Member Spotlight: Centering Healthcare Institute

By Perdita Henry

The 86th Texas Legislative Session ended with a few healthcare triumphs for Texas women. We saw an increase in funds for the Women’s Health Programs, and an improvement to auto-enrollment notification for postpartum women into the Healthy Texas Women (HTW) program. Other potential improvements to the healthcare safety net, such as increasing contraception access for 18-and 19-year-olds in the Children’s Health Insurance Program (CHIP) and extending Medicaid access for postpartum women from 60 days to 12 months failed to garner enough support.

Despite those challenges, the organizations that make up the Texas Women’s Healthcare Coalition (TWHC) continue blazing paths to ensure Texas women have more opportunities to access quality healthcare. The Centering Healthcare Institute (CHI) is doing exactly that by working with healthcare organizations to implement programs like CenteringPregnancy (CPreg), which empowers patients and improves healthcare delivery.

I got to chat with CHI’s Regional Director, Juan Siegel, MD, MS, MHA, about their mission, how the CenteringPregnancy model works, and what they hope the future of women’s healthcare looks like.

Can you tell me more about your organization and its work?

CHI is a non-profit organization that works side by side with healthcare providers from all sectors to improve health and transform the way care is delivered. With over two decades of experience as the go-to resource for group care, we have developed and sustained the Centering model at nearly 600 practice sites across the U.S.

CHI’s Centering model combines health assessment, interactive learning, and community building to help support positive health behaviors and drive better health outcomes.

CenteringPregnancy and CenteringParenting provide the highest quality of care to families from pregnancy through the child’s second year. The CenteringHealthcare model is being extended to many different health conditions including asthma, diabetes, opioid recovery, cancer survivors, chronic pain and other patient populations.

We offer training in group facilitation and group care, implementation support for system change, site approval for model fidelity and quality assurance, practice management and support tools – including CenteringCounts data collection and reporting – curriculum materials and supplies that support providers and patients, as well as certification for facilitators.

How does CenteringPregnancy assist medical providers and the women they serve?

CPreg is an evidence-based model of group prenatal care that’s shown to improve a wide range of birth outcomes. From lowering the risk of preterm births, reducing low-birth weights, and reducing NICU admissions, to increasing rates of breastfeeding, postpartum visits, and interconception family planning – especially among patients at risk for negative birth outcomes due to social determinants of health. With over 100 published studies and peer-reviewed articles, evidence shows that CPreg decreases costs, improves health outcomes for mothers and their babies, and reduces racial health disparities.

CPreg group care follows the recommended schedule of ten prenatal visits, but each one is ninety minutes to two hours long. Ten times longer than the standard prenatal visit. This gives patients time to interact with their provider team. During their visit, patients are encouraged to engage in their care by taking their own weight and blood pressure, recording that health data, and then having private time with their provider for the clinical assessment.

The visit schedule and content offer flexibility and time to explore health and wellness topics that fit the group's needs. Receiving healthcare in a group setting leads to greater engagement, learning, and self-confidence.

Centering is the only intervention that offers continuity of care from pregnancy through the critical early childhood period of health and development (prenatal to age 2+) with a focus on parent activation and empowerment.

How is the CenteringHealthcare Institute uniquely positioned to help medical practices provide better care to their patients and manage the challenges associated with switching over to value-based payments?

CPreg is a group prenatal care model that allows facilitators to lead eight-to-ten women, all in similar stages of pregnancy, through a curriculum of ten 90- to 120-minute interactive group discussions. They’ll cover several medical and non-medical aspects of pregnancy, including nutrition, common discomforts, stress management, labor and delivery, breastfeeding, and infant care. This model of care is backed up by a growing body of evidence suggesting it can improve birth outcomes and increase providers’ and women’s satisfaction in the delivery of prenatal care.

Our current fee-for-service payment models don’t typically reward the added value that CPreg can achieve. We understand that aligning emerging value-based payment models that reward providers for better outcomes with group prenatal care is an opportunity to make it financially sustainable.

In Medicaid, the largest payer for maternity care, states have an opportunity to offer the program to more women as part of their emerging payment and delivery system reforms. CPreg is a holistic model of mutual support that creates an environment where social and economic factors affecting health can be identified and addressed. It has the potential to improve outcomes and women’s satisfaction with their maternity care.

It does involve a significant shift in the model and schedule of prenatal care because it replaces the traditional individual appointments. This change presents opportunities for alignment with alternative payment models that can be sustainably financed along the continuum of value-based payment (VBP), from enhanced payments per visit, to bonuses for improvement in outcomes, to the use of a bundled maternity payment with CPreg as one of the care delivery options.

Ideally, providers and payers can assess their readiness to implement VBP for maternity care models like CPreg together. Because of the same growing evidence that CPreg reduces costs and leads to high satisfaction with care, policymakers, payers, and providers should work to integrate CPreg and VBP within maternity care.

Why is it important for your organization to be a member of TWHC?

TWHC’s ongoing efforts “toward the vision of a state where every woman has access to the preventive and preconception care that will help her stay healthy and prepare for healthy, planned pregnancies” is one we wholeheartedly support at CHI.

What does an ideal future for women’s health look like according to the CenteringHealthcare Institute?

CHI is working with dedicated individuals and organizations to build a future where group care becomes the standard of healthcare. We have created a movement that’s impacting outcomes, patient experience, and provider satisfaction. We cherish the opportunity to expand access to the Centering model of group care visits and improve maternal and infant birth outcomes in the state of Texas and across the U.S.