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The "Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal" Project: Community-Generated Recommendations

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Summary
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Community engagement using deliberative democracy yielded actionable recommendations to reduce maternal mortality and severe maternal morbidity among Medi-Cal beneficiaries in California. These solutions aim to improve birth equity for this underserved population.

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Area of Science:

  • Public Health
  • Health Equity Research
  • Community-Based Participatory Research

Background:

  • California's overall maternal mortality (MM) rate is lower than the national average.
  • However, Medi-Cal (Medicaid)-insured births disproportionately experience MM and severe maternal morbidity (SMM).
  • Engaging the Medi-Cal community is crucial for advancing health equity in perinatal care.

Purpose of the Study:

  • To engage Medi-Cal stakeholders with lived experience in California's perinatal care system.
  • To generate an actionable agenda of recommendations for decreasing MM and SMM in the Medi-Cal population.
  • To foster birth equity within the Medi-Cal system.

Main Methods:

  • Employed deliberative democracy methods for community engagement.
  • Convened 37 Medi-Cal stakeholders (patients, providers, administrators, advocates) in co-learning sessions.
  • Facilitated deliberation sessions for stakeholders to develop recommendations.

Main Results:

  • Recommendations focused on five key areas: covered benefits, data, patient experience, reimbursement rates, and accountability for racism.
  • Stakeholders identified specific Medi-Cal system actors for implementing solutions.
  • The project successfully generated community-driven solutions for critical health equity issues.

Conclusions:

  • Deliberative democracy is a feasible and successful method for generating community-led solutions to health equity challenges.
  • Engaged stakeholders proposed both immediate actions and long-term shifts for birth equity in Medi-Cal.
  • This approach supports the development of targeted interventions to reduce MM and SMM in vulnerable populations.