Press Release  MASSACHUSETTS RANKS 45th IN NATION FOR SEVERE MATERNAL MORBIDITY RATES; HPC PROPOSES INVESTMENT TO ADDRESS LEADING CAUSE OF PREGNANCY-RELATED ILLNESS

BOSTON — Today, the Massachusetts Health Policy Commission (HPC) Policy Committees discussed data from the HPC’s ongoing work focused on severe maternal morbidity (SMM) in Massachusetts, and a complementary investment program aimed at improving care and delivery outcomes for at-risk birthing people.

SMM is defined as unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to health, including pregnancy-related conditions such as eclampsia and severe cardiovascular complications, and procedures such as hysterectomy.

Despite Massachusetts performing well for many indicators of reproductive care and women’s health, including low infant and maternal mortality, the Commonwealth Fund reported that the Commonwealth ranked 45th in the nation for SMM rates.

Among Massachusetts residents, SMM rates were highest for Black non-Hispanic birthing people, with a rate of SMM 2.5 times higher than White non-Hispanic birthing people as well as the highest rate of postpartum hospitalizations for SMM. This increased incidence of SMM for Black non-Hispanic birthing people persisted even after accounting for differences in age, hospital type, payer, and community income level.

SMM has significant impacts for patients and the health care system at large, including patient health consequences, increased medical costs, and longer hospital stays. Maternity episodes with SMM were almost twice as costly, on average, than episodes without SMM among both commercially and publicly insured patients.

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

Complications of hypertensive disorders during pregnancy are a leading cause of SMM and readmissions, and Black birthing people had higher rates of hypertension pre-pregnancy and higher rates of hypertensive conditions that started during pregnancy. As research suggests early intervention in hypertensive disorders may improve health outcomes and reduce SMM, the HPC proposed a remote blood pressure monitoring investment program. A $1.5 million investment would support several innovative programs providing remote blood pressure monitoring for patients from birth to 6 weeks post-partum, which is the period of greatest risk of SMM.

“Investment programs like the proposed remote blood pressure monitoring project are critical in supporting care delivery and outcome transformations and prioritizing health equity,” said David Seltz, HPC Executive Director. “This program is aligned with the HPC’s mission to advance a more transparent, accountable, and equitable health care system for all Massachusetts residents.”

Severe Maternal Morbidity Research Key Findings:

Racial/Ethnic Health Inequities in SMM:

• Rates of SMM are statistically significantly higher among people of color. Compared to the rate of SMM per 10,000 deliveries among White non-Hispanic birthing people (98.5 incidents of SMM), rates of SMM were 2.5 times higher for Black non-Hispanic birthing people (241.6 incidents of SMM). Rates were also higher for Hispanic (143.5 incidents of SMM) and Asian/Pacific Islander non-Hispanic (122.8 incidents of SMM) birthing people.
• Black non-Hispanic birthing people were statistically significantly more likely to experience SMM compared to White non-Hispanic birthing people even after accounting for age, hospital type, payer, and community income level.
• Commercially insured Black non-Hispanic birthing people had a rate of SMM 17% higher than their publicly insured counterparts. Out of every 10,000 deliveries from 2019-2022, 264.1 commercially-insured compared to 225.1 MassHealth-insured Black non-Hispanic birthing people experienced SMM.

• There are clear indicators of disproportionate experiences of racism among the Massachusetts birthing population based both on race and insurance type. Black, Hispanic, and Asian birthing people who were commercially insured reported a higher prevalence of racism than publicly insured birthing people of the same race/ethnicity.
• In Massachusetts, Black birthing people received less prenatal care than birthing people from all other racial/ethnic groups. From 2017-2022, 72% of Black birthing people received adequate prenatal care compared to 76% of Hispanic birthing people and 85% of white birthing people.

Spending & affordability implications:

• Maternity episodes with SMM were almost twice as costly, on average, than episodes without SMM among both commercially and publicly insured patients. Between 2019 to 2022 in Massachusetts, the average total spending for a commercially insured maternity episode without SMM was $22,543 compared to $43,142 with SMM, and the average total spending for a publicly-insured maternity episode without SMM was $15,009 compared to $28,197 with SMM.
• Total spending for a maternity episode varied by race/ethnicity for birthing people who experienced SMM. Among commercially insured birthing people, Black non-Hispanic people with SMM had the highest average spending for a maternity episode (over $50,000).
• Cost-sharing varied by 55% by race and ethnicity for commercial patients who experienced SMM, with Black non-Hispanic patients having the highest average cost-sharing amount ($2,123). Some of this variation in cost-sharing may be explained by additional postpartum ED & hospitalization visits and differences in insurance design.

Data reflects incidences of SMM per 10,000 deliveries, including postpartum hospitalizations for SMM, from 2019-2022 in Massachusetts. HPC researchers analyzed SMM in Massachusetts by examining data from CHIA’s Acute Hospital Case-Mix and the All-Payer Claims Database (APCD), as well as survey data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess health care experiences and care access.

Remote Blood Pressure Monitoring for Birthing People With Hypertensive Disorders of Pregnancy

Emerging research suggests that remote blood pressure monitoring can be an effective tool to enable adherence to blood pressure monitoring guidelines, address racial disparities in blood pressure control, and improve patient experience. The Massachusetts Department of Public Health’s Review of Maternal Health Services recommends the implementation of remote blood pressure monitoring programs across all hospitals in Massachusetts.  

Efforts to implement remote blood pressure monitoring have been complicated for providers by lower reimbursement rates than in-person care and start-up costs, and for patients by lack of access to technology and other programmatic barriers. To address these issues and improve health outcomes for birthing people, especially populations disproportionally impacted by SMM, the HPC proposed a remote blood pressure monitoring investment program.

The HPC plans to invest $1.5 million dollars to support the funding of several awardee programs, which would utilize wireless remote BP monitoring with telehealth to support patients with hypertensive disorders of pregnancy. These investments would support hospitals in implementing remote patient monitoring programs that address participation barriers for patients and measure outcomes, patient experience, and impact on cost of care – with particular consideration for addressing disparities based on race, ethnicity or other factors relevant to the patient population.

Next steps for this proposed investment program include finalizing the program design in collaboration with the Perinatal Neonatal Quality Improvement Network (PNQIN). The HPC anticipates that the procurement process will begin in June with awardee recommendations shared with the HPC Board for final approval in the fall.

A recording of the committee meetings is available on the HPC’s YouTube page. The SMM research and remote blood pressure monitoring investment program presentations from the Care and Delivery Transformation meeting and health planning presentations from the Market Oversight and Transparency meeting are available on the HPC’s website.

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