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May 10, 2024

Research highlights disparities in maternal health costs

An ambulance Photo | Courtesy of UMass Memorial Medical Center UMass Memorial Health ambulance

Complications during pregnancy and delivery can cost twice as much in medical spending compared to caring for patients who do not experience severe maternal morbidity (SMM), according to a new analysis from state health regulators.

People who were commercially insured in Massachusetts and experienced SMM during delivery or the postpartum period racked up $43,142 in average spending and cost sharing, compared to $22,543 for individuals who did not have complications, according to Health Policy Commission research based on data from 2019 to 2022. For people insured through MassHealth, average total spending was $28,197 for people with SMM, compared to $15,009 for those without complications, the HPC found.

Massachusetts has one of the highest rates of SMM in the country. SMM rates are also 2.5 times higher for Black Bay Staters compared to their white counterparts, the HPC says.

While Massachusetts performs strongly in most indicators for reproductive care and women's health, the commonwealth ranks 45th in the country for SMM rates, Laura Nasuti, the HPC's director of research and analytics, said during a committee meeting Thursday. The ranking, issued last June by the Commonwealth Fund, reflects that 105.5 pregnant Bay Staters experienced SMM for every 10,000 hospital deliveries in 2020, compared to the national average of 88.2, an HPC spokesperson said.

"The trends of rising severe maternal morbidity in Massachusetts are alarming, particularly as these trends disproportionately impact Black non-Hispanic birthing people," Barbara Blakeney, HPC chair of the Care Delivery Transformation Committee, said in a statement. "These data underscore that we must do more as a Commonwealth to improve these outcomes."

The committee's exploration of new research builds on the Healey administration's increasing focus on racial disparities in maternal health care amid a spate of facility closures, including the controversial closure of the maternity ward at Leominster Hospital last September. The rate of SMM nearly doubled from 2011 to 2020, with Black individuals experiencing the highest rate of health issues, the Department of Public Health said last July.

"The Health Policy Commission wanted to add to this conversation and expand upon the work by examining spending and cost sharing associated not only with the birthing episode, but also with the postpartum period for those who experience severe maternal morbidity," Nasuti said.

Average total commercial spending for Black patients with SMM was $52,721. That compares to $42,342 for Hispanic patients; $48,342 for "other non-Hispanic" backgrounds including Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native; and $40,380 for white patients.

Some of the spending differences can be attributed to insurance coverage, including small employers that offer more high-deductible plans, in addition to the intensity of services provided, Nasuti said. A larger share of Black patients with SMM had an extra inpatient stay or emergency department visit compared to Hispanic or white individuals, according to her presentation.

The HPC also examined how racism contributes to poor maternal health outcomes, alongside other social determinants such as education, transportation, food access and socioeconomic status.

"We ran a regression analysis and found that even after accounting for age, community income level, payer whether it be MassHealth or commercial, or the type of hospital an individual went to, Black non-Hispanic birth people were more likely to experience severe maternal morbidity compared to white non-Hispanic birthing people," Nasuti said.

Black individuals had the highest prevalence of hypertension before pregnancy, she said. During pregnancy, they also had the highest prevalence of hypertension, pre-eclampsia and eclampsia, a trend the HPC wants to tackle through a proposed $1.5 million investment in remote blood pressure monitoring.

The money would cover "several innovative programs" that offer remote blood monitoring for patients from birth to six weeks postpartum, which the HPC says is the time period that poses the biggest risk of SMM. Officials are expected to finalize program details in the coming weeks.

"This program is aligned with the HPC's mission to advance a more transparent, accountable, and equitable health care system for all Massachusetts residents," David Seltz, HPC's executive director, said in a statement.

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