Medicaid innovation models improve care for moms, but design matters

A new study led by researchers at the Department of Population Medicine - Harvard Pilgrim Health Care Institute, Boston Medical Center, and Boston University School of Public Health finds that how Medicaid programs are designed can make a big difference in the care pregnant and postpartum people receive.

The study, “Medicaid Accountable Care Model Designs and Maternal Health Measures”, was published October 8 in JAMA Network Open.

Maternal health care in the U.S. is in crisis. There is an urgent need to identify models of care that may improve maternal health outcomes, especially within Medicaid, which covers over 40% of U.S. births. Medicaid accountable care organizations (ACOs) – groups of health care providers that work together to improve patient care and lower costs - are one potential mechanism for doing so, but there is very little evidence about if and how Medicaid ACOs affect maternal health care.

Researchers compared two types of ACOs: those led by primary care practices and those formed through a health system/managed care organization partnership. Specifically, they looked at over 67,000 births covered by Medicaid in Massachusetts between 2014 and 2020.

They found that:

• Primary care-led ACOs helped increase doctor visits during pregnancy and after birth, allowing pregnant and post-partum patients to stay more engaged in their care.
• Health system-led ACOs were linked to fewer emergency room visits and more timely postpartum care.
• Both types of ACOs improved screening for postpartum depression.

“These findings suggest that Medicaid ACOs hold promise in improving some maternal health outcomes,” said lead author Megan Cole, Member of the Faculty at Harvard Medical School and the Department of Population Medicine. “But their ability to do so may depend on how the ACO is designed.”

The study highlights the importance of thoughtful value-based care delivery design within Medicaid programs. With 37 states still without Medicaid ACOs and 13 considering changes, this research offers timely guidance for policymakers.

“As states and health systems consider how to improve maternal health care through value-based payment models, little evidence is available to guide them,” Dr. Cole added. “This study provides critical new evidence to state Medicaid programs, health systems, and policymakers as they consider how to design and implement Medicaid ACOs in a way that improves maternal health outcomes for low-income women.”

The authors hope their findings will help states and health systems build better care models that support moms before, during, and after pregnancy.

About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky, X, and LinkedIn.