2.9% reduction in the rate of low birth weight and a 6.4% reduction in the rate of very low birth weight in the first year of the program compared to baseline year.

Conclusion: North Carolina's Pregnancy Medical Home model is a promising new approach to improving birth outcomes in the Medicaid population.