The Effects of Medicaid Policy Interventions on Severe Maternal Morbidity
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
AgeNot listed
SponsorUniversity of Pittsburgh
About this trial
The goal of this study is to learn about the effects of Medicaid policy interventions 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?
Participants will be asked to describe experiences as a result of Medicaid policy interventions and focused Medicaid policies.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
Pregnant and postpartum Medicaid beneficiaries across the US
Medicaid beneficiaries who identify as being at risk for poor outcomes 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
Disqualifiers
None
Trial design
Design model
Factorial
Treatments tested in this trial
Medicaid healthcare quality interventions (incentive payment and obstetric bundled payment)
BehavioralThis study has two components, with the first component being examined in Aim 1 and the first and second components being examined in aim 2. 1\) incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care. The obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among beneficiaries at risk for poor outcomes.
Doula
BehavioralThis study has two components, with the first component being examined in Aim 1 and the first and second components being examined in aim 2. 1. Incentive payment program makes available $26 million annually in Medicaid managed care organization (MCO) payments to plans that improve access to timely prenatal care. The obstetric care bundled payment model provides incentives for clinicians to improve on a wide range of pregnancy health outcomes, and specifically incentivizes improvements among beneficiaries at risk for poor outcomes. 2. care intervention by coverage of doula services for all Medicaid beneficiaries across Pennsylvania.
Standard Care
BehavioralParticipants receive standard care without quality interventions or doula care
Treatment groups
10,000,000 Participants
are divided into 4 treatment groupsGroup A: Medicaid healthcare quality interventions (incentive payment and obstetric bundled payment) OnlyOther 2 interventions
Group B: Doula OnlyOther 2 interventions
Group C: Medicaid healthcare quality interventions (incentive payment and obstetric bundled payment) + DoulaOther 3 interventions
Group D: Standard CareNo intervention 0 interventions
Trial outcomes
Primary outcomes
1
Severe maternal morbidity (SMM)
SMM rate based on the Centers for Disease Control algorithm
Time frame
20 weeks gestation through 42 days postpartumSecondary outcomes
1
All cause mortality
Binary indicator of mortality based on Social Security Administration records
Time frame
Delivery date through one year after delivery2
Follow up for chronic conditions
Percent of persons who receive guideline concordant care for depression, substance use disorders, immunizations, and screening and referral for social determinants of health
Time frame
43 days through 1 year after delivery3
Provision of evidence care in pregnancy and postpartum
Percent of Medicaid patients among each provider who receive screening and follow up for depression, treatment for substance use disorders, perinatal immunizations, and screening and referral for social determinants of health
Time frame
During pregnancy and postpartum up to 1 year4
Medicaid managed care administrator perspectives on policy interventions
Qualitative self report of perspectives
Time frame
Year 3Other outcomes
1
Assess the changes in effects of the Medicaid healthcare quality interventions on beneficiaries' experiences
The investigators will collect qualitative data from three different study populations across Pennsylvania who will be affected by the Medicaid policies under study: 1) Medicaid beneficiaries (n=100; Years 2 and 4); 2) Doula care providers (n=60; Years 2 and 4); Managed Care Organization (MCO) leadership (n=10); Year 3
Time frame
Years 2, 3, and 4Sponsors and contacts
Click on the lead sponsor to view all of their trials.
University of Pittsburgh
Lead sponsor
National Institute of Nursing Research (NINR)
Collaborator
Source ClinicalTrials.gov