Promising Approaches to Reducing Disparities in Birth-Related Health Outcomes in Medicaid

Covering nearly half of all births in the United States, Medicaid programs play an important role in directing and influencing payment and delivery system policies and reforms to improve care for pregnant and birthing people.

The Issue

Disparities in birth-related health outcomes are rooted in structural racism and the related policies and practices that result in inequitable distribution of social and economic resources. Research estimates that more than one half of cases of maternal mortality and severe maternal morbidity (SMM) are preventable, and birth-related mortality rates among Black, American Indian, and Alaska Native people are two to three times the rate of white people.

The brief focuses specifically on actions Medicaid agencies can pursue through their managed care programs or directly with provider organizations to promote health equity and improve outcomes. It highlights state interventions and collaborations that demonstrate promise in reducing disparities and begin to center equity in birth-related health policies, including: Virginia, which is integrating and enrolling doula providers and services into Medicaid managed care and streamlining the credentialing process for doulas; North Carolina, which has nearly 10 years’ experience with a pregnancy medical home model of care; and Colorado, which will require hospitals that provide labor and delivery services and participate in a Medicaid performance-based incentive program to begin reporting on their plans for reducing peripartum racial and ethnic disparities.

Key Findings

• An extensive body of research reports on poor birth-related outcomes and disparities in maternal mortality and morbidity in the United States, particularly for individuals enrolled in Medicaid.
• State Medicaid agencies can focus strategies on systemic drivers of birth-related health disparities, including taking action to dismantle institutional racism in healthcare, implementing value-based payment models for pregnancy and birth-related care services, and leveraging Maternal Mortality Review Committees (MMRCs) and Perinatal Quality Collaboratives (PQCs) to inform and improve care delivery.
• For each stage of the reproductive cycle states can implement and direct approaches to reduce disparities and improve outcomes, including by promoting comprehensive preconception care, improving prenatal care, optimizing care during labor and delivery, and ensuring continued access to care in the postpartum period.

Conclusion

Medicaid agencies and their contracted managed care plans play a critical role in advancing state efforts to confront racism in healthcare systems and implementing promising strategies to address birth-related health inequities. Medicaid programs can leverage their purchasing and convening powers to inform approaches and target interventions across the healthcare system and at different stages in the reproductive lifecycle to reduce health disparities and improve birth-related outcomes.

About State Health and Value Strategies—Princeton University School of Public and International Affairs

State Health and Value Strategies (SHVS) assists states in their efforts to transform health and healthcare by providing targeted technical assistance to state officials and agencies. The program is a grantee of the Robert Wood Johnson Foundation, led by staff at Princeton University’s School of Public and International Affairs. The program connects states with experts and peers to undertake healthcare transformation initiatives. By engaging state officials, the program provides lessons learned, highlights successful strategies and brings together states with experts in the field. Learn more at www.shvs.org.

About Bailit Health

This brief was prepared by Erin Taylor, Jennifer Sayles, M.D., and Michael Bailit. Bailit Health is a health policy consulting firm dedicated to ensuring insurer and provider performance accountability on behalf of public agencies and private purchasers. Learn more at www.bailit-health.com.