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The Strong Start for Mothers and Newborns Initiative

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The Strong Start for Mothers and Newborns Initiative was an effort by the Department of Health and Human Services aimed to reduce preterm births and improve outcomes for newborns and pregnant women. On February 8, 2012, the Centers for Medicare & Medicaid Services announced the two strategies of this initiative to achieve these goals. The first was a public-private partnership and awareness campaign to reduce the rate of early elective deliveries prior to 39 weeks for all populations. The other component was a funding opportunity to test the effectiveness of specific enhanced pre-natal care approaches to reduce the frequency of premature births among pregnant Medicaid or Children’s Health Insurance Program (CHIP) beneficiaries at high risk for preterm births.”

The Strong Start Background

The initiative built upon decades of work by organizations like ACOG, the March of Dimes, the National Partnership for Women and Families, the Society for Maternal-Fetal Medicine, and Childbirth Connection, showing that elective deliveries before 39 weeks increase the risk of significant complications for both the mother and the baby, as well as long-term health problems.In addition, Strong Start’s goals and focus were identified with the help of experts at the Centers for Disease Control and Prevention(CDC), National Institutes of Health (NIH), ACF and HRSA.

The Strong Start Effort

Strong Start was a four-year initiative meant to test and evaluate enhanced prenatal care interventions for women, enrolled in Medicaid or CHIP, who were at most risk for pre-term births. The goal was to determine if these approaches to care could reduce the rate of preterm births, improve the health outcomes of pregnant women and newborns, and decrease the anticipated total cost of medical care during pregnancy, delivery and over the first year of life for children born to these mothers.

Two Strong Start Strategies

The Strong Start for Mothers and Newborns Initiative had two strategies:

  1. Reduce Early Elective Deliveries – Building on the work of the Partnership for Patients, this effort tested ways to encourage best practices and supports providers in reducing early electives deliveries prior to 39 weeks. CMS also teamed up with advocacy and professional organizations to increase public awareness efforts and develop new ones. 
  2. Enhance Prenatal Care Models – This initiative tested three evidence-based maternity care service approaches that enhanced care delivery, and addressed the medical, behavioral and psycho-social factors that might be present during pregnancy and contribute to preterm-related poor birth outcomes. The 27 Awardees tested one of three interventions for enhanced prenatal care: through Centering/Group Visits, at Birth Centers, and at Maternity Care Homes.

The Strong Start Legacy

Women who received prenatal care in Strong Start Birth Centers had better birth outcomes and lower costs relative to similar Medicaid beneficiaries not enrolled in Strong Start. In particular, rates of preterm birth, low birth weight, and cesarean section were lower among Birth Center participants, and costs were more than $2,000 lower per mother-infant pair during birth and the following year. Going forward, these promising Birth Center results may be useful to state Medicaid programs seeking to improve the health outcomes of their covered at-risk mothers and newborns.

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