Medicaid Accountable Care Organizations and Childbirth Outcomes

Abstract

Some states have adopted Accountable Care Organization (ACO) models to transform their Medicaid programs, but little is known about their impact on health care outcomes and costs. Medicaid ACOs are uniquely positioned to improve childbirth outcomes because of the number of births covered by Medicaid. Using Healthcare Cost and Utilization Project hospital data, we examined the relationship between ACO adoption and (a) neonatal and maternal outcomes, and (b) cost per birth. We compared outcomes in states that have adopted ACO models in their Medicaid programs with adjacent states without ACO models. Implementation of Medicaid ACOs was associated with a moderate reduction in hospital costs per birth and decreased cesarean section rates. Results varied by state. We found no association between Medicaid ACOs and several birth outcomes, including infant inpatient mortality, low birthweight, neonatal intensive care unit utilization, and severe maternal morbidity. Improving these outcomes may require more time or targeted interventions.

Coordinated Care Organizations and mortality among low‐income infants in Oregon

“…Our findings indicated that infant mortality declined among infants enrolled in Medicaid after 4 years of the implementation of the Oregon CCO model. Previous studies on the impacts of CCOs or Medicaid ACOs found favorable effects on infant mortality, but these findings were not statistically significant . Several reasons may account for the differences between our findings and prior studies.…”

“…Our study examined the effects on outcomes after 4 years of implementation of the CCO model. Second, in order to change mortality outcomes, Medicaid ACO models may require not only coordinated care but also the delivery of care that addresses the social determinants of health . With the ability to examine the effects of CCOs in a longer time frame, our findings suggest that the Oregon CCO model was effective in improving survival within a year after birth of infants enrolled in Medicaid.…”

“…that addresses the social determinants of health. 27 With the ability to examine the effects of CCOs in a longer time frame, our findings suggest that the Oregon CCO model was effective in improving survival within a year after birth of infants enrolled in Medicaid.…”

“…Few studies have, however, investigated the impact of pediatric Medicaid ACO models on health care utilization, cost, and care quality partly because of modest growth of pediatric ACOs . Only one study to our knowledge examined the effect of Medicaid ACOs on childbirth outcomes and found no impact on infant inpatient mortality . Specific for Oregon, a recent study investigated the impact of CCO implementation on neonatal and infant outcomes, including infant mortality .…”

“…26 Only one study to our knowledge examined the effect of Medicaid ACOs on childbirth outcomes and found no impact on infant inpatient mortality. 27 Specific for Oregon, a recent study investigated the impact of CCO implementation on neonatal and infant outcomes, including infant mortality. 28 Findings from this study indicated that CCO implementation was not associated with a reduction in infant mortality after 1 year of implementation.…”