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

项目摘要/摘要 在美国，严重孕产妇发病率(SMM)和死亡率继续上升，并已 在大流行期间加剧了。SMM中的严重种族不平等和死亡率 是一种公共卫生危机，是历史和当代结构和社会的结果 决定因素包括体制和社会政策。将种族平等的镜头整合到 医疗补助政策干预是解决长期存在的种族问题的一项有前途的战略 医疗保健和孕产妇保健方面的不平等现象。在宾夕法尼亚州，医疗补助计划是 实施明确以黑人人口为重点的政策干预。三项政策 干预措施将是本研究的重点：股权激励支付计划，股权- 产科重点护理捆绑支付模式与助产士报销方案 服务。这些政策干预至关重要，但不会成功地解决种族不平等问题。 没有多学科、社区参与的流程，涉及持续的关键 分析这些政策制定和实施过程中的种族公平。我们会 进行多臂干预研究以评估医疗质量的影响 干预措施(股权奖励支付和以股权为重点的产科护理捆绑)和 医疗保健质量导乐护理计划与标准护理。因为这些干预措施 预期分配给所有PA Medicaid受益人，我们将比较州内的变化 事后干预，以及比较术后干预前后结果的变化 PA医疗补助受益人相对于居住在类似州的医疗补助受益人。我们的 多学科团队包括多个学术机构的研究人员和领导者， 医疗补助研究中心、健康起步公司、宾夕法尼亚州杜拉委员会和 产妇护理联盟。我们的研究目的是：1)评估医疗补助医疗质量的影响 SMM干预措施，2)评估医疗补助医疗质量干预的效果 DOULA CARE，3)评估医疗补助受益人接受服务和 DOULA服务和股权实践整合的潜在影响。我们的中心假设是 干预后黑人人群的SMM患病率将比其他人群有所下降 其他种族群体。这项工作将通过实施以下措施促进公共卫生和卫生政策 与受医疗公平影响的医疗补助受益者接触的创新方法 政策，并提供卫生公平政策干预影响的量化估计 黑人孕妇和育儿人员的结局。这项研究的结果将通知州政府 联邦卫生政策制定者考虑在医疗补助计划中进行结构性政策干预 解决种族平等问题的工具。

Project Summary/Abstract Rates of severe maternal morbidity (SMM) and mortality continue to rise in the US and have been exacerbated during the pandemic. The significant racial inequities in SMM and mortality are a public health crisis and are a result of historical and contemporary structural and social determinants including institutional and societal policies. Integrating a racial equity lens to Medicaid policy interventions is a promising strategy for addressing the long-standing racial inequities in SMM and broadly in maternal health. In the state of Pennsylvania, Medicaid is implementing policy interventions that explicitly focus on Black populations. Three policy interventions will be the focus of this study: the equity incentive payment program, the equity- focused obstetric care bundled payment model and the reimbursement program for doula services. These policy interventions are critical but will not successfully address racial inequities without a multi-disciplinary, community engaged process that involves a constant critical analysis for racial equity in the development and implementation of these policies. We will conduct a multi-armed intervention study to assess the effects of the healthcare quality interventions (equity incentive payment and equity-focused obstetric care bundle) and the healthcare quality + doula care program vs. standard care. Because these interventions are prospectively assigned to all PA Medicaid beneficiaries, we will compare within-state changes pre-post interventions, as well as comparing changes in outcomes pre-post interventions among PA Medicaid beneficiaries relative to Medicaid beneficiaries residing in similar states. Our multidisciplinary team includes researchers and leaders across multiple academic institutions, the Medicaid Research Center, Healthy Start Inc, the Pennsylvania Doula Commission and the Maternity Care Coalition. Our study aims to: 1) estimate the effect of Medicaid healthcare quality interventions on SMM, 2) estimate the effect of Medicaid healthcare quality interventions + doula care, 3) Assess Medicaid beneficiaries’ experiences in receiving services and the potential impact of integration of doula services and equity practices. Our central hypothesis is that SMM rates will decline among Black populations after interventions relative to people of other racial groups. This work will advance public health and health policy by implementing innovative methods to engage with Medicaid beneficiaries who are affected by health equity policies and provide quantitative estimates of the effects of health equity policy interventions on outcomes among Black pregnant and parenting people. Results from this study will inform state and federal health policymakers considering structural policy interventions within Medicaid as a vehicle for addressing racial equity.