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Objective Study Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To examine the association of Massachusetts Medicaid Accountable Care Organization (ACO) implementation with changes in mental health care utilization in the postpartum period.We examine care for people with a birth covered by Medicaid or private insurance. We used a difference‐in‐differences design to compare differences before and after Medicaid ACO implementation for those with Medicaid versus those with private insurance. The primary outcome was a binary measure of having at least one outpatient mental health care visit in the 6 months postpartum. We estimated linear probability models controlling for age, prenatal mental illness, pregnancy complications, birth mode, and ZIP code characteristics.Data are from the Massachusetts All‐Payer Claims Database. The analytic sample included Massachusetts residents with a live birth between July 1, 2016, and September 30, 2019, with complete data.107,813 births were included (53.0% Medicaid, 47.0% private). 7.8% of these had at least one outpatient mental health visit in the 6 months postpartum, with similar rates among those with Medicaid versus those with private insurance pre‐ACO implementation (7.9% Medicaid versus 7.7% private). An increase in utilization among privately insured individuals and a decrease among Medicaid beneficiaries post‐ACO implementation was observed. Regression‐adjusted difference‐in‐differences estimates indicate that Medicaid ACO implementation was associated with a 1.3 percentage point [pp] decrease (95% confidence interval: 1.3 pp, −0.5 pp; p < 0.01) in the probability of having an outpatient mental health visit for those with Medicaid.Medicaid ACO implementation was associated with decreases in use of outpatient mental health care in the postpartum period among people with Medicaid, overall and compared to those with private insurance. Future research should determine whether this increased disparity in mental health care utilization persists with maturation of the ACO delivery model. [ABSTRACT FROM AUTHOR]

Author(s): Kimberley H. Geissler [sup.1] , Jessica Pearlman [sup.2] , Laura B. Attanasio [sup.1] Author Affiliations: (1) grid.266683.f, 0000 0001 2166 5835, Department of Health Promotion and Policy, University of [...], Objective Referrals are an important component of patient care, and have been increasing over time. During pregnancy, people have intensive contact with the healthcare system, but little is known about the involvement of different physicians for pregnant patients during this period. This study examines referral patterns during prenatal care visits. Methods Using the 2006-2015 National Ambulatory Medical Care Survey and national birth certificate data, we estimate the number of referrals per pregnancy from prenatal care visits with OB/GYN and family medicine physicians. We use multivariable regression analysis to compare the probability of receiving a referral during a prenatal visit for visits with family medicine and OB/GYN physicians, controlling for visit, patient, and physician characteristics. Analyses are weighted to make results nationally representative. Results 224,335,436 prenatal visits over 19,893,015 pregnancies were included; 60% of these visits were covered by private insurance. On average, 0.3 referrals are made per pregnancy (95% confidence interval [CI] 0.22, 0.38). A prenatal visit with an OB was 5.5% points less likely to result in a referral than a visit with a family medicine physician, controlling for other characteristics. Conclusions Referrals are relatively common in prenatal care, and are more commonly initiated by family medicine physicians than by OB/GYNs. Understanding the contribution of multiple clinicians to a pregnant person&apos;s health during the prenatal period and how coordination among clinicians impacts care receipt is an important next step. As healthcare becomes more specialized, better understanding care teams of individuals during the perinatal period is important for improving prenatal care.

Background: This study aimed to determine whether birthing people who experience severe maternal morbidity (SMM) are more likely to be diagnosed with a postpartum mental illness. Materials and Methods: Using the Massachusetts All Payer Claims Database, this study used modified Poisson regression analysis to assess the association of SMM with mental illness diagnosis during the postpartum year, accounting for prenatal mental illness diagnoses and other patient characteristics. Results: There were 128,161 deliveries identified, with 55.0% covered by Medicaid. Of these, 3.1% experienced SMM during pregnancy and/or delivery hospitalization, and 20.1% had a mental illness diagnosis within 1 year postpartum. In adjusted regression analyses, individuals with SMM had a 10.6% increased risk of having any mental illness diagnosis compared to individuals without SMM, primarily due to an increased risk of a depression or post-traumatic stress disorder diagnosis among people with SMM than those without SMM. Conclusions: Individuals who experienced SMM had a higher risk of a mental illness diagnosis in the postpartum year. Given increases in SMM in the United States in recent decades, policies to mitigate mental health sequelae of SMM are urgently needed. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic disease in children, disproportionately affects families with lower incomes, and is a leading reason for acute care visits and hospitalizations. This retrospective cohort study used the Massachusetts All Payer Claims Database (2014–2018) to examine differences in acute care utilization and quality of care for asthma between Medicaid- and privately insured children in Massachusetts. Outcomes included acute care use (emergency department [ED] or hospitalization), ED visits with asthma, routine asthma visits, and filled prescriptions for asthma medications. Multivariable logistic regression was used to account for differences in demographics, ZIP codes, health status, and asthma severity. Overall, 10.0% of Medicaid-insured children and 5.6% of privately insured were classified as having asthma. Among 317,596 child-year observations for children with asthma, 64.4% were insured by Medicaid. Medicaid-insured children had higher rates of any acute care use (50.4% vs. 30.0%) and ED visits with an asthma diagnosis (27.2% vs. 13.3%) compared to privately insured children. Only 65.4% of Medicaid enrollees had at least one routine asthma visit compared to 74.3% of privately insured children. Most children received at least one asthma medication (88.6% Medicaid vs. 83.3% privately insured), but a higher percentage of Medicaid-insured children received at least one rescue medication (84.0% vs. 73.7%), and a lower percentage of Medicaid-insured (46.1% vs. 49.2%) received a controller medication. These results suggest that opportunities for improvement in childhood asthma persist, particularly for children insured by Medicaid. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid and private medical insurance in Massachusetts. METHODS: This cross-sectional study analyzed well-child visits for children aged 1 to 5 years paid by Medicaid and private insurance during 2016-18 in Massachusetts. Multivariate regression models, with all covariates interacting with insurance type, were used to calculate odds ratios and adjusted predicted probabilities of fluoride varnish during wellchild visits by calendar year and age. RESULTS: Across 957,551 well-child visits, 40.0% were paid by private insurers. Unadjusted rates of fluoride varnish were significantly lower among well-child visits paid by private insurers (6.6%) than visits paid by Medicaid (14.2%). In the fully interacted regression model, the odds of a visit including fluoride varnish were significantly lower for older children than for children aged 1 for visits paid by both insurance types. Adjusted rates of fluoride varnish increased significantly from 2016 to 2018 for both insurance types. Moreover, rates were higher among visits for children covered under Medicaid than privately insured children in all years, and the differences by insurance type declined over time (2016: 8.0% points, 95% confidence interval = -8.7 to -7.3, 2018: 5.3% points, 95% confidence interval = -6.6 to -3.9). CONCLUSIONS: Rates of fluoride varnish applications during well-child visits were low for both Medicaid and private insurance despite growth from 2016 to 2018 in Massachusetts. Low rates are concerning because this is a recommended service with the potential to help address racial, geographic, and income-based disparities in access and oral health outcomes. [ABSTRACT FROM AUTHOR]