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

项目总结/摘要 美国严重孕产妇发病率（SMM）和死亡率持续上升， 在大流行期间恶化。SMM和死亡率方面的严重种族不平等 是一场公共卫生危机，是历史和当代结构和社会因素的结果。 决定因素包括体制和社会政策。将种族平等的透镜纳入 医疗补助政策干预是解决长期存在的种族歧视问题的一项有希望的战略。 在妇幼保健和广泛的孕产妇保健方面的不公平现象。在宾夕法尼亚州，医疗补助是 实施明确关注黑人人口的政策干预。三个政策 干预措施将是本研究的重点：股权激励支付计划，股权- 重点产科护理捆绑支付模式和导乐的报销方案 服务这些政策干预措施至关重要，但不会成功解决种族不平等问题。 如果没有一个多学科的，社区参与的过程， 在制定和执行这些政策时进行种族平等分析。我们将 进行多组干预研究，以评估医疗质量的影响 干预措施（公平奖励支付和注重公平的产科护理包）和 医疗质量+导乐护理方案与标准护理。因为这些干预措施是 前瞻性地分配给所有PA医疗补助受益人，我们将比较州内的变化 干预前后，以及比较干预前后 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 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，健康开始公司，宾夕法尼亚州导乐委员会和 产妇护理联盟。本研究的目的是：1）评估医疗补助医疗质量的影响 对SMM的干预，2）估计医疗补助医疗质量干预的效果+ 导乐护理，3）评估医疗补助受益人接受服务的经验， 导乐服务与平等做法相结合的潜在影响。我们的核心假设是 在相对于黑人的干预措施之后，黑人的SMM率将下降。 其他种族。这项工作将通过实施 创新方法，与受健康公平影响的医疗补助受益人互动 政策，并提供卫生公平政策干预措施对 黑人怀孕和养育子女的结果。这项研究的结果将告知国家 和联邦卫生政策制定者考虑在医疗补助范围内的结构性政策干预， 这是解决种族平等问题的一种手段。

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.