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

Priya Batra, Gabriela Alvarado, Chloe E. Bird

ResearchPublished Jul 24, 2023

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.

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Batra, Priya, Gabriela Alvarado, and Chloe E. Bird, Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal: Community-Generated Recommendations to Decrease Maternal Mortality and Severe Maternal Morbidity. Santa Monica, CA: RAND Corporation, 2023. https://www.rand.org/pubs/research_reports/RRA2630-1-v2.html.
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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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This publication supersedes a previous version published in 2023 (RR-A2630-1).