Michigan Strong Beginnings Pay for Success

The Challenge:

Prenatal and postpartum preventive services have been shown to reduce the likelihood of health outcomes such as preterm births or rapid repeat pregnancies. Not only are these complications expensive for the state, but they also lead to poorer life outcomes for mothers and children. Evidence has shown nurse home visits to be a particularly effective way to deliver these services to new mothers. Although addressing maternal and infant health is a priority in Michigan, the state’s Maternal Infant Health Program (MIHP) only covers a few visits to the doctor for Medicaid-eligible women. This falls short of the extensive home visiting services that have had a demonstrable positive effect on health outcomes.

The Project:

The GPL assisted the state in creating a Pay for Success (PFS) contract to expand nurse home visiting services to women in Kent County, Michigan. They selected Strong Beginnings, an experienced family healthcare provider, to deliver home visiting services, and the state will make success payments based on reductions in preterm births and rapid repeat pregnancies. In particular, the project:

1. Expanded comprehensive home visiting services to 1,700 families. Strong Beginnings provides a program of comprehensive home visiting services to Medicaid-eligible women in Kent County. A trained nurse visits a new mother from early in her pregnancy until two years after her child’s birth to provide prenatal care, breastfeeding support, parenting and life skills-building, and healthcare or emotional support. These nurses also provide case management services and facilitate access to additional services such as mental health counseling, a fatherhood program, community education, parenting classes, and other needs-based services.

2. Tailored services to improve accessibility by implementing culturally relevant and sensitive programming. The expanded home visiting program works to ensure that services are accessible to the diverse population of Medicaid-eligible first-time mothers in Kent County. Strong Beginnings accounts for the unique racial and cultural backgrounds of participants in its programming. For example, programs are offered in English and Spanish, and nurses are trained on racial and cultural sensitivity.

3. Identified and filled a critical gap in services by streamlining referral process to include all eligible participants. Strong Beginnings aims to enroll every Medicaid-eligible, first-time mother in Kent County into its home visiting program. Women are referred to the program by their health provider, streamlining enrollment processes and expanding overall enrollment.

The Innovations:

1. Implements a quasi-experimental evaluation to assess the impact of home visiting services. Since nearly all eligible women in Kent County are receiving home visiting services, creating a control group necessary for a randomized controlled trial is not possible. Instead, Michigan State University will evaluate the program by matching each participant with a demographically similar person who lives outside Kent County and is therefore ineligible to receive services. They will then compare each pair’s outcomes to determine the impact of the program. While not as rigorous as a randomized control trial, this methodology is a vast improvement over standard practices of comparing to a historic baseline (or to nothing at all).

2. Piloted the program to test enrollment procedures and make improvements before a population-wide rollout. Since Strong Beginnings hoped to provide services to every eligible new mother, it needed time to tailor its programming to the needs of this specific population. A five-month pilot period allowed Strong Beginnings to make necessary program adaptations and test them without affecting success payment outcomes.

3. Utilized a Medicaid waiver to leverage federal funding, making it possible to serve all eligible families. The state received a waiver from the Centers for Medicare and Medicaid Services. This waiver permitted Strong Beginnings to bill Medicaid directly for services, reducing the financial burden on the state by allowing the federal government to pay for a portion of the project’s costs.