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An Evaluation of a Medicaid Managed Maternity Program: The Impact of Comprehensive Care Coordination on Utilization and Pregnancy Outcomes

Author: CARROLL S. NASON, GREG R. ALEXANDER, MARY ANN PASS, and JOHN M. BOLLAND
Published in JHHSA, Vol. 26 No. 2

The purpose of this study is to evaluate the effectiveness of the
implementation of a Medicaid managed maternity care program in a
public health department service population, analyzing race-specific
models of WIC participation and risk of small-for-gestational age of
term. There were 13,095 singleton deliveries during the period 1987-
1990 to women with prenatal care in this managed maternity care pro-
gram. The research design entailed comparison of the intervention
group (those receiving regular prenatal care plus comprehensive care
coordination in 1989-90) with an historical comparison group of
women who received only regular prenatal care in the two years (1987-
88).

For the intervention groups, black women were 1.7 times and white
women 2.1 times more likely to participate in WIC than their compar-
ison groups. The impact of care coordination on term-SGA births
indicates a protective odds ratio of 0.851 for black women. Results for
white women were not significant. These findings suggest that care
coordination is associated with an increase in WIC participation and with lower risk of term-SGA births for black women but not for white
women. The overall results add to growing evidence regarding the
efficacy of comprehensive care coordination in improving specific
pregnancy outcomes and inform our understanding of the evaluation of
a comprehensive approach in preventive, community-based inter-
vention.

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