{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:17:37Z","timestamp":1788337057271,"version":"build-2803163510"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01MD017703"],"award-info":[{"award-number":["R01MD017703"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Identifying social risk factors during the perinatal period may improve pregnancy-related outcomes. In 2018, the Massachusetts Medicaid program implemented an accountable care organization (ACO)\u2014which required social risk factor screening\u2014under 2 ACO model types: Model A (health system\/Medicaid managed care plan partnership model) and Model B (primary care practice model).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the 2016-2020 Massachusetts All Payer Claims Database and a difference-in-differences (DiD) design, we compared changes in any social risk factor documentation (ie, ICD-10 Z-codes) for Medicaid-enrolled deliveries in non-ACOs vs ACO Model A vs Model B, measured separately for the prenatal period, 60 days postpartum, 12 months postpartum, and the perinatal period. Secondary outcomes included documentation of specific Z-codes related to homelessness and food insecurity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both Model A (DiD = 1.03 percentage points [PP], P &amp;lt; .001) and Model B (DiD = 0.65 PP, P &amp;lt; .001) were associated with significant increases in Z-code documentation of food insecurity in the perinatal period. Model B was associated with a significant increase in Z-code documentation of homelessness in the perinatal period (DiD = 1.10 PP, P &amp;lt; .001) but not Model A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Massachusetts' Medicaid ACO was associated with modest increases in Z-code documentation during the perinatal period, with some variation by ACO model type.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag220","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:41:05Z","timestamp":1787398865000},"source":"Crossref","is-referenced-by-count":0,"title":["Changes in documentation of social risk factor diagnosis codes: comparison of Medicaid Accountable Care Organization model types"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7417-6322","authenticated-orcid":false,"given":"Kevin H","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9687-5634","authenticated-orcid":false,"given":"Kenneth","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7450-3837","authenticated-orcid":false,"given":"Kathryn","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]},{"name":"Department of Community Health Sciences, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4743-2014","authenticated-orcid":false,"given":"Sarah H","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0661-9926","authenticated-orcid":false,"given":"Collette N","family":"Ncube","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lois","family":"McCloskey","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan B","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]},{"name":"Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston, MA 02215 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026090203412709700_qxag220-B1","author":"Medicaid and CHIP Payment and Access 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