GROUP PRENATAL CARE

WHAT IS GROUP PRENATAL CARE AND WHY IS IT IMPORTANT?

Group prenatal care is a model of prenatal care facilitated by a trained healthcare provider, but delivered in a group setting, which integrates health assessments, education and skills building, and peer social support.1,2 Group prenatal care typically serves pregnant people with low-risk pregnancies who do not require individual monitoring. The groups include 8 to 12 people of similar gestational age who meet every 2 to 4 weeks, totaling 15 to 20 hours in prenatal care over the course of their pregnancies, compared to 2 to 4 hours in traditional individual care.3,4,5

Early and Regular Prenatal Care Improves the Likelihood of a Healthy Pregnancy

The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommends evaluating the needs and risks of women early and continuously throughout prenatal care.6 Research shows that pregnant women who receive adequate care early in pregnancy experience positive perinatal outcomes, through the education, risk screening, and physical assessments included in prenatal care visits.7,8

Group Prenatal Care Adds Social Support to Traditional Prenatal Care

Group prenatal care augments the individual prenatal care model in ways that can positively impact pregnant women and their families by integrating family members and peer support into prenatal care and education, which can be a protective factor for women’s psychosocial health. Further, group prenatal care includes more contact with providers and medical support services, which may better serve the needs of participants.9

Women May Be More Likely to Attend Group Prenatal Care Visits Compared to Traditional Prenatal Care

Group prenatal care emerged as an alternative form of care, in part as a response to challenges with accessing individual prenatal care.10 Women who choose group prenatal care over individual care may be more likely to attend more of their scheduled visits if group prenatal care meets their needs in ways that individual care does not.

CenteringPregnancy Is the Most Prominent Model of Group Prenatal Care

CenteringPregnancy is the predominant model of group prenatal care. It is the most widely studied model and the model on which other forms of group prenatal care are often based.11 CenteringPregnancy is currently being implemented in approximately 350 sites across more than 40 states.12 Other (less studied) models of group prenatal care include March of Dimes’ Supportive Pregnancy Care, Expect With Me, Pregnancy & Parenting Partners, and Honey Child.

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on group prenatal care.

WHAT IMPACT DOES GROUP PRENATAL CARE HAVE?

Participation in group prenatal care improves the likelihood that mothers receive adequate prenatal care. Impacts on mothers’ physical and emotional health and on breastfeeding initiation are mixed—demonstrating both positive and null findings. The most rigorous studies on healthy and equitable births typically find no differences between group and traditional prenatal care.

More Research Is Needed to Determine the Potential of Group Prenatal Care to Decrease Racial and Ethnic Disparities

Systemic racism, combined with discrimination within hospital and health care delivery systems, is one of the drivers of poorer quality prenatal care and adverse birth outcomes among people of color.13 Some existing evidence indicates that group prenatal care benefits Black mothers—Black mothers participating in group prenatal care were significantly less likely to receive inadequate prenatal care or have a preterm birth.14 These results, however, are not sufficient to conclude that group prenatal care addresses racial disparities in prenatal care or birth outcomes. Future research must focus on examining the differential impacts of group prenatal care by race and ethnicity.

For more information on what we know and what we still need to learn about group prenatal care, see the evidence review on group prenatal care.

HOW CAN STATES EFFECTIVELY IMPLEMENT GROUP PRENATAL CARE?

In contrast to the evidence for the five state-level policies that are included in this Roadmap, the current evidence base does not identify a specific policy lever that states should adopt and fully implement to effectively provide group prenatal care services to all of the pregnant people who want this type of care. In the absence of an evidence-based state policy lever to allow for access to group prenatal care, we present several choices that states can make to more effectively implement group prenatal care in their state. Additionally, we leverage available data to assess state variation in group prenatal care services across a range of factors to identify the leaders among states, and to demonstrate what progress states are making relative to one another.

State Leaders in Group Prenatal Care

  • Serve a high share of their state’s pregnant people relative to other states;
  • Invest state funds to expand access to group prenatal care; and
  • Provide an enhanced reimbursement for group prenatal care services through Medicaid.

Policy and Administrative Choices States Make Affect Access to Group Prenatal Care

States vary considerably in their level and type of support for group prenatal care services, which leads to variation in the number of pregnant people who have access to the effective strategy. Pregnant people have access to the evidence-based CenteringPregnancy model of group prenatal care in all but five states. In the 46 states that have a CenteringPregnancy site, the percentage of all births served by the model is relatively low in most states, ranging from 0.4% in Arkansas and Tennessee to over 14% in the District of Columbia.

Several states offer varying levels of direct state funding and support and enhanced reimbursements through Medicaid, which can expand access to services, but many states do very little to support group prenatal care.

States Can Use Medicaid to Provide an Enhanced Reimbursement for Group Prenatal Care

Nine states currently use or will implement Medicaid billing codes that reimburse providers for group prenatal care at a rate that is higher than traditional prenatal care. These enhanced rates range from less than $10 per patient, per visit to over $40 per patient, per visit. CenteringPregnancy has worked with many of these states to create these billing codes within respective state Medicaid programs and typically aims to reimburse providers an additional $30 per patient, per visit. Some states require that group prenatal care models are certified CenteringPregnancy programs to be reimbursable.

Despite having billing codes and enhanced reimbursements, some states do not always “turn on” or use the codes for reasons such as lack of education about the services/codes and/or low reimbursement rates. Rates are set per patient, per visit, therefore reimbursements are not always enhanced at the individual level, but at the group level.

States Use Grant Funding to Support Pilot Programs for Group Prenatal Care

Another funding mechanism used by seven states is to use state funds to provide grants or discretionary funding to pilot initiatives that reimburse group prenatal care services at a rate that is higher than traditional prenatal care, or to scale up a group prenatal care model in the state.

States Can Include Group Prenatal Care in Their Alternative Payment Method Plans

In 11 states, managed care organizations use alternative payment methods to support enhanced maternity care, which typically means that states will pay for episodes of care (i.e., prenatal, labor, and postpartum care services are billed as one service) using a value-based payment (VBP) model. Value-based payment models reward providers for better patient health outcomes, which may incentivize providers to offer group prenatal care services because of the model’s evidence base for improving maternal and child health outcomes.

States Can Support Group Prenatal Care Through Nonfinancial Initiatives

States have also taken nonfinancial steps to encourage group prenatal care by recognizing it as an effective strategy for improving maternal and child health outcomes and/or by listing CenteringPregnancy as a resource on state websites.

WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO MORE EFFECTIVELY IMPLEMENT GROUP PRENATAL CARE SERVICES?

States have complete latitude in how they implement group prenatal care services. This past year, the COVID-19 pandemic has had a substantial impact on how group prenatal care services are offered, because of factors such as social distancing guidelines and unestablished billing codes for telehealth services. These barriers have resulted in delays in implementation and expansion and nearly every state has seen a reduction in CenteringPregnancy sites (for this reason, in this Roadmap, we use information on the number of sites in a state as of the end of 2019).

Despite the changes wrought by the pandemic, three states took legislative or administrative action this last year to expand access to group prenatal care services to pregnant people. Maryland invested $72 million in a maternal and child health initiative, that includes a partnership between Maryland Medicaid and CenteringPregnancy to implement the group prenatal care model more widely across the state.

In Illinois, the managed care organization, Blue Cross Blue Shield of Illinois, announced that it will provide grants to implement CenteringPregnancy in Federally Qualified Health Centers across the state. The state’s Perinatal Advisory Committee also recommended that the Illinois Medicaid program adopt an enhanced reimbursement policy for group prenatal care, although the state has not yet done so.

Finally, in the last year, Ohio offered $4.4 million in grant funds to sites to implement CenteringPregnancy as part of the Ohio Equity Institute Infant Mortality Prevention grants program. The state also adjusted its Medicaid billing codes to provide an enhanced reimbursement of $45 per patient, per visit for group prenatal care services, which will go into effect in January 2022.

HOW DOES GROUP PRENATAL CARE VARY ACROSS STATES?

States Vary in the Percentage of Births to Persons Participating in Group Prenatal Care

Group prenatal care can be offered by health providers using their own method or other models, however, national data on prevalence are only available for the CenteringPregnancy model, which is the model with the only rigorous evidence base, to date. Based on estimates from 2019, which predates the pandemic that caused many sites to reduce services because of safety concerns, relatively few pregnant people had access to group prenatal care in most states.

Five states (Connecticut, Delaware, Rhode Island, Utah, and Wyoming) had no CenteringPregnancy sites in 2019, and we are unaware of the number of pregnant people that any other group prenatal care model served in those states. Of the 46 states that have at least one CenteringPregnancy site in the state, 17 states had fewer than 2% of pregnant people access the group prenatal care model. In only ten states did at least 5% of pregnant people access CenteringPregnancy.

States Vary in Their Financial or Explicit Support of Group Prenatal Care

As noted above, states vary in how they financially support group prenatal care. Nine states (California, Louisiana, Michigan, Montana, New Jersey, Ohio, South Carolina, Texas, and Utah) use Medicaid to reimburse providers at a higher rate than traditional prenatal care, which may help increase access to services. In these states, the enhanced reimbursement rates vary considerably, with some states offering an additional $40 to $50 per patient, per visit for group prenatal care, and other states offering a rate that only provides additional funding to providers if they serve large groups.

Seven states allocate funds to provide grants to expand access to group prenatal care services or use discretionary funding to pilot initiatives that reimburse providers at an enhanced rate.

Eleven states have managed care organizations that use alternative payment methods to support enhanced maternity care, which typically means that states will pay for episodes of care (i.e., prenatal, labor, and postpartum care services are billed as one service) using a value-based payment (VBP) model. Value-based payment models reward providers for better patient health outcomes, which may incentivize providers to uptake group prenatal care services because of the model’s evidence base for improving maternal and child health outcomes.

Explore more of the Missouri Roadmap

  1. American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
  2. Ickovics, J.R., Kershaw, T.S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S.S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Journal of Obstetrics and Gynecology, 110(2 Pt 1), 330-339. dx.doi.org/10.1097/01.AOG.0000275284.24298.23 [Group Prenatal Care Evidence Review Study C]
  3. American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
  4. Ickovics, J.R., Kershaw, T.S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S.S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Journal of Obstetrics and Gynecology, 110(2 Pt 1), 330-339. dx.doi.org/10.1097/01.AOG.0000275284.24298.23 [Group Prenatal Care Evidence Review Study C]
  5. American Academy of Pediatrics and the American College of Obstetrics and Gynecologists. (8th) (2017). Guidelines for perinatal care. https://www.acog.org/clinical-information/physician-faqs/-/media/3a22e153b67446a6b31fb051e469187c.ashx
  6. American Academy of Pediatrics and the American College of Obstetrics and Gynecologists. (8th) (2017). Guidelines for perinatal care. https://www.acog.org/clinical-information/physician-faqs/-/media/3a22e153b67446a6b31fb051e469187c.ashx
  7. American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
  8. National Institutes of Health. (2017, January 31). What is prenatal care and why is it important? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care
  9. Centering Healthcare Institute (n.d). CenteringPregnancy. https://www.centeringhealthcare.org/what-we-do/centering-pregnancy
  10. American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
  11. American College of Obstetricians and Gynecologists. (2018). Group prenatal care: ACOG committee opinion No. 731. Obstetrics & Gynecology, 131(3), e104–8. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/03/group-prenatal-care#:~:text=Evidence%20suggests%20patients%20have%20better,group%20prenatal%20care%20causes%20harm
  12. Centering Healthcare Institute. (n.d.). Locate Centering Sites. https://centeringhealthcare.secure.force.com/WebPortal/LocateCenteringSitePage
  13. Taylor, J., Novoa, C., Hamm, K., & Phadke, S. (2019, May 2). Eliminating racial disparities in maternal and infant mortality. A comprehensive blueprint. Center for American Progress. https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/
  14. Ickovics, J.R., Kershaw, T.S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S.S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Journal of Obstetrics & Gynecology, 110(2 Pt 1), 330-339. dx.doi.org/10.1097/01.AOG.0000275284.24298.23 [Group Prenatal Care Evidence Review Study C]