The Strong Start effort to test new approaches to prenatal care was a four-year initiative to test and evaluate enhanced prenatal care interventions for women enrolled in Medicaid or CHIP who were at risk for having a preterm birth. The goal of the initiative was to determine if these approaches to care could reduce the rate of preterm births, improve the health outcomes of pregnant women and newborns, and decrease the anticipated total cost of medical care during pregnancy, delivery and over the first year of life for children born to mothers in Medicaid or CHIP.
The Strong Start initiative period of performance has concluded and is no longer active.
Awardees receiving Strong Start funds could administer more than one approach to enhanced prenatal care at multiple provider sites; however, individual provider sites can administer only one of the three enhanced approaches.
Strong Start awardees served women in the areas with the highest preterm birth rates in the country, including areas that were among the top ten prematurity and infant mortality counties according to the Centers for Disease Control and Prevention.
This initiative tested three evidence-based maternity care service approaches that enhanced the current care delivery and addressed the medical, behavioral and psychosocial factors that may be present during pregnancy and contribute to preterm-related poor birth outcomes. Awardees tested one of the three following interventions, but could not use funds to supplement or supplant any funding sources, including Medicaid and CHIP reimbursement:
- Enhanced Prenatal Care through Centering/Group Visits – group prenatal care that incorporated peer-to-peer interaction in a facilitated setting for health assessment, education and psycho-social support.
- Enhanced Prenatal Care at Birth Centers – comprehensive prenatal care facilitated by teams of health professionals including peer counselors. Services included collaborative practice, intensive case management, counseling and psycho-social support.
- Enhanced Prenatal Care at Maternity Care Homes – enhanced prenatal care including psychosocial support, education and health promotion in addition to traditional prenatal care. Services provided expanded access to care, improved care coordination and provided a broader array of health services.
The Center for Medicare and Medicaid Innovation (CMS Innovation Center), in partnership with the Health Resources and Services Administration (HRSA) and Administration on Children and Families (ACF), also evaluated a fourth approach to preventing preterm births, enhanced prenatal care through home visiting, as part of the evaluation of two evidence-based models under the Maternal, Infant, and Early Childhood Home Visiting program, Nurse Family Partnership and Healthy Families America. The Strong Start evaluation of these two models built on the Maternal and Infants and Early Childhood Home Visiting Program Evaluation.
Length of Awards
Program participants received an initial award for the first year of program implementation to pursue the goals and objectives of the Strong Start initiative. After the initial award, non-competing continuation awards were awarded for up to two additional years contingent upon availability of funding, participant performance, and demonstrated progress toward the goal of reducing premature births. Participants were also considered for awarding funds in the fourth year for data collection. CMS was under no obligation to make additional awards under this program.
To be eligible to participate in the Strong Start initiative, applicants had to be:
- Providers of obstetric care (for example, provider groups or affiliated providers and facilities);
- State Medicaid Agencies, in partnership with providers;
- Medicaid managed care organizations (MCOs), in partnership with providers; or
- Conveners in partnership with other applicants. The convener could be a direct applicant, or could convene and support other organizations to become applicants. Examples of conveners include professional trade associations or other health service related organizations.
Funds were awarded with consideration to:
- Available funding;
- Geographic diversity; and
- Quality of each application and the ability to meet the goals of the initiative
Strong Start awardees participated in monitoring and evaluation activities to ensure that quality care is being delivered. Participants were expected to provide the CMS Innovation Center performance metrics consistent with the goals of the initiative on a quarterly basis. Among other measures, awardees reported information on gestational age and birth weight for the infants of the mothers participating in one of the three approaches to enhanced prenatal care. Participants also provided the gestational age and birth weight data on births from a historical baseline period that spanned at least two years prior to the start of the intervention.
Participants also submitted quarterly progress reports on the specific uses of the cooperative agreement funds, assessment of the overall project implementation, and other specific information. They also had to submit quarterly data reporting on operations, utilization and outcomes.
CMS provided technical assistance, analytic support and coordination to help participants launch their interventions to reduce premature births. As with all Innovation Center initiatives, participants participated in opportunities for shared learning and dissemination with others.
State data linkages for intervention and comparison mothers and infants CMS worked with states or other entities to link vital statistics with Medicaid and CHIP claims and encounter data as part of the national program evaluation. This linked data supplemented the data reported by awardees on the intervention participants and a comparison population.
- Strong Start for Mothers and Newborns Initiative: General Information
- Strong Start for Mothers and Newborns Initiative: Effort to Reduce Early Elective Deliveries
- Year One Evaluation Report: Strong Start for Mothers and Newborns - Enhanced Prenatal Care Models (PDF)
- Fact Sheet: Strong Start for Mothers and Newborns - Testing Approaches to Prenatal Care
- Strong Start Archived Materials
- Year Two Evaluation Report: Strong Start for Mothers and Newborns - Enhanced Prenatal Care Models
- Year Three Evaluation Report: Strong Start for Mothers and Newborns - Enhanced Prenatal Care Models
- Year Four Evaluation Report: Strong Start for Mothers and Newborns - Enhanced Prenatal Care Models
- Final Evaluation Report: Strong Start for Mothers and Newborns - Enhanced Prenatal Care Models
For more information, please email StrongStart@cms.hhs.gov.