The "Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal" Project: Community-Generated Recommendations to Decrease Maternal Mortality and Severe Maternal Morbidity.

Background: Through applied research and health care quality improvement, California has achieved a maternal mortality (MM) rate significantly lower than that measured nationally. However, Medicaid (Medi-Cal)-insured births in the state continue to experience disproportionate shares of MM and severe maternal morbidity (SMM), which often precedes death. Failure to engage the Medi-Cal community in this work may impede efforts to increase equity.

Methods: This community engagement project used deliberative democracy methods to engage stakeholders with lived experience in California's Medi-Cal perinatal care system to generate an actionable and specific agenda of recommendations to decrease MM and SMM in the Medi-Cal population.

Findings: A total of 37 Medi-Cal stakeholders-representing birthing people, providers, health plan administrators, and advocates-participated in longitudinal co-learning sessions on the topics of MM/SMM in Medi-Cal. Most of these stakeholders (75.7%) then participated in deliberation sessions. Deliberation recommendations fell into five distinct categories: Medi-Cal perinatal covered benefits, data collection and dissemination, patient experience and its link to care quality, Medi-Cal reimbursement rates, and accountability with respect to racism in perinatal care. Stakeholders identified the Medi-Cal system actors best positioned to implement specific recommendations to directly impact MM/SMM.

Conclusions: This project demonstrates the feasibility and success of using deliberative democracy methods to generate local and community-generated solutions to critical problems in health equity. Active and engaged stakeholders were keen to identify both immediate actions and long-term research and quality improvement paradigm shifts to support birth equity in Medi-Cal.