Centering Patient Care: How APPs Offer Easy Access, Better Health, and Lower Costs

Improving patient care and health outcomes while lowering costs is healthcare’s “Triple Aim,” a popular business strategy championed by Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Health Improvement (IHI). While the Triple Aim approach of “Better Care, Better Health, Lower Costs” is widely embraced, implementation often proves elusive. But organizations targeting the Triple Aim can hit their marks—and for over 25 years, the Centering model of care has led the way.


Centering started in the 1990s, when Sharon Schindler Rising, MSN, CNM, FACNM, realized that traditional prenatal care wasn’t meeting the needs of all patients. To facilitate rich, meaningful engagement between expectant parents, their providers, and their communities, Rising developed Centering Pregnancy, a group-care model that increased patients’ access to quality care without increasing costs.

The Centering model’s three components are healthcare, interactive learning, and community building. Women opt into Centering groups based on their anticipated delivery date and remain in the same groups through the postpartum period.

At regular group appointments lasting 90 minutes each (ten times longer than a traditional prenatal visit), providers—often certified nurse midwives—provide one-on-one healthcare for each group member, along with group education. Group members engage in community building and celebrate shared milestones to promote individual health empowerment and activate personal agency.

As neighboring healthcare groups learned of the model, demand for Centering Pregnancy groups grew. By 2016, the model had expanded to serve an estimated 50,000 women per year at 400 sites. Over two decades, the program has served over 70,000 families nationwide.


The Centering model has been widely adopted and well-studied. Over 200 published articles, including three randomized trials, have reported improved health outcomes for new mothers, including a 47 percent reduction in preterm birth, better attendance at prenatal visits, higher levels of satisfaction, increased breastfeeding rates, longer pregnancy spacing, and improved immunization rates.

Yale University reported a 33 percent reduction in preterm birth for women in Centering groups, along with higher satisfaction and improved readiness for birth. Thanks in large part to lower rates of preterm birth, the University of Kentucky estimates that Centering Pregnancy saved their health system approximately $2.1 million over two years.

In 2001, Rising established the nonprofit Centering Healthcare Institute (CHI) to expand the model to other sectors of healthcare. Today, more than a dozen CHI consultants conduct training groups and site visits to help organizations successfully implement group-care models for prenatal care, parenting, and chronic conditions. Its enduring success proves that when patient care remains centered, healthcare organizations can achieve their Triple Aim.

Sources: Centering Healthcare Institute; American Academy of Nursing