The Effect of An Integrated Accountable Model on Healthcare Utilization During Pregnancy Among Low-Income Women with Comorbid Mental and Physical Conditions: Evidence from Oregon's Coordinated Care Organizations.

INTRODUCTION: The prevalence of chronic conditions continues to increase in the United States, disproportionately affecting low-income women and Medicaid beneficiaries. This study examined whether an accountable care approach implemented in Oregon Medicaid, known as Coordinated Care Organizations (CCOs), which integrates the delivery of physical and mental health services, may improve high-value healthcare utilization during pregnancy among female Oregon Medicaid beneficiaries with chronic mental-physical comorbidities (MPCs).

METHODS: We performed a retrospective analysis of Oregon Medicaid data from 2008 to 2016, linked with birth certificates and hospital discharge records. Measures of high-value utilization included timely and adequate prenatal care visits, preventable hospitalizations, and preventable emergency department (ED) visits. We utilized a quasi-experimental difference-in-differences approach, comparing the pre-post changes in the outcomes between CCO enrollees and other Medicaid beneficiaries.

RESULTS: CCO enrollment was associated with greater odds of having the first prenatal care visit in the first trimester of pregnancy (OR 1.51, CI 1.21, 1.88) and the adequacy of prenatal care (OR 1.40, CI 1.10, 1.78) among women with MPCs. However, no statistically discernible associations were found for preventable hospitalization and ED visits.

DISCUSSION: CCOs are effective in improving timely and adequate utilization of prenatal care among women with MPCs. Further research is needed to understand whether and how CCOs may reduce preventable costly healthcare utilization among women with MPCs during and beyond pregnancy.