Some Models of Medical Service Delivery for Pregnancy Centers

Some Models of Medical Service Delivery for Pregnancy Centers
This section of the Guidance offers a replicable model for pregnancy resource centers making the
transition to medical services. In addition it acknowledges that there are other models which might
accomplish such a transition, and applicants are welcome to pursue those plans if they believe them to
be better suited to their organizations.
The U.S. Department of Health and Human Services has published a set of goals and objectives to be
achieved by 2010 that includes providing early prenatal care for every pregnant woman. Prenatal care
is something everyone can agree on as a desirable goal. Early prenatal care is aligned with the national
health objectives of the United States. In order to pursue health care service delivery federal grants
organizations must be able to provide health care services. To acquire such abilities requires a
substantial amount of money. To provide the services after acquiring the ability requires money also.
The first two requirements that must be met to establish the medical model are to acquire the
equipment and establish a method of reimbursement for services rendered.
The model presented is based upon the Healthy Beginnings medical practices program which serves
Cincinnati, Ohio (population 835,000). In the model a holding company or umbrella 501(c)3 is created
to provide the medical services delivered to the target population. This umbrella clinic can serve many
pregnancy resource centers and the more it serves the greater leverage for partnerships with local
hospitals, physicians and other related organizations. The umbrella clinic is also the holder of medical
malpractice insurance relieving the individual pregnancy centers from that burden.
The umbrella organization will be largely funded by Medicaid and health insurance revenue.
Additionally by expanding into pre-natal care the pregnancy centers will be able to compete for
various federal grants. There may be other medical funding sources available from your state
government. For example in Ohio there is Healthy Start and CHIP. This income source is stable and
provides much more funds than the current sources of funding that most pregnancy centers operate on.
The umbrella clinic also answers the problem of liability for the involved centers. The umbrella
organization can lease space from the pregnancy center and offer the necessary care with its own
doctors and technicians. The umbrella group could also be located at a separate location. In larger
metropolitan areas multiple clinic sites are desirable.
Once a woman has been referred by a local pregnancy resource center where she received a pregnancy
test and counseling, she is referred to the umbrella clinic. At the umbrella clinic she may receive an
ultrasound at no charge to her. The clinic will encourage her to apply for state medical aid and assist
her in doing so.
A Description of the Business Model
The umbrella 501(c)3 is a non-profit, medical practice providing obstetrical services. It is structured
similarly to a private OB/GYN practice. The Healthy Beginnings model reports that 85% of the
patients initially enroll for prenatal care without insurance. Between 90 and 95 % will be enrolled by
the time they are taken to the hospital to deliver their babies. It is essential to have a staffer
knowledgeable in the process of Medicaid reimbursement.
Some patients are self-paying under an agreement between Healthy Beginnings and their hospital
partner. By paying $2,500 in advance, a patient can cover their prenatal care and their entire delivery

at the hospital. This represents a substantial discount from the $7,000 that the hospital customarily
charges. Some clients pay on a sliding scale based on their income.
Referrals for delivery from the pregnancy centers to the partnering hospital or hospitals are needed to
increase the leverage of working with hospitals and other medical providers for the donation of
services and supplies to the centers and the umbrella clinic. The motivation of the partnering hospital
or hospitals is high since they are reimbursed for all the deliveries they make. A typical hospital in
Ohio will receive $2,000 for a Medicaid patient’s delivery and the physician will get $650 from the
delivery alone. Healthy Beginnings calculates that their referrals for delivery generate over $1 million
in revenue for the local hospital. Hospitals need patients.
An additional selling point to potential hospital partners is that your delivery referrals will have fewer
medical complications due to the pre-natal care provided by your umbrella clinic. The Healthy
Beginnings model has generated statistics that show that the “at risk” mothers they serve who deliver
VLBW (very low birth weight) babies have a survival rate equal to the average of the general
population and higher than the average of the African American population within the State of Ohio.
Documenting such outcomes is critical, and a plan to do so should be part of every proposal.
Such partnering and networking is also extremely helpful in recruiting the volunteer hospital resident
physicians and faculty members needed by the umbrella clinic. The objective is to get the partnering
hospitals to provide them at no cost to the clinic with the inducement of referrals of deliveries to that
hospital. Such patients who do deliver their babies at the partnering hospital frequently become long
term consumers at that hospital, an added inducement for the hospital.
In most states the majority of patients will qualify for some type of Medicaid program. At the
Cincinnati Healthy Beginnings Ohio model, about 70% of the income generated is reimbursed by the
Medicaid insurance program. There are different income qualifying levels for patients that go from
100% to 200% of poverty income level, but most Medicaid programs allow coverage for prenatal care.
Private health insurance is another source of reimbursement.
Again citing the Healthy Beginnings model, the Ohio State Medicaid program pays $74 for the initial
prenatal visit, thereafter $50 per visit for prenatal care. The initial budget for the center can be
constructed around the number of patients estimated to be seen. Medicaid typically reimburses within
two weeks of billing. Current state budget problems may impact on Medicaid reimbursements
however. Check with your state Medicaid office for the latest information.
Most organizations will have to rely on volunteer physicians, nurse midwives, and nurse practitioners
because of the prohibitive cost of paying salaries to these professionals. Serving the Healthy
Beginnings model are twenty volunteer physicians. There are also over twenty other medical and
nursing volunteers.
The average amount of time each physician spends working in the clinic varies. Some spend two to
four hours per week, others two to four hours per month. By having nurse midwives and nurse
practitioners on site patient needs can be met while accommodating most doctors schedules allowing
them to volunteer even on an occasional basis.
Some organizations with limited capacity will find it advisable to operate the clinic only one or two
days per week until sufficient revenue is generated from Medicaid reimbursements to expand operating
hours.

Networking Approaches
In addition to partnering with hospitals and benefiting from their donations of the time of medical
professionals and equipment, the ability to provide medical services also creates opportunities to
approach other philanthropic organizations and grant making institutions for financial and in-kind
support. Medical suppliers, the pharmacological industry and manufacturers of medical equipment
should also be contacted and ask to contribute and participate in the program. Find out what the needs
are of the organization you plan to approach for support and find a way for your organization to meet
some of those needs in exchange for their support of your program.
Other Models
Some centers might prefer to offer their medical practice and pregnancy resource services as a single
unit. Others may wish to expand upon their present operations. Others may wish to restructure their
present offerings to be eligible to receive federal reimbursement. All appropriate approaches will be
considered. But the applicant should be mindful that the overall objective of the grant is to enhance
the capacity of the organization to obtain federal reimbursement in the form of federal grants,
contracts, and cooperative agreements. Therefore, the applicant should demonstrate how their model
will qualify for the maximum amount of federal reimbursement. Medical models which rely on private
donations or grant sources other than government funds are not within the scope of this grant process.
Possible Help
For a list of organizations that can provide referrals of medical personnel and organizations that may
provide cash or in kind contributions contact:
Fr. John Roddy
Director
Compassion Capital Fund
(703) 471-8750 ext. 134