Project Summary

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.

More to Explore...

Project Resource: Co-learning Session Slides

Project Resource: B-CORE Briefing Book

Project Information

Chloe Bird, PhD
Priya Batra, MD, MS
RAND Corporation

Key Dates

24 months


Project Status
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: November 10, 2022