Background: People who give birth in the United States experience the highest rates of maternal mortality (MM) among all industrialized nations. Severe maternal morbidity (SMM, an unexpected serious complication of labor/birth) often precedes or precipitates a maternal death. While MM rates in California—which accounts for 500,000 births annually—have declined by more than half over the past two decades, Medicaid (Medi-Cal)-insured individuals in the state continue to shoulder a disproportionate burden of maternal deaths and SMM. Medi-Cal members account for just less than half of state births, but experience almost two-thirds of the pregnancy-related deaths. California has achieved improvements in birth outcomes by using MM/SMM data to guide quality improvement and research. This suggests that better engaging Medi-Cal stakeholders in similar research efforts holds promise to extend gains to this population.
Proposed Solution to the Problem: The Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal project will employ novel approaches to address the problem of the “engagement gap” between California SMM/MM researchers and Medi-Cal stakeholders. These Medi-Cal stakeholders will include Medi-Cal beneficiaries, network perinatal care providers, and Medi-Cal plan administrators. First, the project will directly engage Medi-Cal stakeholders—with a focus on members who have had a pregnancy or birth in Medi-Cal—to develop comparative CER and PCOR priorities to address MM and SMM. Second, to engage Medi-Cal stakeholders in building capacity to participate in CER, B-CORE will use deliberative democracy methods and a community-partnered participatory research (CPPR) framework.
Objectives: The B-CORE in Medi-Cal project has two overarching objectives:
- Building sustainable and adaptable infrastructure to support capacity for engagement between Medi-Cal enrollees who have experienced a pregnancy/birth, Medi-Cal perinatal care providers, plan administrators, and researchers
- Establishing a CER/PCOR agenda that is responsive to priorities identified by Medi-Cal stakeholders
Activities: A B-CORE steering council will be formed with at least two representatives from each key stakeholder group: birthing persons, perinatal providers, Medi-Cal plan administrators, and researchers (Aim 1). The steering council will recruit additional stakeholders from California Medi-Cal plans, organized into four regional stakeholder panels (Aim 2). The steering council, stakeholder panels, and project team will lead a series of live virtual co-learning activities on SMM/MM, CER, and research ethics (Aim 2). The project team will then conduct four regional B-CORE deliberative forums—one with each stakeholder panel. Deliberation—a tested methodology used to build health priority consensus—will identify stakeholder CER priorities to decrease SMM and MM in Medi-Cal (Aim 3).
Projected Outcomes and Outputs: Short-term B-CORE outcomes include: (a) increased knowledge of SMM, MM, and CER in key Medi-Cal stakeholders (birthing persons, providers, health plan leaders), and (b) a “deliberation manual” to guide the use of stakeholder panels to create community-driven research agendas in Medicaid across diverse settings. A key long-term outcome will be implemented partnered CER between Medi-Cal stakeholders and researchers focused on SMM/MM.
Patient and Stakeholder Engagement Plan: The stakeholders who will drive B-CORE activities and products will include Medi-Cal beneficiaries who have experienced a pregnancy/birth, Medi-Cal network perinatal care providers, Medi-Cal health plan administrators, California-focused maternal health experts, and regional maternal health advocates. Steering council engagement will occur during quarterly meetings spanning the two-year project timeline. Stakeholder panels will meet for eight monthly co-learning sessions in year one of B-CORE. In year two, stakeholders will use deliberation forums to create the key B-CORE deliverable: a CER “roadmap” to address MM/SMM in Medi-Cal.
Project Collaborators: B-CORE project participants will include: the California Maternal Quality Care Collaborative (CMQCC), California Health Care Foundation (CHCF), the National Committee on Quality Assurance (NCQA), and several Medi-Cal health plans across California.