BCBSA study: Maternal health disparities exist across commercial, Medicaid populations

Women of color are at higher risk of maternal health complications, and those disparities persist regardless of whether they are enrolled in commercial health plans or Medicaid coverage, a new study found.

The report, released by the Blue Cross Blue Shield Association, found that pregnancy-related complications have risen 9% since 2018, an increase driven in part by the COVID-19 pandemic. The study examines the rate of childbirth complications based on the Centers for Disease Control and Prevention's Severe Maternal Morbidity (SMM) measure.

Overall, women aged 35 to 44 were more likely to experience an SMM complication, according to the study. However, Black women in this age range have an SMM rate that is 66% higher than that of white women in the same group and are far more likely to experience pregnancy-related complications, according to the study.

Latina and Asian women also have higher risk of complications during pregnancy compared to white women, according to the study.

The study outlines a number of risk factors for maternal health complications including body weight, preexisting diabetes, hypertension and asthma. The prevalence rate of these risk factors is higher among either Black, Latina or Asian women than white women for each, and at times more prevalent across all three. For example, Black women with commercial coverage were 53% more likely than white women to have preexisting diabetes. 

Among Latina women, the prevalence of preexisting diabetes was 44% higher than white women, and 22% it was higher among Asian women, the study found.

Similar disparities exist for women enrolled in Medicaid, according to the study. Black women with Medicaid coverage have a 40% higher prevalence of diabetes compared to white women. For Latina women, prevalence is 37% higher, and it is 26% among Asian women with Medicaid.

"It's not just pregnancy-related care that’s important to change here, it’s also the overall health of these populations," Adam Myers, M.D., chief transformation officer at BCBSA, told Fierce Healthcare.

Insurers and providers can take action to address these disparities, according to the report, and the paper offers several places to start:

  • Design treatment plans that account for SMM, which is particularly urgent for Black women over the age of 35 who may have chronic illnesses.
  • Offer care that is culturally competent and accounts for implicit biases.
  • Make chronic conditions a priority at all points of the care journey, including preconception, during pregnancy and postpartum.
  • Make prenatal care accessible by addressing barriers such as transportation and scheduling.
  • Measure providers based on quality. BCBSA, for example, labels hospitals as Distinction Centers for Maternity Care if they meet specific standards for quality, patient experience and expertise.

In April 2021, BCBSA set the goal of reducing racial disparities in maternal health by 50% over the next five years. The initiative focuses on harnessing data analytics to track risks as well as taking programs that work for individual Blues plans and bringing them to scale.

Myers said the new data help reinforce the urgency of that goal and also highlight potential focus areas for the future. For instance, the impact of chronic conditions makes it clear that the postpartum period should also be a major focus, he said.

"We knew we had our work cut out for us, but this study really underscores the need," he said. "Some of these data, what they reveal, further inform the focus of our strategy."