Comparison of perinatal outcomes among TennCare managed care organizations

Objective. To compare perinatal outcomes among the managed care organizatio ns (MCOs) providing care to beneficiaries enrolled in TennCare, Tennessee's capitated Medicaid managed care program. Design. Retrospective cohort analysis. Subjects. Infants born in Tennessee during 1995 to women enrolled in TennCa re. Primary Outcome Measures. Prenatal care use, birth weight (BW), death in th e first 60 days of life, and delivery of extremely low BW (< 1000 g) infant s in hospitals without level 3 neonatal intensive care units. Results. During 1995, 34 402 infants were born to mothers enrolled in TennC are. The MCOs differed widely in the demographic characteristics of their e nrollees. In addition, there were small differences in prenatal care utiliz ation, but no differences in BW outcomes among the MCOs. In multivariate an alysis, however, infants born to women enrolled in 1 MCO were 2.8 times mor e likely to die in the first 60 days of life than were infants born to wome n enrolled in the largest MCO (OR: 2.81; 95% CI: 1.31-6.03). Women enrolled in this same MCO seemed to have a higher proportion of extremely low BW (< 1000 g) infants delivering in a hospital lacking a level 3 neonatal intens ive care unit (38% vs 20% in the largest MCO). Conclusion. The differences among MCOs in early infant death and in the del ivery of high-risk infants in hospitals lacking appropriate neonatal facili ties suggest that monitoring of care delivery to vulnerable children should include assessment of appropriate use of specialized services.