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November 1, 2016

A Bullseye Approach to Prenatal Care

Since Greenville Health System began implementing the CenteringPregnancy© model of prenatal care in 2007, they have seen the power it has to improve outcomes, increase patient and physician satisfaction, and reduce costs at the same time. The Centering approach spread throughout the state in 2013 thanks to the Centering Expansion Project, which helped 10 new providers implement this new prenatal care approach. Thanks to that effort, nearly 1,900 medically high-risk women were in CenteringPregnancy groups from July 2013-February 2016.

The design of CenteringPregnancy does not deviate in principle from traditional individual prenatal care. Patients have an initial intake appointment with a physical, medical history, and lab work. But instead of continuing the process alone, the provider places them with 8-12 women with similar due dates to have all their prenatal care appointments together throughout their second and third trimesters. They have four monthly sessions during their second trimester, then they meet every two weeks up through 40 weeks. There’s also a reunion session a month or two postpartum.

Prenatal care in a group requires an initial 30-40 minutes for self-assessment and individual assessments with the provider in the group space, followed by 60-75 minutes of “circle up” facilitated discussion time which encourages questions and interactive learning.

The benefits of this approach are numerous. For the provider, they can share information at one time instead of repeating themselves with individual patients. They also enjoy working with activated, engaged patients and having more fun. Patients appreciate never having to wait in the waiting room for their appointments. They also have the opportunity to learn and share with other pregnant women.

Each session has an overall plan and tackles many of the common areas of concern and growth for pregnant families, from infant development and nutrition to stress management and family planning. There are “Mom’s Notebooks” and a facilitator’s guide to help cover the curriculum of each session.

The difference is in the support the members of a group give one another by sharing common life experiences, encouraging trust and community building, and promoting a better continuity of care. By sharing their knowledge and experiences, the patients empower themselves and help each other.

Mothers in Centering practices across South Carolina also have seen better outcomes. With a total investment at $2.2 million, the calculated cost savings from reductions in NICU admissions, low birthweights, and preterm births total $6.6 million in Medicaid expenditures through the first year of life for those babies, says Dr. Amy H. Crockett, a maternal/fetal medicine specialist at Greenville Health.

“After controlling for differences between the two groups, we [still] saw a 34% reduction in the odds of preterm births. The overall rate was 8.6% for women in Centering compared to 11.1% in the control group,” said Crockett.

Even more exciting, according to Crockett, is that the approach also might be able to close racial disparity gaps – overall rates were nearly identical for black (8.3%) and white (8.0%) women in Centering.

Given the success of Centering, along with the sustainable funding support from Medicaid and BlueCross BlueShield of South Carolina, the South Carolina Birthing Outcome Initiative hopes to see this model become the new normal across the state.

Learn more about the program here.