Strong Start for Mothers and Newborns Evaluation

Babies born prematurely are a growing public health problem with significant consequences for families and an estimated cost to society of at least $26 billion each year. Infants born preterm are at greater risk for mortality and many endure a lifetime of developmental and health problems. In addition to enormous medical needs, these children often require early intervention services, special education, and have conditions that impact their productivity as adults.

An overview of the evaluation findings shows that women who received care in birth centers had better birth outcomes and lower costs compared to similar women with Medicaid.

The Strong Start for Mothers and Newborns initiative—a Center for Medicare & Medicaid Innovation (CMMI) demonstration project—tested and evaluated enhanced prenatal care interventions for more than 45,000 women enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) at risk for preterm birth. The three interventions were conducted at more than 200 sites across the country and used maternity care homes, group prenatal care, and birth centers. The goal was to improve quality of care and reduce rates of preterm birth and low-birthweight infants while reducing costs to Medicaid during pregnancy, birth and the infant’s first year.

As a subcontractor to the Urban Institute, AIR conducted case studies, collected participant-level evaluation data, and provided technical assistance to states for the linkage of Medicaid and vital records data for an impact analysis. For the case studies, AIR interviewed awardee and site staff each year and conducted onsite patient focus groups, awardee and site staff interviews, and clinic observations every other year. AIR analyzed the collected data to identify and understand facilitators and barriers to implementation at individual Strong Start sites. AIR also conducted cross-site analyses to develop evaluation findings for each model as well as across all models. For the evaluation, AIR collected quantitative data, including risk factors, services delivered, and birth outcomes from sites quarterly to provide feedback to CMMI and Strong Start awardees and sites on patient characteristics, key performance indicators, and interim outcomes. AIR used rapid-cycle evaluation tools, such as monitoring dashboards, to identify data quality issues and provide feedback to sites and awardees to foster continuous improvement in performance and outcomes reporting.