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

Conditions

• Maternal Death
• Severe Maternal Morbidity

Eligibility Criteria

Sex

ALL

Age

N/A - N/A

Healthy Volunteers

Accepted

Interventions

• Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) — BEHAVIORAL
  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
• Doula — BEHAVIORAL
  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.
• Standard Care — BEHAVIORAL
  Participants receive standard care without quality interventions or doula care

Study Details

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.

Key Dates

Start date

Jan 3, 2023

Status verified

Jul 2025

Primary completion

Jun 30, 2027

Completion

Jun 30, 2027

Study Design

Enrollment

10,000,000 participants (estimated)

Allocation

NON_RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

HEALTH_SERVICES_RESEARCH

Arms

• Other: Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) Only
  The investigators will employ a quasi-experimental study design to test two hypotheses: H1: SMM rates among Black people will decline after the interventions (equity payment and obstetric bundled payment), relative to people of other race groups within Pennsylvania (PA); and H2: Racial inequities in SMM will decline among those exposed to the interventions in PA, relative to those in similar states. The investigators will collect qualitative data to assess the effects of the Medicaid healthcare interventions on beneficiaries' experiences.
• Other: Doula Only
  The investigators will test two hypotheses: H1: SMM rates among Black people will decline more after the addition of doula care in PA, relative to healthcare quality interventions alone. H2: Racial inequities in SMM will decline more among those exposed to both healthcare quality and doula care interventions in PA, relative to states implementing doula care only. The investigators will collect qualitative data to assess the effects of the Medicaid healthcare and service interventions on beneficiaries' experiences.
• Other: Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula
• No Intervention: Standard Care

Primary Outcome Measure

Severe maternal morbidity (SMM) [ Time Frame: 20 weeks gestation through 42 days postpartum ]

Locations (1)

Find similar trials in Pittsburgh, PA

Related Studies

• MOMs Chat and Care Study
  Recruiting · Northwell Health · Manhasset, New York
• Assessing the Maternal Outcome Monitoring Systems
  Recruiting · Columbia University · New York, New York