Medicaid Accountable Care Model Designs and Maternal Health Measures

Area of Science:

• Health Services Research
• Maternal Health
• Health Policy

Background:

• Medicaid Accountable Care Organizations (ACOs) exhibit diverse designs, with limited understanding of their impact on maternal health outcomes.
• Massachusetts implemented a Medicaid ACO program in 2018 featuring two distinct models: Model A (health system-MCO partnership) and Model B (PCP-led).
• These models may differentially influence care coordination, integration, and quality for pregnant and postpartum individuals.

Purpose of the Study:

• To assess the differential association between Medicaid ACO model designs (Model A vs. Model B vs. non-ACO) and maternal health care measures.
• To investigate how specific ACO structures influence quality-sensitive maternal health indicators and healthcare utilization.

Main Methods:

• A cohort study utilizing the 2014-2020 Massachusetts All Payer Claims Database for Medicaid-insured deliveries.
• Employed a difference-in-differences (DID) approach to compare maternal health measures before (2016-2017) and after (2018-2020) ACO implementation.
• Analyzed six quality-sensitive maternal health measures and two utilization measures, adjusting for patient-level characteristics and including fixed effects.

Main Results:

• Both Model A and Model B ACOs were associated with increased postpartum depression screening compared to non-ACOs.
• Model A demonstrated higher rates of timely postpartum visits and reduced prenatal emergency department visits.
• Model B was linked to increased prenatal and postpartum office visits; changes in cesarean delivery rates were inconclusive.

Conclusions:

• Significant heterogeneity exists in the association between Medicaid ACO models and maternal health care measures.
• The findings underscore the importance of considering specific ACO design features when aiming to improve maternal care quality and outcomes.
• Policymakers should evaluate how different ACO structures can be optimized to enhance care for pregnant and postpartum populations.