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

University of Pittsburgh

Status: Enrolling

Conditions: Maternal Death; Severe Maternal Morbidity

Treatments: Behavioral: Medicaid healthcare quality interventions (equity payment and obstetric bundled payment); Behavioral: Doula; Behavioral: Standard Care

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05678699

1R01NR020670-01 (U.S. NIH Grant/Contract)

STUDY22080184

Details and patient eligibility

About

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.

Enrollment: 10,000,000 estimated patients

Sex: All

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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10,000,000 participants in 4 patient groups

Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) Only

Other group

Description:

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.

Treatment:

Behavioral: Standard Care

Behavioral: Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)

Doula Only

Other group

Description:

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.

Treatment:

Behavioral: Standard Care

Behavioral: Doula

Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula

Other group

Treatment:

Behavioral: Standard Care

Behavioral: Doula

Behavioral: Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)

Standard Care

No Intervention group