# Improving Quality of Care for Low-Income Pregnant People through Medicaid Accountable Care Organizations: A Natural Experiment

> **NIH NIH R01** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2024 · $720,997

## Abstract

PROJECT SUMMARY
Maternal health in the US is in crisis, where low-income pregnant and postpartum people (PPP) and PPP of
color experience suboptimal quality of care across the prenatal, delivery, and postpartum periods. As the
largest payer of maternity care, covering 66% of Black births and 60% of Hispanic births, the Medicaid program
plays a critical role in shaping maternal health for lower-income PPP of color, with significant opportunity for
care delivery models such as Accountable Care Organizations (ACOs) to improve PPP’s outcomes and equity
at scale through improved care integration, coordination, and quality improvement incentives. Despite growing
state interest in Medicaid ACOs, empirical evidence on the effects of Medicaid ACOs and ACO model types on
PPP is very limited. Yet, identifying optimal ACO model designs is critical for the 35 states that have not yet
implemented Medicaid ACOs and for other states looking to reform their ACOs. This R01 will fill these gaps by
evaluating the innovative, statewide Massachusetts (MA) Medicaid ACO, which aims to integrate medical,
behavioral, and social services and improve care quality and coordination across 16 ACOs under two distinct
ACO model types: (1) a primary care physician (PCP)-led ACO, where specialists (e.g., OB/GYNs) are not part
of the ACO and (2) a health system and Medicaid managed care plan partnership ACO, where PCPs and
specialists are part of the ACO. As patients do not select into a Medicaid ACO or model type, this creates a
novel nested natural experiment, which we will leverage in combination with qualitative methods, to examine
how Medicaid ACO programs affect health care quality and equity for PPP. Specific aims are to (1) evaluate
the effect of MA’s Medicaid ACO program on quality of care-sensitive measures for PPP, including prenatal
measures, delivery-related measures, and postpartum measures, using a difference-in-differences approach
with claims data, where sub-analyses will examine differential effects by racial/ethnic zip code group, (2)
evaluate the effect of PCP-led vs. health system partnership Medicaid ACO models on PPP, using the same
outcomes and analytic approach as in Aim 1, and (3) assess how efforts to address maternal health outcomes
are being operationalized and prioritized within MA Medicaid ACOs, and how this varies by model type, by
conducting semi-structured interviews with clinicians, care coordinators, and leadership; interviews will further
capture successes and challenges of these efforts, different organizational programs used to improve maternal
health care and equity for the ACO, and how inclusion or exclusion of OB/GYNs and specialists from the ACO
affects care management and coordination for PPP. As more states and Medicaid providers implement ACOs,
little evidence is available to guide them. Understanding how Medicaid ACOs can improve quality of care for
one of their most vulnerable populations—PPP—through value-based care is imperative bot...

## Key facts

- **NIH application ID:** 10830480
- **Project number:** 5R01MD017703-03
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Megan B. Cole
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $720,997
- **Award type:** 5
- **Project period:** 2022-08-28 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10830480

## Citation

> US National Institutes of Health, RePORTER application 10830480, Improving Quality of Care for Low-Income Pregnant People through Medicaid Accountable Care Organizations: A Natural Experiment (5R01MD017703-03). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10830480. Licensed CC0.

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