maternal and child health

Professor Receives $3.8M NIH Grant to Study Impact of Medicaid ACOs on Maternal Health Outcomes

Megan Cole received the five-year award from the National Institute on Minority Health and Health Disparities to evaluate how Medicaid accountable care organizations can improve quality and equity of care for pregnant patients.

Nearly one-third of Medicaid-enrolled pregnant people do not receive adequate prenatal care, and nearly 40 percent do not attend the standard six-week postpartum visit with their provider. This poor quality of care is, in part, a reflection of subpar integration and coordination of care within the healthcare system, and is fueling continued disparities in maternal mortality among low-income pregnant and postpartum people of color in the US, where Black pregnant people are more than twice as likely to die from pregnancy-related complications than White people. 

Now, a School of Public Health researcher has received a $3.8 million grant from the National Institute on Minority Health and Health Disparities to better understand how Medicaid accountable care organizations (ACOs) can close these gaps in equitable care for pregnant and postpartum patients. Medicaid ACOs are value-based payment and delivery healthcare models that aim to improve coordination and quality of care, while integrating medical, behavioral, and social services for patients.

Through this five-year grant, Megan Cole, associate professor of health law, policy & management (HLPM), will lead a multidisciplinary team of maternal health experts, Medicaid ACO providers, OB/GYN physicians, health economists, and more to evaluate the effects of Medicaid ACOs and ACO model designs on critical maternal health outcomes. 

Currently, 14 states have implemented statewide Medicaid ACOs. Despite growing interest among other states to adopt this model, there is very limited research on the impact of ACOs on maternal health among low-income pregnant and postpartum people, for which Medicaid covers the majority of births. A disproportionate share of Black and Hispanic pregnant people also relies solely on Medicaid health insurance. 

“Low-income birthing people experience huge inequities in care across the prenatal, delivery, and postpartum periods,” says Cole, who is the principal investigator of the project. “There exists a lot of potential for Medicaid ACO models to move the needle on quality of care and equity of care for pregnant patients. Timely evidence is particularly important as state Medicaid programs simultaneously aim to address our maternal health crisis while considering whether and how to implement large-scale value-based payment innovations like Medicaid ACOs.”

Several SPH faculty will participate in the project, including Lois McCloskey, professor of community health sciences; Collette Ncube, assistant professor of epidemiology; Kathleen Carey, professor of HLPM; Sarah Gordon, assistant professor of HLPM; and Howard Cabral, professor of biostatistics. The team will utilize claims data for Medicaid-enrolled pregnant and postpartum patients and qualitative data from ACO leadership and clinicians to evaluate the effectiveness of this model in Massachusetts—a state in which 70 percent of residents under 65 years old are enrolled in a Medicaid ACO program. 

The project includes integral partnerships with safety-net health system Boston Medical Center, which offers the largest “Partnership” Medicaid ACO model in the Commonwealth, with Community Care Cooperative (C3), which offers the largest “Primary Care” Medicaid ACO model, and with other health systems. The team also includes Karen Lasser, professor of community health sciences and medicine at SPH and Boston University Chobanian & Avedisian School of Medicine, respectively, a general internist physician at BMC, and a member of BMC’s Medicaid ACO research team; and Elizabeth Patton, an OB/GYN physician at BMC and a health services researcher at the Chobanian & Avedisian School of Medicine.

“I am excited to participate in a project that has the potential to identify models of care that reduce maternal health inequities,” Lasser says.