byHarvard Pilgrim Health Care Institute

Credit: CC0 Public Domain

A new study led by researchers at the Department of Population Medicine–Harvard Pilgrim Health Care Institute, Boston Medical Center, and Boston University School of Public Health finds that how Medicaid programs are designed can make a big difference in the care pregnant and postpartum people receive.

The study, "Medicaid Accountable Care Model Designs and Maternal Health Measures," appears inJAMA Network Open.

Maternal health care in the U.S. is in crisis. There is an urgent need to identify models of care that may improve maternal health outcomes, especially within Medicaid, which covers over 40% of U.S. births. Medicaid accountable care organizations (ACOs)—groups of health care providers that work together to improvepatient careand lower costs—are one potential mechanism for doing so, but there is very little evidence about if and how Medicaid ACOs affect maternal health care.

Researchers compared two types of ACOs: those led by primary care practices and those formed through a health system/managed care organization partnership. Specifically, they looked at over 67,000 births covered by Medicaid in Massachusetts between 2014 and 2020.

They found that:

"These findings suggest that Medicaid ACOs hold promise for improving some maternal health outcomes," said lead author Megan Cole, Member of the Faculty at Harvard Medical School and the Department of Population Medicine. "But their ability to do so may depend on how the ACO is designed."

The study highlights the importance of thoughtful value-based care delivery design within Medicaid programs. With 37 states still without Medicaid ACOs and 13 considering changes, this research offers timely guidance for policymakers.

"As states and health systems consider how to improve maternal health care through value-based payment models, little evidence is available to guide them," Dr. Cole added. "This study provides critical new evidence to state Medicaid programs, health systems, and policymakers as they consider how to design and implement Medicaid ACOs in a way that improves maternal health outcomes for low-income women."

The authors hope their findings will help states and health systems build better care models that support moms before, during and after pregnancy.

More information: Medicaid Accountable Care Model Designs and Maternal Health Measures, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.36565 Journal information: JAMA Network Open

Provided by Harvard Pilgrim Health Care Institute