Joshua Baker was a 2019-2020 Young Scholar Awards Program recipient. He is a graduate of Baylor University.
The doctor is in; then, the doctor is out. The rush that accompanies your primary care visit or check-up stands in stark contrast to the tedious mounds of paperwork and time you invested preceding your appointment. Surely, you think, there has to be a better method of care? Maybe one that does not leave you questioning if the doctor really answered that one important question you had about your medication?
It turns out that simply spending more time with your physician may not be the only answer to this dilemma, though that certainly would help. Rather than entirely focusing on time constraints due to electronic medical records or decreased compensation in clinics, healthcare administrators and patients alike may find the answer to some of their ailments in group care.
Group care, an innovation that develops an economy of scale, has great potential to advance treatment, especially in primary care and preventive medicine. For patients, implementation has the potential to improve health outcomes as well as increase consumer satisfaction. For healthcare administrators, it has the potential to decrease expenditures.
Group prenatal care offers a unique insight generalizable to the group treatment model as a whole. Group prenatal care, with the original model branded Centering Pregnancy, is a treatment that brings together a cohort of eight to twelve women for up to two hours at ten regularly spaced intervals throughout their pregnancy. Typically, the program reserves thirty minutes for standard prenatal risk assessment and then proceeds to a didactic group session that is easily led by a nurse practitioner or similar health professional.
In this discussion, questions are answered, relationships are formed, and patients are ultimately empowered, potentially leading to better health outcomes and certainly resulting in higher patient satisfaction. Further, patients spend, on average, ten times more time with a healthcare provider compared to a traditional, individual model of care.
Medicine is relational and educational, and this is especially true of primary care. Providers should empower patients with knowledge, a thorough understanding of their condition, and the clearest action items to take home to continue to better their health.
The group model of prenatal care does just that, and perhaps does it better than traditional one-on-one models of care. In turn, group prenatal care may even improve infant health outcomes, decreasing the percentage of preterm and low birth weight deliveries compared to what is possible through individual appointments. Although this outcome may not be generalizable to other aspects of medicine, group prenatal care has at least been shown to cause no harm or worse outcome than traditional appointments.
Economically, group prenatal care, if implemented in centers with sufficient numbers of patients, has the potential to decrease expenditures. This is especially the case if patients see their providers, then have an extended discussion with a lower cost, qualified prenatal care provider such as a nurse practitioner. That’s the catch. Patients may not spend more time with their provider, but they’ll undoubtedly receive far more education and instruction that is nearly absent in the traditional, individualized care model, and often at a lower cost.
Notably, Medicaid is the largest payer of maternity care in the country. A recent study in South Carolina found that implementation of group prenatal care following an investment of $1.7 million, resulted in a return of nearly $2.3 million. The study thus concluded that the institution of group prenatal care among low-risk Medicaid beneficiaries resulted in significant cost savings.
Thus, it seems possible that group prenatal care not only improves patient satisfaction and even health outcomes, but that it is also more cost-effective for both clinics and insurers than standard one-on-one care. Furthermore, in the realm of preventive treatment, there is potential for wide-scale implementation of group care generally. Plenty of conditions require check-up visits or basic preventive appointments. To date, health systems have effectively implemented group care to treat asthma, autoimmune diseases, cancer, and mental health issues, among other health conditions.
It is true that the group model of prenatal care won’t work in all cases. Namely, group prenatal care is often reserved and only recommended for low-risk patients, as one-on-one personalized treatment may still be required for more intensive patients due to the nature of their health condition. And for health systems to invest in group prenatal care and the initial human capital necessary for certification, among other things, enhanced reimbursement is often required.
It is also true that further research is required. What populations stand to gain from group prenatal care, where implementation results in better health outcomes and decreased healthcare expenditures? Additionally, under what condition is group prenatal care cost-effective? These questions need to be answered.
Still, relatively novel success and a lack of widespread implementation reveal considerable room for expansion driven by patient, administrator, and insurance interests. Given our current state of healthcare delivery, group care appears to be promising, group prenatal care included.