{"id":244681,"date":"2024-09-04T08:28:00","date_gmt":"2024-09-04T12:28:00","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?post_type=bu-article&#038;p=244681"},"modified":"2024-09-23T10:02:31","modified_gmt":"2024-09-23T14:02:31","slug":"medicaid-accountable-care-organizations-may-increase-care-engagement-and-quality-among-pregnant-and-postpartum-patients","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2024\/medicaid-accountable-care-organizations-may-increase-care-engagement-and-quality-among-pregnant-and-postpartum-patients\/","title":{"rendered":"Medicaid Accountable Care Organizations May Increase Care Engagement and Quality Among Pregnant and Postpartum Patients"},"content":{"rendered":"\t<div class=\"wp-block-editorial-leadin sphnews-block-editorial-leadin is-style-text-over-image has-media has-box has-media-focus-center-middle has-text-position-x-right has-dark-theme\">\n\t\t<div class=\"container-lockup\">\n\n\t\t\t<div class=\"wp-block-leadin-media\">\n\t\t\t\t\n\t\t\t\t<img width=\"2120\" height=\"1414\" src=\"\/sph\/files\/2024\/09\/medicaid-aco-pregnancy.jpg\" class=\"\" alt=\"Pregnant woman and afro doctor with face masks during examination in hospital. Doctor is measuring temperature to her patient. Doctor is measure the temperature of pregnant woman\" loading=\"lazy\" srcset=\"https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy.jpg 2120w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-636x424.jpg 636w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-1024x683.jpg 1024w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-768x512.jpg 768w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-1536x1024.jpg 1536w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-2048x1366.jpg 2048w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-755x504.jpg 755w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-1499x1000.jpg 1499w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-900x600.jpg 900w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-450x300.jpg 450w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-600x400.jpg 600w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-1920x1281.jpg 1920w, https:\/\/www.bu.edu\/sph\/files\/2024\/09\/medicaid-aco-pregnancy-1200x800.jpg 1200w\" sizes=\"(max-width: 2120px) 100vw, 2120px\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\n\t\t\t\n\t\t\t\t<div class=\"container-words-outer\">\n\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"container-words-inner has-opacity-80\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"wp-prepress-tag\">strategic direction<\/span>\n\t\t\t\t\t\t\t\t<h1 class=\"head\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tMedicaid ACOs May Increase Care Engagement and Quality Among Pregnant and Postpartum Patients\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/h1>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"deck\">A new study found that Medicaid accountable care organizations in Massachusetts were associated with increases in prenatal and postpartum office visits, postpartum depression screenings, and timely postpartum care.<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\n\t\t<\/div>\n\n\t\t\n\t<\/div>\n\n\t\n<div class=\"wp-prepress-component-metabar js-block-editorial-metabar sphnews-prepress-layout-metabar\">\n\t<div class=\"wp-prepress-component-metabar-wrapper\">\n\t\t\t\t\t<div class=\"wp-prepress-component-metabar-date\">September 4, 2024<\/div>\n\t\t\n\t\t\t\t<div class=\"wp-prepress-component-metabar-credits\">\n\t\t\t\t\t\t\t\t<ul data-credit-type=\"By\">\n\t\t\t\t\t\t<li><a href=\"https:\/\/www.bu.edu\/sph\/news\/authors\/jillian-mckoy\/\">Jillian McKoy<\/a><\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wp-prepress-component-metabar-share js-bu-prepress-share-tools\">\n\t\t\t<span class=\"icon-twitter\"><span>Twitter<\/span><\/span>\n\t\t\t<span class=\"icon-facebook\"><span>Facebook<\/span><\/span>\n\t\t\t<span class=\"icon-action\"><\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t\n\n\n<p>Despite recent declines in nationwide maternal mortality, the United States continues to experience a significant maternal health crisis, in part shaped by <a rel=\"noreferrer noopener\" href=\"https:\/\/www.cdc.gov\/womens-health\/features\/maternal-mortality.html\" target=\"_blank\">inequitable access<\/a> to quality healthcare for too many pregnant and postpartum people, particularly those who are covered by Medicaid.\u00a0<\/p>\n\n\n\n<p>Medicaid accountable care organizations (ACOs) have the ability to address this inequity in care by improving both coordination and quality of care for pregnant patients during and after their pregnancy, according to a new study led by the School of Public Health.<\/p>\n\n\n\n<p><a href=\"https:\/\/www.healthaffairs.org\/doi\/10.1377\/hlthaff.2024.00230\" target=\"_blank\" rel=\"noreferrer noopener\">Published in the journal <em>Health Affairs<\/em><\/a>, the study examined changes in pregnancy and postpartum healthcare after the implementation of Medicaid ACOs in Massachusetts and found that this value-based model of care was linked to increases in prenatal and postpartum office visits, postpartum depression screening rates, and the likelihood of a timely postpartum visit.\u00a0<\/p>\n\n\n\n<p>The results provide valuable insight and data on the maternal health benefits of ACOs for pregnant and postpartum Medicaid enrollees. Almost <a href=\"https:\/\/www.medicaid.gov\/medicaid\/quality-of-care\/quality-improvement-initiatives\/maternal-infant-health-care-quality\/index.html#:~:text=Nearly%20two%20out%20of%20every,births%20in%20the%20United%20States.\" target=\"_blank\" rel=\"noreferrer noopener\">half<\/a> of all pregnant people in the US are covered by Medicaid, yet only 12 US states to date have active, statewide Medicaid ACOs. The need is urgent: pregnant Medicaid enrollees have an 82-percent <a href=\"https:\/\/www.macpac.gov\/wp-content\/uploads\/2020\/01\/Maternal-Morbidity-among-Women-in-Medicaid.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">greater risk<\/a> of severe maternal complications\u2014and thus, maternal mortality\u2014than privately insured pregnant patients. Preterm birth rates are similarly higher among this group, and <a href=\"https:\/\/www.macpac.gov\/wp-content\/uploads\/2020\/06\/June-2020-Report-to-Congress-on-Medicaid-and-CHIP.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">40 percent<\/a> of Medicaid enrollees do not receive postpartum care.<\/p>\n\n\n\n<p>\u201cOur results suggest that expanding Medicaid ACO models\u2014especially in the 38 states that don\u2019t currently have Medicaid ACOs\u2014has the potential to improve engagement in prenatal and postpartum care,\u201d says study lead and corresponding author <a href=\"https:\/\/www.bu.edu\/sph\/profile\/megan-cole-brahim\/\">Megan Cole<\/a>, associate professor of health law, policy &amp; management (HLPM) and co-director of the <a href=\"https:\/\/www.bu.edu\/sph\/research\/centers-and-groups\/medicaid-policy-lab\/\" target=\"_blank\" rel=\"noreferrer noopener\">Medicaid Policy Lab<\/a>. \u201cIncreased care engagement provides more opportunity to address the physical, behavioral, and social needs of patients, which is especially important given that many Medicaid patients have inadequate engagement in prenatal and postpartum care.\u201d<\/p>\n\n\n\n<p>Funded by the National Institute on Minority Health and Health Disparities (NIMHD), the study presents the first major findings from a <a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2023\/professor-receives-3-8m-nih-grant-to-study-impact-of-medicaid-acos-on-maternal-health-outcomes\/\" target=\"_blank\" rel=\"noreferrer noopener\">five-year NIMHD grant<\/a> that Dr. Cole received in 2023 to evaluate how Medicaid ACOs can improve quality and equity of care for pregnant patients.<\/p>\n\n\n\n<p>The research team from SPH and Boston Medical Center leveraged an opportunity to evaluate the effects of a statewide Medicaid ACO program on pregnancy and postpartum quality-of-care measures in a real-world, natural setting when Massachusetts formed <a href=\"https:\/\/www.mass.gov\/info-details\/masshealth-health-plans\" target=\"_blank\" rel=\"noreferrer noopener\">17 ACOs<\/a> under its Medicaid program in 2018\u2014one of the most comprehensive Medicaid ACO programs in the nation that aimed to better coordinate and integrate physical, behavioral, and social care of Medicaid patients. Under the program, participating Medicaid providers were tasked with improving cost and quality of care for Medicaid patients, where providers could receive financial incentives for performance measures such as timely prenatal care and depression screenings. The ACO program could have especially benefited pregnant and postpartum Medicaid patients.<\/p>\n\n\n\n<p>The team utilized claims data on Medicaid-covered live deliveries in Massachusetts to examine changes in pregnancy and postpartum quality of care for more than 65,000 unique deliveries, comparing measures between ACO and non-ACO pregnant patients, from 2016-2020 (before and after the Medicaid ACO program was implemented).<\/p>\n\n\n\n<p>Although there were positive changes in care engagement and process-oriented quality measures, the team observed no changes in delivery or health outcomes, such as SMM or preterm birth, nor prenatal or postpartum emergency department visits.&nbsp;&nbsp;<\/p>\n\n\n\n<p>The lack of improvement in outcome measures suggests that there are opportunities to reform and redesign ACOs\u2014in Massachusetts and in other states\u2014in a way that better prioritizes and improves maternal health outcomes, the researchers say.<\/p>\n\n\n\n<p>\u201cOur findings are encouraging, yet prompt us to look further,\u201d says study senior author <a href=\"https:\/\/www.bu.edu\/sph\/profile\/lois-mccloskey\/\">Lois McCloskey<\/a>, clinical professor of community health sciences. \u201cWhat is it about ACOs, and how they are structured and led, that leads to stronger engagement in care? We are using qualitative methods to shed light on that question. And beyond that, we want to understand how the care provided by ACOs can be improved and make a difference in the health outcomes of pregnant and postpartum people.\u201d<\/p>\n\n\n\n<p>Ultimately, says Cole, \u201cefforts to improve maternal health through care delivery reforms must happen alongside broader efforts that address the social and structural determinants of maternal health inequities.\u201d\u00a0<\/p>\n\n\n\n<p>At SPH, the study was coauthored by <a href=\"https:\/\/www.bu.edu\/sph\/profile\/sarah-gordon\/\">Sarah Gordon<\/a>, assistant professor of HLPM; <a href=\"https:\/\/www.bu.edu\/sph\/profile\/karen-lasser\/\">Karen Lesser<\/a>, professor of community health sciences; <a href=\"https:\/\/www.bu.edu\/sph\/profile\/collette-ncube\/\">Collette Ncube<\/a>, assistant professor of epidemiology; Nigel Deen, HLPM doctoral student; <a href=\"https:\/\/www.bu.edu\/sph\/profile\/kathleen-carey\/\">Kathleen Carey<\/a>, professor of HLPM; <a href=\"https:\/\/www.bu.edu\/sph\/profile\/howard-cabral\/\">Howard Cabral<\/a>, professor of biostatistics; and Shannon Ogden, HLPM doctoral student.<\/p>\n\n\n\t<aside class=\"wp-block-editorial-relatedstories is-style-card has-two sphnews-block-editorial-relatedstories\">\n\t\t<h3 class=\"wp-block-editorial-relatedstories-title\">Related<\/h3>\n\t\t<ul class=\"wp-block-editorial-relatedstories-list\">\n\t\t\t\t\t\t\t<li class=\"wp-block-editorial-relatedstories-list-item\">\n\t\t\t\t\t<article class=\"wp-block-editorial-relatedstories-article\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-block-editorial-relatedstories-article-image\">\n\t\t\t\t\t\t\t\t\t<img width=\"600\" height=\"362\" src=\"\/sph\/files\/2023\/03\/medicaid-grant-600.jpeg\" class=\"attachment-post-thumbnail size-post-thumbnail wp-post-image\" alt=\"Shot of an female doctor listening to movement inside of a pregnant patient with a stethoscope at a hospital during the day\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wp-block-editorial-relatedstories-article-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-category\"><span>maternal and child health<\/span><\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"wp-block-editorial-relatedstories-article-title\"><a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2023\/professor-receives-3-8m-nih-grant-to-study-impact-of-medicaid-acos-on-maternal-health-outcomes\/\" class=\"wp-block-editorial-relatedstories-article-title-link\">Professor Receives\u00a0$3.8M NIH Grant\u00a0to Study Impact of Medicaid\u00a0ACOs on Maternal Health Outcomes<\/a><\/h4>\n\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-date\">March 17, 2023<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/article>\n\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t<\/aside>\n\t","protected":false},"excerpt":{"rendered":"<p>Despite recent declines in nationwide maternal mortality, the United States continues to experience a significant maternal health crisis, in part shaped by inequitable access to quality healthcare for too many pregnant and postpartum people, particularly those who are covered by Medicaid.\u00a0 Medicaid accountable care organizations (ACOs) have the ability to address this inequity in care [&hellip;]<\/p>\n","protected":false},"author":15205,"featured_media":244718,"comment_status":"closed","ping_status":"closed","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"","_bu_prepress_primary_term_manual":""},"tags":[2070,2178,2847,2136,1616,1871,1766,2157,1537,4006,3887],"bu-publication":[3516],"sphnews-article-category":[3519,3521,3525,3530,3531,3535,3540],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[488,2462],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/244681"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/15205"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=244681"}],"version-history":[{"count":11,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/244681\/revisions"}],"predecessor-version":[{"id":244745,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/244681\/revisions\/244745"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/244718"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=244681"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=244681"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=244681"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=244681"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=244681"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=244681"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=244681"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=244681"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}