Physician Recommendations for Integrating Enhanced Prenatal Care into Medical Practices: Focus Group Results

Background:In Michigan, all pregnant women enrolled in Medicaid are eligible for enhanced prenatal care (EPC), yet only 30% of women receive services; one-third initiate services in the last trimester.  Public health nurses often provide EPC services and are often dependent on timely referral from prenatal care (PNC) providers.  Medicaid (CMS) is interested in integrated EPC and maternity home and home visiting models; Michigan Medicaid is interested in increasing early EPC enrollment.  However, little is known how physicians view EPC or the low referrals rates.  The objective of this study is to identify physician’s knowledge of EPC and their perspectives on how EPC early referral and integration could be accomplished in the context of a population system of care model.

Methods: The study used qualitative focus group methods.  Obstetric physicians were asked about their general knowledge of EPC services and how best to help identify, connect, and coordinate care with EPC. 

Results:Participants indicated they were unaware of services and need education about the program; physicians need to be convinced the program provides value; timely communication is important as physicians want to be more aware of care provided; and an intake nurse or patient educator can automatically refer all Medicaid-eligible patients to the program.      

Conclusions: Physicians could readily identify specific strategies for increasing early enrollment in the Medicaid EPC benefit and integrating EPC into prenatal care.  Local practice sites have initiated recommendations resulting with increases in county EPC participation rates.