Reducing racial disparities in maternal health care is a California Department of Healthcare Services (DHCS) Bold Goal and a top priority for many organizations in the state. In pursuit of this goal, Molina Healthcare of California, a health plan that served 1,579 birthing people in the Inland Empire in 2023, is taking a unique approach. With funding from the California Improvement Network, Molina Healthcare set out to close the gaps in maternal health equity through qualitative analysis aimed at understanding the lived experiences of patients, community-based organizations (CBOs), and doulas with a focus on place-based disparities.
Through structured conversations, interviews, interactions, and observations of in-person activities with providers, health plan members, and CBOs, Molina Healthcare identified three essential learnings that might be helpful to other organizations collaborating with communities on reducing racial disparities in maternal health care.
Lesson 1: Building trust through community engagement must come before information gathering
Building relationships to establish trust is critical before formal qualitative data collection from an underserved community can begin. Mimi Velazquez, health equity program manager for Molina Healthcare, developed relationships in the Inland Empire over six months by attending local health meetings with public health agencies, meeting with leaders of local CBOs, and joining Black maternal health community collaboratives.
The trust-building process not only involved connecting with long-standing partners and building new connections but also repairing relationships within Molina Healthcare’s network to help address and resolve existing issues. For example, CBOs shared with Velazquez that they had provided services to Molina Healthcare’s members but had yet to be paid. This prompted Molina Healthcare to create more direct connections between CBOs and their billing department to resolve any standing issues, and as a result, those CBOs became more willing to share insights with Velazquez.
In its efforts to build credibility in the community, Molina Healthcare also realized the importance of acknowledging the historical oppression often encountered when engaging with underserved communities and the mistrust these communities can experience due to past exploitation and lack of follow-up from research initiatives. “Research projects are known for coming into a community, taking data, publishing information, and then the community never hears from them again and they feel used,” says Velazquez.
In an effort to repair and honor the value of community members’ time and wisdom, Molina Healthcare provided monetary compensation ($100 per interviewee) to people sharing their lived experiences, whether they were providers, health plan members, or CBO representatives.
Through consistency and demonstrated actions over time, Molina Healthcare earned trust — community partners noted that they now feel more connected, seen, and heard by the health plan.
Lesson 2: Health plans must prioritize sharing information — for members and for providers
Through the interview process with members and providers, Molina Healthcare learned of information gaps that exist for their prenatal and postpartum members, as well as for doulas serving the community. Members shared that they didn’t have sufficient information about their doula care options and doulas shared they didn’t have information about how to contract with Molina Healthcare. This information gap is particularly harmful for patients who identify as Black, Indigenous, and People of Color who are most in need of culturally appropriate care options which doulas can often provide, to ensure positive health outcomes. It also aligns with lower rates of doula usage by Medi-Cal members in the Inland Empire, despite this region having the second highest number of Medi-Cal enrolled doulas in the state.
Members shared that they didn’t have timely information about the types of services doulas offer or how to choose a doula best suited for their maternal care needs. One of their members shared, “When I found out that I could get a doula and signed up, Riverside County was busy as far as the availability. I was told I could have maybe three or four visits with the doula before I had the baby and three or four visits after. But by the time I finally got matched with a doula, I was pretty close to my due date,… And I didn’t even know that the insurance would cover doula services!” Not only did this member miss their opportunity to receive timely care, but they were unaware that their health plan covered doula services due to lack of information sharing.
Additional members suggested a possible solution in the form of a handbook of doulas in their region, sorted by relevant demographics, as well as a welcome packet from the health plan with information about doulas and the services they provide. Of note, the Department of Healthcare Services offers an FAQ page for Medi-Cal members around doula services.
Similarly, doulas also voiced a need for more communication from the health plan. They asked for workshops about contracting with Molina Healthcare and to be recruited to provide doula care in rural areas where they live, which are known as health care deserts. Listening to doulas was therefore just as important as listening to members when understanding how information gaps were impacting maternal health care delivery.
Lesson 3: Health plans must follow through on community-informed programmatic interventions
Acting on the information shared with them was Molina Healthcare’s critical next step to maintaining trust and making progress on maternal health equity. In addition to fixing CBO payment issues, Molina Healthcare is now actively responding to members’ and providers’ requests related to doula care. Molina Healthcare offers a guide to members seeking doula services and has provided workshops on how doulas can contract with the health plan. Molina Healthcare is also looking to secure a doula consultant from among the interviewees to help the health plan in its efforts to equitably build out its doula services.
Another important example of action is Molina Healthcare’s efforts to continue to foster relationships and maintain or build trust across the Inland Empire. For example, CBOs have invited Velazquez to participate in the qualitative data collection process for their community health needs assessments and organizations that support Black maternal health in the region are now partnering with Molina Healthcare.
By building meaningful partnerships based on trust, prioritizing the elimination of information gaps that serve as barriers to care, and by committing to acting on learnings from members and providers, Molina Healthcare is optimistic that those efforts will soon translate into more equitable maternal health care. How might your organization partner with community stakeholders to create maternal care interventions that eliminate health disparities?
The California Improvement Network (CIN) is a learning and action community that advances equitable health care experiences and outcomes for Californians through cross-sector connections, spreading good ideas, and implementing improvements. Learn more about the California Improvement Network, a project of the California Health Care Foundation that is managed by Healthforce Center at UCSF, and sign up for the CIN newsletter.
