The association between care management and neonatal outcomes: the role of a Medicaid-managed pregnancy medical home in North Carolina

Published:March 09, 2022DOI:


      Preterm birth is a significant clinical and public health issue in the United States. Rates of preterm birth have remained unchanged, and racial disparities persist. Although a causal pathway has not yet been defined, it is likely that a multitude of clinical and social risk factors contribute to a pregnant person’s risk. State-based public health and provider programmatic partnerships have the potential to improve care during pregnancy and reduce complications, such as preterm birth. In North Carolina, a state-based Medicaid-managed Pregnancy Medical Home Program screens pregnant individuals for psychosocial and medical risk factors and utilizes community-based care management, to offer support to those at highest risk.


      This study aimed to examine the association between care-management and birth outcomes (low birthweight and preterm birth rates) among high-risk non-Hispanic White and Black pregnant people enrolled in the North Carolina Pregnancy Medical Home.

      Study Design

      This was a quasi-experimental study of people in the Medicaid-managed North Carolina Pregnancy Medical Home who had singleton pregnancies and who enrolled in the program between January 2016 and December 2017. Black and White pregnant people were included in the analysis if they had singleton pregnancies, were enrolled in the Pregnancy Medical Home, and for whom there were data regarding care management involvement. Preterm birth and low birthweight were chosen as the outcomes of interest. Two different methodologies were used to test the effect of care management on outcomes: Method 1 evaluated the effect of intensive care management (≥5 face-to-face visits from a care manager) and Method 2 evaluated the effect of the implementation of a specific risk-stratification system. Chi-squared and multivariate logistic regressions were performed as appropriate.


      From January 1, 2016 to December 31, 2017, a total of 3564 singleton pregnancies occurred among non-Hispanic Black and White pregnant Medicaid beneficiaries, who were a part of the Pregnancy Medical Home in North Carolina. White pregnant people comprised 57% and Black pregnant people comprised 43% of the sample. In the Method 1 analysis, intensive care management was significantly associated with reductions in preterm birth and low birthweight among Black and White pregnant people whereas in the Method 2 analysis, the implementation of a risk-stratification score only resulted in a significant reduction among Black pregnant people. In multivariable logistic modeling, race, number of prenatal visits, and intensive care management were all significantly associated with the outcomes of interest.


      Care management is associated with reductions in preterm birth and low birthweight in the Medicaid-managed Pregnancy Medical Home in North Carolina. This study contributes to a growing body of literature on the role of state-based initiatives in reducing perinatal morbidity. These results are significant as it demonstrates the importance of care coordination and management, in identifying and providing resources for high-risk pregnant people. In the United States, where pregnancy-related outcomes are poor, programs that address the multitude of economic, social, and clinical complexities are becoming increasingly crucial and necessary.

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        • Centers for Disease Control and Prevention
        Preterm birth.
        (Available at:)
        • Byrnes J.
        • Mahoney R.
        • Quaintance C.
        • et al.
        Spatial and temporal patterns in preterm birth in the United States.
        Pediatr Res. 2015; 77: 836-844
        • Bronstein J.M.
        • Wingate M.S.
        • Brisendine A.E.
        Why is the U.S. Preterm birth rate so much higher than the rates in Canada, Great Britain, and western Europe?.
        Int J Health Serv. 2018; 48: 622-640
        • Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes
        Behrman R.E. Butler A.S. Preterm birth: causes, consequences, and prevention. National Academies Press, Washington, DC2007
        • Klebanoff M.A.
        • Keim S.A.
        Epidemiology: the changing face of preterm birth.
        Clin Perinatol. 2011; 38: 339-350
        • Institute of Medicine (US) Roundtable on Environmental Health Sciences, Research, and Medicine
        Mattison D.R. Wilson S. Coussens C. Gilbert D. The role of environmental hazards in premature birth: workshop summary. National Academies Press, Washington, DC2003
        • Lee King P.A.
        • Young D.
        • Borders A.E.B.
        A framework to harness the power of quality collaboratives to improve perinatal outcomes.
        Clin Obstet Gynecol. 2019; 62: 606-620
        • Conrey E.J.
        • Manning S.E.
        • Shellhaas C.
        • et al.
        Severe maternal morbidity, a tale of 2 states using data for Action-Ohio and Massachusetts.
        Matern Child Health J. 2019; 23: 989-995
        • Berrien K.
        • Ollendorff A.
        • Menard M.K.
        Pregnancy medical home care pathways improve quality of perinatal care and birth outcomes.
        N C Med J. 2015; 76: 263-266
        • Tucker C.M.
        • Berrien K.
        • Menard M.K.
        • et al.
        Predicting preterm birth Among women screened by North Carolina’s pregnancy medical home program.
        Matern Child Health J. 2015; 19: 2438-2452
        • Newman R.B.
        • Sullivan S.A.
        • Menard M.K.
        • et al.
        South Carolina Partners for preterm birth prevention: a regional perinatal initiative for the reduction of premature birth in a Medicaid population.
        Am J Obstet Gynecol. 2008; 199: 393.e1-393.e8
        • Park Y.J.
        • Weinberg S.
        • Cogan L.W.
        The impact of the Medicaid high-risk ob care management program in New York State.
        Health Serv Res. 2020; 55: 71-81
        • Redding S.
        • Conrey E.
        • Porter K.
        • Paulson J.
        • Hughes K.
        • Redding M.
        Pathways community care coordination in low birth weight prevention.
        Matern Child Health J. 2015; 19: 643-650
        • Nair A.A.
        • Farber H.J.
        • Chen H.
        Utilization of opioid versus non-opioid analgesics in Medicaid and CHIP enrolled children with current asthma.
        Pharmacoepidemiol Drug Saf. 2021; 30: 1520-1531
        • Potter A.J.
        • Bowblis J.R.
        Nursing home care under Medicaid managed long-term services and supports.
        Health Serv Res. 2021; 56: 1179-1189
        • Maeng D.D.
        • Snyder S.R.
        • Baumgart C.
        • Minnich A.L.
        • Tomcavage J.F.
        • Graf T.R.
        Medicaid managed care in an integrated health care delivery system: lessons from Geisinger’s early experience.
        Popul Health Manag. 2016; 19: 257-263
        • Bailey J.E.
        • Womeodu R.J.
        • Wan J.Y.
        • Van Brunt D.L.
        • Somes G.W.
        Improvements in diabetes management and outcomes in a Medicaid managed care system.
        Tenn Med. 2001; 94: 425-430