MCO Perspectives on Medicaid Policy: Racial Equity in Pregnancy and Child Health.

Abstract

Introduction: In 2020 and 2021, Pennsylvania implemented the Equity Incentive Program and the Maternity Care Bundled Payment program, two unique pay-for-performance (P4P) programs that provide financial incentives for managed care organizations (MCOs) that make improvements in utilization and quality metrics for Black women and children. The current study addresses gaps in the research about MCO perceptions regarding the ability of financial policy incentives to improve racial health inequities.

Methods: Qualitative, semi-structured group interviews with representatives (n = 30) from the six Medicaid MCOs in Pennsylvania were completed in the summer of 2022. Data were thematically coded, using a preestablished codebook.

Results: Interviews with representatives from six Pennsylvania MCOs generated four distinct but interconnected themes: (1) data optimism, (2) pursuing uniform care, (3) diffusion of responsibility, and (4) missing pieces of the puzzle.

Discussion: Perspectives of MCO representatives indicate the need for MCO involvement in Medicaid policymaking. Interviews revealed MCO representatives' perceptions that warrant further research: (1) the expectation for providers to change care delivery based solely on data, (2) racial health equity in pregnancy and child health can be accomplished by providing uniform care, and (3) the limited responsibility MCOs believe they have in addressing racial health inequities.

Racial health implications: Little is known about MCOs' general understanding of and reactions to P4P models and implementation, particularly models aimed at addressing racial inequities. Findings from this study can assist Medicaid agencies in understanding how MCOs interpret and implement equity-based policy to ensure intended populations are benefiting from the planned outcomes.