{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:58:21Z","timestamp":1784282301027,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T00:00:00Z","timestamp":1728604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007746","name":"W.K. Kellogg Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007746","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real\u2010world data and a return\u2010on\u2010investment (ROI) analysis approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post\u2010COVID\u201019 program costing estimates were also performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per\u2010person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The BBB\u2010enhanced community doula program was cost\u2010saving to payers and increased access to doula support for low\u2010income people. Even with post\u2010COVID\u201019 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget\u2010conscious Medicaid payers that doula services are affordable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12886","type":"journal-article","created":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T06:54:01Z","timestamp":1728716041000},"page":"299-307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Return\u2010on\u2010Investment Analysis of an Enhanced Community Doula Program: Pre\u2010 and Post\u2010COVID\u201019 Considerations"],"prefix":"10.1111","volume":"52","author":[{"given":"Julie","family":"Mottl\u2010Santiago","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Boston Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmitry","family":"Dukhovny","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Oregon Health and Sciences University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Feinberg","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Moore","sequence":"additional","affiliation":[{"name":"Institute for Medicaid Innovation  Washington, DC USA"},{"name":"Department of Obstetrics and Gynecology University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Parker","sequence":"additional","affiliation":[{"name":"Peter T. Paul College of Business and Economics University of New Hampshire  Durham New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Cabral","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Bowser","sequence":"additional","affiliation":[{"name":"Connell School of Nursing Boston College  Chestnut Hill Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene","family":"Declercq","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,11]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Advancing Birth Justice: Community\u2010Based Doula Models as a Standard of Care for Ending Racial Disparities","author":"Bey A.","year":"2019"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.12112"},{"key":"e_1_2_9_4_1","article-title":"Continuous Support for Women During Childbirth","volume":"7","author":"Bohren M. 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Current State Doula Medicaid Efforts \u201daccessed January 25 2023 https:\/\/healthlaw.org\/doulamedicaidproject."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2022.04.004"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-022-03373-x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20221108.744438"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12972"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12218"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.301201"},{"issue":"2","key":"e_1_2_9_16_1","first-page":"58","article-title":"An Economic Model of the Benefits of Professional Doula Labor Support in Wisconsin Births","volume":"112","author":"Chapple W.","year":"2013","journal-title":"WMJ"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.01.008"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2015.11.015"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12529-014-9437-z"},{"key":"e_1_2_9_20_1","unstructured":"J.Mottl\u2010Santiago \u201cA Mixed Methods Economic Analysis of Doula\u2010Service Enhanced Maternity Care as Compared With Standard Maternity Care.\u201d (Doctoral Dissertation Boston University)2020 https:\/\/open.bu.edu\/handle\/2144\/41455."},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2020.0007"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/heq.2022.0200"},{"key":"e_1_2_9_23_1","unstructured":"X.Cui H.Diop S. 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