Researchers: Medicaid ACO Development Could Improve Maternal Healthcare

Only a minority of states have implemented Medicaid accountable care organizations (ACOs), but a new study published in the September issue of Health Affairs points to strong potential benefits of Medicaid ACO development in the context of pregnant enrollees and those who have given birth.

The article, entitled “Massachusetts Medicaid ACO Program May Have Improved Care Use And Quality For Pregnant and Postpartum Enrollees,” was authored by Megan B. Cole, Jihye Kim, Sarah H. Gordon, Karen E. Lasser, Collette Ncube, Elizabeth Patton, Nigel Deen, Kathleen Carey, Howard Cabral, Anna L. Goldman, Shannon Ogden, and Lois McCloskey.

The researchers write that “Value-based care models, such as Medicaid accountable care organizations (ACOs), have the potential to improve access to and quality of care for pregnant and postpartum Medicaid enrollees. We leveraged a natural experiment in Massachusetts to evaluate the effects of Medicaid ACOs on quality-of-care-sensitive measures and care use across the prenatal, delivery, and postpartum periods. Using all-payer claims data on Medicaid-covered live deliveries in Massachusetts, we” compared outcomes before and after “Medicaid ACO implementation among ACO and non-ACO patients,” they write.

And what the researchers found was that, “After three years of implementation, the Medicaid ACO was associated with statistically significant increases in the probability of a timely postpartum visit, postpartum depression screening, and number of all-cause office visits in the prenatal and postpartum periods,” with results suggesting that “implementing Medicaid ACOs in the thirty-eight states without them could improve maternal health care outpatient engagement, but alone it may be insufficient to improve maternal health outcomes.”

Indeed, the authors write in the article, “Unrealized opportunities remain for Medicaid ACOs to improve maternal health outcomes, as none of the outcome measures examined in our study improved under the Medicaid ACO. This,” they write, “is supported by recent qualitative work finding that the Massachusetts Medicaid ACOs often did not prioritize pregnant populations.” In that regard, they write, “Health systems and states with existing Medicaid ACO models, including Massachusetts, should consider whether and how to better improve maternal health outcomes through ACO model redesign.”

In the end, the researchers write, “Medicaid ACOs in Massachusetts were associated with increased outpatient care engagement during the prenatal and postpartum periods, increases in timely postpartum care, and increases in reported postpartum depression screening, with no overall change sin other study outcomes.” These findings,” they say, “suggest that expansion of Medicaid ACO models in other states may be one way to improve care engagement among prenatal and postpartum Medicaid enrollees.”

They add a caution: “However,” they write, “In the shorter term, these improvements in care processes did not translate into improvements in measured maternal health outcomes. To improve these outcomes, policy makers should consider Medicaid delivery reform redesigns that prioritize maternal health alongside broader social policies that address the underlying determinants of maternal health outcomes.”