The Effects of Medicaid Policy Interventions on Racial Equity in Severe Maternal Morbidity
NCT ID: NCT05678699
Last Updated: 2025-07-22
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
10000000 participants
INTERVENTIONAL
2023-01-03
2027-06-30
Brief Summary
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1. What is the effect of Medicaid healthcare quality interventions on SMM?
2. What is the effect of Medicaid healthcare quality interventions + doula care?
3. What are Medicaid beneficiaries' experiences in receiving services and the potential impact of integration of doula services and equity practices?
Participants will be asked to describe experiences as a result of structural interventions and focused Medicaid policies.
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Detailed Description
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Conditions
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Study Design
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NON_RANDOMIZED
FACTORIAL
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) Only
The investigators will employ a quasi-experimental study design to test two hypotheses: H1: SMM rates among Black people will decline after the interventions (equity payment and obstetric bundled payment), relative to people of other race groups within Pennsylvania (PA); and H2: Racial inequities in SMM will decline among those exposed to the interventions in PA, relative to those in similar states. The investigators will collect qualitative data to assess the effects of the Medicaid healthcare interventions on beneficiaries' experiences.
Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)
This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2.
1\) health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries
Standard Care
Participants receive standard care without quality interventions or doula care
Doula Only
The investigators will test two hypotheses: H1: SMM rates among Black people will decline more after the addition of doula care in PA, relative to healthcare quality interventions alone. H2: Racial inequities in SMM will decline more among those exposed to both healthcare quality and doula care interventions in PA, relative to states implementing doula care only. The investigators will collect qualitative data to assess the effects of the Medicaid healthcare and service interventions on beneficiaries' experiences.
Doula
This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2.
1. health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries.
2. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.
Standard Care
Participants receive standard care without quality interventions or doula care
Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula
Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)
This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2.
1\) health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries
Doula
This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2.
1. health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries.
2. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.
Standard Care
Participants receive standard care without quality interventions or doula care
Standard Care
No interventions assigned to this group
Interventions
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Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)
This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2.
1\) health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries
Doula
This study has two components, with the first component being examined in Aim 1 and the first and second components being examine in aim 2.
1. health equity incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care and well-child visits among Black beneficiaries. The equity-focused obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among Black beneficiaries.
2. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.
Standard Care
Participants receive standard care without quality interventions or doula care
Eligibility Criteria
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Inclusion Criteria
Qualitative:
* Medicaid beneficiaries who self-identify as Black and/or live in PA Health Equity Zones
* Doulas who provide care to Medicaid beneficiaries in Pennsylvania
* Medicaid Managed Care Organization (MCO) administrators in Pennsylvania. Severe maternal morbidity and mortality outcomes will be assessed in healthcare records and for these quantitative outcomes, patients will not be recruited individually
Exclusion Criteria
ALL
Yes
Sponsors
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National Institute of Nursing Research (NINR)
NIH
University of Pittsburgh
OTHER
Responsible Party
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Dara Mendez
Associate Professor
Locations
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University of Pittsburgh School of Public Health
Pittsburgh, Pennsylvania, United States
Countries
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Facility Contacts
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Other Identifiers
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STUDY22080184
Identifier Type: -
Identifier Source: org_study_id
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