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

Maternal Death Clinical Trial

Official title:

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

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05678699
• Other study ID #: STUDY22080184
• Secondary ID: 1R01NR020670-01
• Status: Recruiting
• Phase: N/A
• Start date: January 3, 2023
• Est. completion date: June 2027

Study information

• Verified date: August 2023
• Source: University of Pittsburgh
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 10000000
• Est. completion date: June 2027
• Est. primary completion date: June 2027
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

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:

-

Related Conditions & MeSH terms

• Maternal Death

Intervention

Behavioral:
• Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)
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
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. 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. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.
• Standard Care
Participants receive standard care without quality interventions or doula care

Locations

Country	Name	City	State
United States	University of Pittsburgh School of Public Health	Pittsburgh	Pennsylvania

Sponsors (2)

Lead Sponsor	Collaborator
University of Pittsburgh	National Institute of Nursing Research (NINR)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Assess the changes in effects of the Medicaid healthcare quality interventions on beneficiaries' experiences	The investigators will collect qualitative data from three different study populations across Pennsylvania who will be affected by the Medicaid policies under study: 1) Medicaid beneficiaries (n=100; Years 2 and 4); 2) Doula care providers (n=60; Years 2 and 4); Managed Care Organization (MCO) leadership (n=10); Year 3	Years 2, 3, and 4
Primary	Severe maternal morbidity (SMM)	SMM rate based on the Centers for Disease Control algorithm	20 weeks gestation through 42 days postpartum
Secondary	All cause mortality	Binary indicator of mortality based on Social Security Administration records	Delivery date through one year after delivery
Secondary	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	43 days through 1 year after delivery
Secondary	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	During pregnancy and postpartum up to 1 year
Secondary	Medicaid managed care administrator perspectives on policy interventions	Qualitative self report of perspectives	Year 3