Introducing the ‘Pregnancy Medical Home’

By Kristine Hartvigsen on April 27th, 2017

Since the Institute for Healthcare Improvement introduced its “Triple Aim” initiative as an approach to health system improvement, it has become part of the industry lexicon.

Triple Aim proposes to 1) improve patient care experience, 2) improve the health of populations, and 3) reduce the per capita cost of healthcare. A commonly proposed approach to achieving those goals is the patient-centered medical home (PCMH), a system that manages the care of the patient ideally from cradle to grave, coordinating care across services and specialties as well as tracking individual patient progress over time.

A handful of states, including Texas, North Carolina, and Wisconsin, have implemented pilot programs that adapt this model specifically to maternity care. In fact, such a Pregnancy Medical Home (PMH) model tested in Texas was spotlighted at the Society for Maternal-Fetal Medicine (SMFM) annual meeting earlier this year in Las Vegas.

Study presenters concluded that Medicaid-covered women and their newborns who received perinatal care through a PMH had fewer emergency department visits and fewer inpatient stays — both before and after delivery — which resulted in significant savings to the state’s health insurance plan.

“The decreased need to use these services resulted in an estimated annual savings of over $800,000 for pregnant women and over $1.6 million for newborns,” explained Lisa Hollier, M.D., professor of obstetrics and gynecology for Baylor College of Medicine and one of the authors of the study. “We believe this model can readily serve as a national model for improved health care, substantial savings and improved outcomes.”

The study was published in the January 2017 issue of the American Journal of Obstetrics and Gynecology (AJOG).

North Carolina was among the first states to implement the PMH model. One result of the program was a reduction in NC low birthweight infants of 6.7% between 2011 and 2014. Among patients in the PMH program, an estimated 17% received same-day appointments, and 40% began their prenatal care in the first trimester.

The PMH model characteristically mirrors an integrated care model in terms of assigning a care coordinator (sometimes called a “nurse navigator”) to monitor and manage maternity care across multiple specialties at a single site. In addition to OB/GYN, this might include maternal fetal medicine, behavioral health, laboratory, and pharmacy.

Though the PMH model is relatively new, the concept is gaining momentum as a viable quality-enhancing, cost-reducing strategy for maternal health.

This blog provides general information and discussion about healthcare-related subjects. The content and linked materials provided are not intended and should not be construed as medical advice. If the reader is an expectant mother with a medical concern, she should consult with an appropriately licensed physician or healthcare provider.


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