An evaluation of a Medicaid managed maternity program: the impact of comprehensive care coordination on utilization and pregnancy outcomes

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 program. 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 comparison 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 intervention.