Boston University Reports Findings in Health and Medicine (Medicaid Accountable Care Organization Implementation and Perinatal Claims Documentation of Social Risk Factors): Health and Medicine

2025 MAY 23 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Fresh data on Health and Medicine are presented in a new report. According to news reporting originating in Boston, Massachusetts, by NewsRx journalists, research stated, “Importance Addressing social risk factors (eg, food insecurity) during the perinatal period has the potential to improve pregnancy-related outcomes. While social risk factor diagnosis codes (ie, International Statistical Classification of Diseases, Tenth Revision, Z codes) were introduced in 2016, adoption in claims has been slow.”

Financial support for this research came from National Institute on Minority Health and Health Disparities of the National Institutes of Health.

The news reporters obtained a quote from the research from Boston University, “In 2018, Massachusetts’ Medicaid program implemented an accountable care organization (ACO) model, including a requirement that all ACOs screen for social risks. To assess claims documentation of Z codes in the perinatal period for Medicaid enrollees and evaluate changes in documentation following implementation of Massachusetts’ Medicaid ACO program. Setting, and Participants This cross-sectional study used the Massachusetts All-Payer Claims Database to identify all Medicaid-enrolled live deliveries between January 31, 2016, and December 31, 2020, among people 18 years or older. A difference-in-differences (DiD) approach was used to compare Z code documentation before (2016-2017) vs after (2018-2020) ACO implementation for Medicaid ACO vs non-ACO deliveries. Data were analyzed between August 23, 2024, and January 27, 2025. Exposures Attribution to a Medicaid ACO (vs non-ACO), determined based on whether an enrollee’s primary care physician participated in an ACO. Main Outcomes and Measures The primary outcome was claims documentation of any Z code, measured separately for the prenatal period, 60 days post partum, 12 months post partum, and the full perinatal period. Secondary outcomes included documentation of specific Z codes (eg, housing, food insecurity). The study sample included 79 293 deliveries (mean [SD] age of Medicaid-enrolled pregnant people, 28.2 [5.7] years), of which 69 535 (87.7%) were in a Medicaid ACO. Among all Medicaid deliveries from 2016 to 2020, 4.45% had claims documentation of a Z code in the prenatal period; 1.14%, within 60 days post partum; and 3.31%, within 12 months post partum. Within the prenatal period, Medicaid ACO implementation was associated with statistically significant increases in documentation of any Z code (DiD, 1.09 [95% CI, 0.38-1.80] percentage points [PP]), housing or economic circumstances codes (DiD, 1.52 [95% CI, 1.07-1.97] PP), and food insecurity codes (DiD, 0.58 [95% CI, 0.42-0.73] PP). The Medicaid ACO was associated with few changes in Z code documentation in the postpartum period. Conclusions and Relevance In this cross-sectional study of Medicaid-enrolled live births in Massachusetts, ACO implementation was associated with increased claims documentation of Z codes during the perinatal period, driven by increases in the prenatal period.”

According to the news reporters, the research concluded: “While Z code documentation remains low, implementation of care delivery models that incentivize screening and documentation of social risk factors among Medicaid enrollees may help to identify the care needs of pregnant and postpartum people.”

For more information on this research see: Medicaid Accountable Care Organization Implementation and Perinatal Claims Documentation of Social Risk Factors. JAMA Network Open, 2025;8(4). JAMA Network Open can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

Our news correspondents report that additional information may be obtained by contacting Kevin H. Nguyen, Boston University, School of Public Health, Dept. of Health Law Policy and Management, 715 Albany St, Boston, MA 02118, United States. Additional authors for this research include Sarah H. Gordon, Kenneth Lim, Kathryn D. Thompson, Megan B. Cole and Collette N. Ncube.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1001/jamanetworkopen.2025.5999. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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