Attanasio Laura B, Geissler Kimberley H
Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts.
Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School-Baystate, Springfield, Massachusetts.
Womens Health Issues. 2025 Mar-Apr;35(2):89-96. doi: 10.1016/j.whi.2024.12.002. Epub 2025 Feb 1.
More than 40% of U.S. birthing people are covered by Medicaid. Accountable Care Organizations (ACOs) are increasingly common in state Medicaid programs and may influence maternal health, quality of care, and outcomes. However, there has been limited examination of how Medicaid ACOs operate in the context of perinatal care. Our objective was to explore how individuals in ACO leadership have approached program design to address maternal health and how these programs have shaped health care utilization and maternal health from the perspective of postpartum ACO beneficiaries and clinicians.
We conducted virtual semi-structured interviews with three key stakeholder groups in Massachusetts (ACO leaders, maternity care clinicians, and Medicaid ACO members who had given birth within the past 6-24 months) between November 2021 and May 2023. Purposive sampling aimed to achieve variation in geographic location (members and clinicians) and race/ethnicity (members). Interviews were recorded, professionally transcribed, and analyzed iteratively using thematic analysis.
Thirty-three interviews were conducted: four with ACO leaders, 15 with maternity care clinicians, and 14 with ACO members. Maternity care clinicians did not perceive that ACO implementation had substantially impacted perinatal health care. Interviews with ACO leadership suggested that the lack of perceived impact may be partially explained by competing priorities; the Massachusetts Medicaid ACOs generally did not focus on maternal health during the initial implementation period. Postpartum ACO members were largely unaware of ACOs.
Lack of explicit attention to the perinatal population in Medicaid financing and delivery system reforms may reduce the potential impact in improving outcomes.
超过40%的美国产妇由医疗补助计划承保。 accountable care organizations（ACO）在州医疗补助计划中越来越普遍，可能会影响孕产妇健康、护理质量和结果。然而，关于医疗补助计划ACO在围产期护理背景下如何运作的研究有限。我们的目的是探讨ACO领导层的人员如何进行项目设计以解决孕产妇健康问题，以及从产后ACO受益人和临床医生的角度来看，这些项目如何塑造了医疗保健利用情况和孕产妇健康。
2021年11月至2023年5月期间，我们对马萨诸塞州的三个关键利益相关者群体（ACO领导者、产科护理临床医生以及在过去6至24个月内分娩的医疗补助计划ACO成员）进行了虚拟半结构化访谈。目的抽样旨在实现地理位置（成员和临床医生）和种族/族裔（成员）方面的差异。访谈进行了录音、专业转录，并使用主题分析进行迭代分析。
共进行了33次访谈：4次与ACO领导者，15次与产科护理临床医生，14次与ACO成员。产科护理临床医生认为ACO的实施对围产期医疗保健没有产生重大影响。对ACO领导层的访谈表明，缺乏明显影响可能部分归因于相互竞争的优先事项；马萨诸塞州的医疗补助计划ACO在初始实施期间通常没有将重点放在孕产妇健康上。产后ACO成员基本上不了解ACO。
在医疗补助计划融资和交付系统改革中，对围产期人群缺乏明确关注可能会降低改善结果的潜在影响。
