This evaluation examined the characteristics, service use, costs, and newborn
outcomes of 209 pregnant mothers who participated in a Pathways Community Hub (PCH) operated by the Bexar County Health Collaborative in San Antonio, Texas from 2019-2023. Program data from the Bexar PCH were linked to Medicaid claims data for analysis. Medicaid data were available for 90 mothers who completed the PCH program and 68 mothers who participated but did not complete the PCH program.

Linked newborn data were available for 70-148 mothers who participated in the PCH program. Compared to matched control groups of pregnant mothers who did not participate in the PCH program at all, pregnant mothers who participated in the Bexar PCH incurred higher prenatal costs and delivery costs. Mothers who completed the Bexar PCH program had a significantly higher number of postpartum visits and, though not statistically significant, had a higher number of prenatal visits than their controls.

However, mothers who completed the Bexar PCH were found to be significantly more likely to have newborns with pre-term births, low birth weight, and neonatal intensive care admissions than matched controls. Sensitivity analyses that relaxed mother newborn matching criteria and included mothers who participated but did not complete the Bexar PCH found no significant differences in birth outcomes between Bexar PCH participants and matched controls.

These findings suggest a limited impact of the Bexar PCH, improving partially perinatal care among those completing the referral process, though not modifying maternal and newborn outcomes. Still, they should be interpreted in the context of several important limitations, including the small sample sizes, reliance on Medicaid claims data, inability to match or adjust for social and contextual differences beyond zip code and race/ethnicity, no assessment of fidelity to the PCH model, and the majority Hispanic sample. Further evaluation is needed to fully test and replicate these findings with a larger sample size and additional data sources.