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, and 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 pregnant people early and continuously throughout prenatal care.6 Research shows that pregnant people 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 people and their families by integrating family members and peer support into prenatal care and education, which can be a protective factor for a pregnant person’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 rigorously studied) models of group prenatal care include March of Dimes’ Supportive Pregnancy Care, Expect With Me, Pregnancy & Parenting Partners, and Honey Child.
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 compared to Black mothers who did not participate in group prenatal care.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.
HOW AND WHY DOES GROUP PRENATAL CARE VARY ACROSS STATES?
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 pregnant people in a high number of sites across the state;
- Invest state funds to expand access to group prenatal care; and/or
- Provide an enhanced reimbursement for group prenatal care services through Medicaid.
State Policy and Administrative Choices 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. Several states offer varying levels of direct state funding and support, including enhanced reimbursements through Medicaid, which can expand access to services, but many states do very little to support 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 the most recent estimates from 2021, 44 states offered at least one CenteringPregnancy site. On average, CenteringPregnancy reports that it served approximately 94 patients per site in 2021, although specific counts of people served are unavailable. Seven states (Connecticut, Delaware, Idaho, Rhode Island, South Dakota, Utah, and Wyoming) had no CenteringPregnancy sites in 2021, and we are unaware of the number of pregnant people that any other group prenatal care model served in those states. Of the 44 states that have at least one CenteringPregnancy site in the state, 10 states have only a single site in the state. In comparison, California and Ohio have the greatest number of sites—56 and 49, respectively.
States Can Use Medicaid to Provide an Enhanced Reimbursement for Group Prenatal Care
States can implement Medicaid billing codes that reimburse providers for group prenatal care at a rate that is higher than traditional prenatal care. As of August 2021, 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.
CenteringPregnancy has worked with many states to create billing codes within respective state Medicaid programs and the program model recommends that states reimburse providers at least an additional $30 per patient, per visit. Some states require that group prenatal care models are certified CenteringPregnancy programs to be reimbursable, but other states are not specific as to which group prenatal care model can receive the enhanced reimbursements.
Despite having billing codes and enhanced reimbursements, some states do not always “turn on” or use the billing codes for reasons such as lack of education about the services/codes and/or low reimbursement rates.
States Use Grant Funding to Support Pilot Programs for Group Prenatal Care
Another funding mechanism 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. 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.
States Can Include Group Prenatal Care in Their Alternative Payment Method Plans
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 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. Of the 21 states that recognize GPNC as an effective strategy, five states (Illinois, Michigan, New Jersey, New York, and North Carolina) also provide support through enhanced reimbursements or grant funding to support pilot programs.
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. 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 resulted in delays in implementation and expansion and most states (36 of the 46 states with at least one Centering Pregnancy site in 2019) saw a reduction in the number of CenteringPregnancy sites between 2019 and 2021.
Two states considered legislative action in the last year to expand access to group prenatal care services. Massachusetts legislators proposed legislation to establish a maternal mental health equity grant program. The program would fund entities establishing or expanding group prenatal care programs with a particular focus on addressing behavioral and mental health and substance use disorders for pregnant and postpartum individuals, especially those belonging to underserved populations. In September of 2022, the legislation was referred for further study.
In Arizona, the legislature proposed appropriating $3 million to the Department of Health Services to administer a three-year group prenatal care grant program. The goals of the program are to increase the number of pregnant people who initiate care early in their pregnancies, reduce health disparities, and improve perinatal health outcomes. The proposal identifies evidence-based group prenatal care models as eligible grantees, and it prioritizes areas of the state with high preterm birth rates, counties in which access to maternity care is limited or absent, and providers serving Medicaid recipients. The bill died when Arizona’s legislature adjourned.