Main Library
The United States has the highest maternal mortality rate of any industrialized country, and it has increased in recent years. Other more common negative maternal health outcomes such as severe maternal morbidity are also on the rise. Improving the quality of perinatal care to address these poor maternal health outcomes is a pressing policy concern. More than 40 percent of births in the US each year are covered by Medicaid (exhibit 1), including 64 percent of births to Black birthing people, making changes to federal Medicaid policy or state Medicaid programs potential policy levers for addressing maternal health and maternal health equity.
Many state Medicaid programs have been experimenting with financing and delivery system reforms that may have implications for perinatal health care. In particular, a number of states have implemented accountable care organizations (ACOs) in their Medicaid programs. In ACOs, a group of clinicians—generally primary care clinicians—provides care for a specified set of patients and has responsibility for the quality and cost of care for those patients. This arrangement is intended to incentivize higher-quality care while reducing costs. ACOs aim to improve care quality by improving coordination in patient care and emphasizing appropriate primary care to avoid potentially preventable and costly emergency department visits and inpatient hospitalizations. ACOs were launched in Medicare following the implementation of the Affordable Care Act, and research has found that Medicare ACOs can have positive effects on quality and may moderately lower costs. Research on the effects of Medicaid ACOs broadly, while limited, has found some evidence of improved quality and lower costs.