Blue Cross and Blue Shield Maternal Health
Racial Ethnic Differences in Maternal Health
Pregnancy and childbirth difficulties in the United States increased by approximately 9% among all women1 between 2018 and 2020. Moreover, racial and ethnic disparities persist in these complications. Black, Latina, and Asian women2 continue to fare worse than white women in terms of the likelihood of complications.
Most notably, this trend holds for all women in this study, suggesting that the increase in birth complications is increasing regardless of whether a woman takes commercial health insurance or Medicaid.
This report analyzes the modern trends in severe maternal morbidity (SMM). Examines nearly 11 million births4 among women with commercial insurance or Medicaid.5 Data covers 2018 to 2021 for women thru commercial insurance and 2016 to 2020 for women with Medicaid.6 Study of births among women with both types of insurance provides a comprehensive picture of health trends among mothers in the United States.
The SMM rate in this report measures unexpected outcomes at the time of delivery in a hospital within six weeks of delivery. These complications can cause serious short-term or long-term health consequences. SMM consists of 21 adverse proceedings recognized as indicators.7 A woman who experiences one or extra of the 21 hands remains considered to have experienced an SMM event.
In This Report
- Key takeaways
- Research results
- Risk factors for SMM
- SMM risk reduction
- Taking action to improve maternal health
- SMM rates increased by 9% between 2018 and 2020 for all racial and ethnic groups in the BCBS commercially insured and Medicaid populations.
- Early evidence among commercially insured women suggests that the pandemic may have exacerbated this trend.
- SMM rates are consistently higher for black, Latina, and Asian women than white women, regardless of age or insurance type.
- While rates of SMM for all women increase with age, black women ages 35-44, particularly those with chronic situations, have a 66% higher risk of experiencing SMM than white women.
- Black, Latina, and Asian women take higher rates of several risk factors for SMM than white women.
Smm Rates Grow Among Women With Business Insurance And Medical
Between 2018 and 2020, SMM rates increased by about 9% for women with commercial insurance or Medicaid. This increasing trend in SMM rates is valid for altogether groups of women in this study. The rate increase is slightly more significant for black women, Latina women, and Asian women with commercial insurance and Medicaid. The rise in SMM rates for white women is +9% and +3% for women with commercial insurance and Medicaid, respectively. Retail insurance claims data available through 2021 show significant rate increases during the COVID-19 pandemic
Smm Rates Are Significantly Higher For Black, Latina, And Asian Women
Black women with commercial insurance had SMM rates 53% higher and Medicaid 73% higher than White women’s SMM rates. Rates were also higher among Latin American and Asian women. Latina women with commercial insurance had a 22% higher rate, and with Medicaid, a 28% higher rate of SMM than white women. Asian women with commercial insurance had a 15% higher rate, and with Medicaid, a 38% higher rate of SMM than white women
Smm Rates Are Higher For Women Of Color, Regardless Of Age
In all populations, women aged 35–44 remained more likely to have an SMM event than younger women (Examples 3a and 3b). However, black women with commercial insurance or Medicaid in this age range take a 66% higher SMM rate than white women.
Risk Factors For Smm
Certain medical situations earlier and during pregnancy can raise a woman’s risk of SMM.10 These include chronic diseases such as diabetes, height, body mass index (BMI), or asthma at the delivery time. Some states may have a more vital link to SMM events than others. A list of risk factors for commercially insured women remains provided in the Appendix. In addition, it gives an estimated level of risk (in terms of hazard ratio) that each contributes to the probability of an SMM event.
Differences In Risk Factors Among Women With Commercial Insurance
Among women with commercial insurance, prevalence rates for each risk factor are higher in at least one and sometimes in all three racial and ethnic groups than in white women. Prevalence rates are highest amongst black women compared to other groups for all risk factors except those older than 36 years.
The disparity in the Number of Risk Factors thru Race and Ethnicity
Associating the number of risk factors between women of colour and white women of the same age offers more profound insight into the extent of these differences. For example, 40% of black women aged 35–44 have one or else new risk factors for SMM, which is 60% more than white women. Fourteen per cent have two or extra risk factors, about 180% higher than white women.
Smm Risk Reduction
The data is clear: we must take immediate action to reverse the trend of rising SMM rates and reduce the disparity in these rates. This work is urgent for women with commercial insurance or Medicaid, especially black women ages 35-44 with one or more risk issues. In addition, healthcare providers and health plans can take instant action to:
Design conduct plans and programs tailored to women at high risk for SMM, a particularly urgent approach for black women over 35 with chronic situations.
Deal with culturally appropriate health care and provide implicit bias training.
Prioritize chronic managing conditions before conception, during pregnancy, and after birth.
Make prenatal care accessible and reduce barriers such as lack of transport or scheduling options.
Measure providers and facilities on the excellence of the care they provide. For example, Blue Cross Blue Shield’s Blue Difference Centers for Maternity Care are hospitals that see specific, expert, nationally recognized standards for quality and patient experience.
Taking Action To Improve Maternal Health
Trends in maternal health disparities are unacceptable. However, reversing the trajectory of these trends, such as the SMM rate highlighted in this report, cannot rest solely on the shoulders of women and healthcare providers. Instead, it will require a concerted effort by the healthcare system, including providers, policymakers, insurers, and the nonprofit and private sectors.
Based on efforts already underway at BCBS companies, we have identified ten concrete steps to address the health disparities highlighted in this report:
Top 10 Events For Equal Health Of Mothers
- Engage maternal voices and communal stakeholders to create, build, and sustain a holistic maternal health program. Build public-private partnerships to address the root reasons for inequalities, disparities, and social determinants of health.
- Offer access to cultural humility and unconscious bias training for everybody on the maternal care continuum.
- Include nurse-midwives and birth centres in supplier networks and design programs to raise education and awareness among health plan members.
- Facilitate access of doulas and community health workers to maternal support services.
- Implement models of facilitated self-management or peer prenatal care such as CenteringPregnancy.™
- Expand benefit coverage to provide postpartum care, including behavioural health care, for one year after delivery.
- Coordinate quality measurement with national standardization organizations and follow up on providers’ quality programs.
- Join and participate in the Perinatal Excellence Collaborative.12
- Device value-based contracts were specific to maternal health.
- Expand programs of particular importance, such as vaccination programs focusing on COVID-19 and influenza.
Racial and ethnic disparities in pregnancy and childbirth complications mean Black, Latina, and Asian women in the U.S. Racial and ethnic disparities in maternal humanity are unacceptable. Struggles to recover the quality of care and equity crossways the life course
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