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

NCT ID: NCT05678699

Last Updated: 2025-07-22

Study Results

Results pending

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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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

10000000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-03

Study Completion Date

2027-06-30

Brief Summary

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The goal of this study is to learn about the effects of structural inventions, such as equity-focused Medicaid polices, on severe maternal morbidity (SMM) and mortality and maternal health. The main questions it aims to answer are:

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.

Detailed Description

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Conditions

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Severe Maternal Morbidity Maternal Death

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

FACTORIAL

Evaluation of policy interventions at the state level comparing within state and across states over time.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

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.

Group Type OTHER

Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)

Intervention Type BEHAVIORAL

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

Intervention Type BEHAVIORAL

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.

Group Type OTHER

Doula

Intervention Type BEHAVIORAL

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

Intervention Type BEHAVIORAL

Participants receive standard care without quality interventions or doula care

Medicaid healthcare quality interventions (equity payment and obstetric bundled payment) + Doula

Group Type OTHER

Medicaid healthcare quality interventions (equity payment and obstetric bundled payment)

Intervention Type BEHAVIORAL

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

Intervention Type BEHAVIORAL

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

Intervention Type BEHAVIORAL

Participants receive standard care without quality interventions or doula care

Standard Care

Group Type NO_INTERVENTION

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

Intervention Type BEHAVIORAL

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.

Intervention Type BEHAVIORAL

Standard Care

Participants receive standard care without quality interventions or doula care

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Pregnant and postpartum Medicaid beneficiaries across the US

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

\-
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Nursing Research (NINR)

NIH

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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Dara Mendez

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University of Pittsburgh School of Public Health

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Countries

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United States

Facility Contacts

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Dara D Mendez, PhD

Role: primary

4126485664

Marquita Smalls, MPH

Role: backup

4123830574

Other Identifiers

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1R01NR020670-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY22080184

Identifier Type: -

Identifier Source: org_study_id

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