PRIMARY-CARE CASE-MANAGEMENT AND BIRTH OUTCOMES IN THE IOWA MEDICAID PROGRAM

Objectives. This study compares prenatal care utilization and birth ou tcomes between Iowa Medicaid recipients receiving can in a primary car e case management (PCCM) system and those receiving care in a fee-for- service (FFS) system. Methods. Birth certificates linked with Medicaid hospitalization claims were analyzed for seven PCCM and seven FFS cou nties. Results. From 1989 through 1992, there was (1) a 20% increase i n the number of women who received adequate prenatal care in the FFS c ounties. vs a 5% increase in the PCCM counties; (2) a 17% increase in the number of women who initiated care within the first trimester in t he FFS counties, vs a 6% increase in the PCCM counties; and (3) a 442% increase in the number of women who received enhanced prenatal servic es in the FFS counties, vs a 278% increase in the PCCM counties. There were no significant differences between groups in mean gestational ag e or birthweight; however, there was an increase of very-low-birthweig ht babies in both groups. Conclusions. PCCM, as implemented by the Iow a Medicaid program, has not appreciably improved prenatal care utiliza tion or birth outcomes.