The B-CORE project, described in this report, applied the deliberative democracy method to engage affected community members in problem-solving focused on maternal health inequities in California. B-CORE aimed to mitigate adverse outcomes in births covered by California's Medicaid program (Medi-Cal). Stakeholders generated an agenda of research and policy priorities to decrease maternal deaths and morbidity in Medi-Cal beneficiaries.
Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal
Community-Generated Recommendations to Decrease Maternal Mortality and Severe Maternal Morbidity
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California leads the nation with its relatively low rate of maternal deaths during pregnancy and the postpartum period. However, individuals insured via Medi-Cal suffer a disproportionate share of maternal deaths and severe complications at birth; within this group of publicly insured individuals, certain racial and/or ethnic groups have even higher rates of poor outcomes. The state can attribute part of its success in lowering rates of maternal mortality (MM) to the implementation of a data-driven statewide portfolio of quality improvement activities focused on the leading causes of maternal death. This quality improvement infrastructure has not previously been leveraged to respond in a focused way to the relatively large shares of MM and morbidity still seen in the Medi-Cal-insured population. B-CORE aimed to expand on existing statewide quality improvement efforts to effectively mitigate these adverse outcomes in Medi-Cal births by engaging Medi-Cal stakeholders.
Recommendations
- Medi-Cal health plans should expand coverage and the benefits offered to pregnant and postpartum beneficiaries.
- Medi-Cal should increase reimbursement rates for perinatal care providers.
- New strategies are needed for MM and/or severe maternal morbidity (SMM) data collection, data use, and data sharing (e.g., further disaggregate data to identify additional disparities, share user-friendly data with patients).
- Patient experience should be a guiding principle in measuring quality of care in Medi-Cal.
- Anti-racism should be a top priority in perinatal care and new approaches are necessary to ensure accountability for racism and bias in the health care system that contribute to MM and/or SMM.
Research conducted by
This research was funded by the Patient-Centered Outcomes Research Institute and carried out within the Quality Measurement and Improvement Program in RAND Health Care.
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