California leads the nation with its relatively low rate of maternal deaths during pregnancy and the postpartum period. However, individuals insured via Medi-Cal suffer a disproportionate share of maternal deaths and severe complications at birth; within this group of publicly insured individuals, certain racial and/or ethnic groups have even higher rates of poor outcomes. The state can attribute part of its success in lowering rates of maternal mortality (MM) to the implementation of a data-driven statewide portfolio of quality improvement activities focused on the leading causes of maternal death. This quality improvement infrastructure has not previously been leveraged to respond in a focused way to the relatively large shares of MM and morbidity still seen in the Medi-Cal-insured population. B-CORE aimed to expand on existing statewide quality improvement efforts to effectively mitigate these adverse outcomes in Medi-Cal births by engaging Medi-Cal stakeholders.

Recommendations

  • Medi-Cal health plans should expand coverage and the benefits offered to pregnant and postpartum beneficiaries.
  • Medi-Cal should increase reimbursement rates for perinatal care providers.
  • New strategies are needed for MM and/or severe maternal morbidity (SMM) data collection, data use, and data sharing (e.g., further disaggregate data to identify additional disparities, share user-friendly data with patients).
  • Patient experience should be a guiding principle in measuring quality of care in Medi-Cal.
  • Anti-racism should be a top priority in perinatal care and new approaches are necessary to ensure accountability for racism and bias in the health care system that contribute to MM and/or SMM.

Read the full article about decreasing maternal mortality by Priya Batra, Gabriela Alvarado and Chloe E. Bird at RAND Corporation.