The Effects of Medicaid Policy Interventions on Racial Equity in Severe Maternal Morbidity

University of Pittsburgh10,000,000 enrolled

Overview

The goal of this study is to learn about the effects of structural inventions, such as equity-focused Medicaid polices, on severe maternal morbidity (SMM) and mortality and maternal health. The main questions it aims to answer are: 1. What is the effect of Medicaid healthcare quality interventions on SMM? 2. What is the effect of Medicaid healthcare quality interventions + doula care? 3. What are Medicaid beneficiaries' experiences in receiving services and the potential impact of integration of doula services and equity practices? Participants will be asked to describe experiences as a result of structural interventions and focused Medicaid policies.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

10,000,000

Conditions

Severe Maternal Morbidity Maternal Death

Interventions

This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2. 1\) health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries

DoulaBEHAVIORAL

This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2. 1. health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries. 2. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.

Eligibility

Sex: ALLHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Pregnant and postpartum Medicaid beneficiaries across the US Qualitative: * Medicaid beneficiaries who self-identify as Black and/or live in PA Health Equity Zones * Doulas who provide care to Medicaid beneficiaries in Pennsylvania * Medicaid Managed Care Organization (MCO) administrators in Pennsylvania. Severe maternal morbidity and mortality outcomes will be assessed in healthcare records and for these quantitative outcomes, patients will not be recruited individually Exclusion Criteria: \-

Outcomes

Primary Outcomes

Severe maternal morbidity (SMM)

SMM rate based on the Centers for Disease Control algorithm

Time frame: 20 weeks gestation through 42 days postpartum

Secondary Outcomes

All cause mortality

Binary indicator of mortality based on Social Security Administration records

Time frame: Delivery date through one year after delivery

Follow up for chronic conditions

Percent of persons who receive guideline concordant care for depression, substance use disorders, immunizations, and screening and referral for social determinants of health

Time frame: 43 days through 1 year after delivery

Provision of evidence care in pregnancy and postpartum

Percent of Medicaid patients among each provider who receive screening and follow up for depression, treatment for substance use disorders, perinatal immunizations, and screening and referral for social determinants of health

Time frame: During pregnancy and postpartum up to 1 year

Medicaid managed care administrator perspectives on policy interventions

Qualitative self report of perspectives

Time frame: Year 3