Preterm Birth among African American Women in a Federal Healthy Start Program: Informing Pay for Success [12J]

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Providers are dependent on community-based, enhanced prenatal care (EPC) and home visiting (HV) programs to augment prenatal care and address health disparities. Given uncertain public resources for EPC/HV, innovative financing models are needed to support effective services. Pay-for-Success, a social impact bond model, partners federal/local governments, private investors, health systems, and providers to fund and deliver effective services to at-risk pregnant women and achieve predetermined health outcomes. If outcomes are achieved, savings repay investors and fund continued services. This comparative study examined baseline preterm birth (PTB) and very preterm birth (VPTB) rates for African American (AA) women enrolled in a federal Healthy Start (HS) program (Strong Beginnings), to explore program effectiveness, guide development of a PFS, and structure financial modeling.


A quasi-experimental study of AA HS participants (n=488; 2009-2014), propensity score matched with non-participants, was conducted using linked HS program, vital record, and Medicaid claims data. The objective was to examine the robustness of the comparison of PTB and VPTB outcomes utilizing multiple statistical methods.


AA women who enrolled in the HS program were less likely to have a preterm or very preterm birth compared to matched Medicaid-insured AA women in the county (PT: 11% vs. 13.1-18.0%, range p values .003-.465); (VPT: 1.8% vs. 3.0-4.1%, range p values .035-.247). Comparisons excluding women who received other HV programs yielded similar results.


Baseline preterm birth findings were positive, although varied dependent on statistical methods, and supported investment in a five year Pay for Success demonstration project.

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