CMS Launches Strong Start Initiative to Improving Maternal and Infant Health

By Brent Ewig, MHS
Director, Public Policy & Government Affairs, AMCHP

The Centers for Medicare & Medicaid Services (CMS) Innovation Center was created by the Affordable Care Act to "test new innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care." According to CMS, the Innovation Center is committed to transforming the Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) to deliver better care for beneficiaries, better health for populations and slower growth in expenditures through improvement for beneficiaries.

As one of the first efforts of this new center, on Feb. 8, HHS announced the Strong Start initiative to reduce preterm births and improve outcomes for newborns and pregnant women. This initiative brings together the activities of CMS, the Health Resources and Services Administration (HRSA), the Administration on Children and Families (ACF), Centers for Disease Control and Prevention (CDC), and the National Institute of Health (NIH).

Strong Start consists of two components:

  1. A test of a nationwide public-private partnership and awareness campaign to spread the adoption of best practices that can reduce the rate of early elective deliveries prior to 39 weeks for all populations
  2. An initiative to reduce the rate of preterm births for women who are at risk for preterm birth and covered by Medicaid through testing-enhanced prenatal care models

To help achieve these aims, HHS will employ three specific strategies:

  1. Implementing a quality improvement platform through Partnership for Patients to share best practices, provide technical assistance to hospitals in implementing and adapting the practices, and report data
  2. Creating support for change with a broad-based campaign to engage providers, patients and the public, working with organizations such as the March of Dimes and the American College of Obstetricians and Gynecologists
  3. Supporting efforts to collect performance data, measure success, promote transparency and continuously improvement

The Strong Start grant funding opportunity is a four-year initiative to test and evaluate the effect enhanced prenatal care has on decreasing prematurity. This initiative will test three evidence-based approaches to the delivery of enhanced prenatal care and better understand how behavioral and psychosocial factors may contribute to poor birth outcomes. The goal of the initiative is to determine if these approaches to care can impact the rate of preterm births, improve the health outcomes of pregnant women and newborns, and decrease the total cost of medical care for mothers and their infants.

The Innovation Center will offer grant funding to test three approaches:

  1. Group prenatal care that incorporates peer-to-peer interaction in a facilitated setting for health assessment, education and psychosocial support
  2. Comprehensive prenatal care facilitated by teams of health professionals, including peer counselors and doulas – services include collaborative practice,

intensive case management, counseling and psychosocial support

3. Enhanced prenatal care, including psychosocial support, education and health promotion in addition to traditional prenatal care – services provided will expand access to care, improve care coordination and provide a broader array of health services

The Innovation Center, in partnership with HRSA and ACF will also evaluate a fourth approach to preventing preterm births, the enhanced prenatal care through home visiting, as part of the Maternal, Infant, and Early Childhood Home Visiting program, building on the program and evaluation already started for that program.

CMS will provide technical assistance, analytic support and coordination to help awardees launch their interventions to reduce premature births. CMS will award, through a competitive process, a set of renewable one-year cooperative agreements to eligible applicants. Strong Start will operate for three years and there will be up to an additional one year beyond the last birth for data collection and submission. Up to $43 million will be available for this initiative. The number of awards will depend on the number of women that applicants can enroll. The Innovation Center intends to fund the cost of additional enhanced prenatal services for approximately 30,000 pregnant Medicaid beneficiaries in each of the three options, or care for approximately 90,000 women in total over three years. Awards are expected to be made in September 2012. Additional information is available here.