Depression: A Measure for Mothers
February 22, 2018 · Matt Brock
We want to tell you about some work on depression that is brewing with our HEDIS® team and their funders, the California Health Care and Zoma foundations. The team put together this information to preview their work for you. We’ll keep you up to date on its progress and share a story or two about women who have faced this issue as new mothers.
NCQA to Address Perinatal Depression Care with HEDIS® Measures
The National Committee for Quality Assurance (NCQA) aims to enhance its existing depression care quality measures to address care for pregnant and postpartum women. The enhanced measures will be proposed for use in the national Healthcare Effectiveness Data and Information Set (HEDIS).
With funding from the California Health Care Foundation and the Colorado-based Zoma Foundation, NCQA will use its multi-stakeholder process to develop the measures. NCQA will test the measures with interested health plan and provider organizations seeking to improve maternal outcomes through high-value, integrated care. Testing will take place in 2018 and 2019 and target plans and providers in California and Colorado, where behavioral health and maternal care are priority areas. The measures will be proposed for HEDIS in 2019.
Why perinatal depression care?
Perinatal depression is common and harmful. Perinatal depression refers to minor and major depression episodes during pregnancy and/or the first 12 months after childbirth. Rates of perinatal depression range from 12-15%, with estimates reaching 20% or higher in some areas of the U.S. Women with untreated depression during pregnancy are at risk of developing postpartum depression and suicidality, and of delivering premature or low birthweight babies. Postpartum depression hinders infant attachment and bonding and can lead to developmental disorders that last into adolescence. During infancy, important caregiving activities such as breastfeeding, sleep, and keeping up with well-child visits and vaccine schedules can be compromised in depressed mothers.
What can be done?
Perinatal depression is treatable. Depression can be treated with medications and behavioral interventions. Screening and treatment guidelines for perinatal depression have been developed by entities such as the U.S. Preventive Services Task Force,1 American Psychiatric Association,2 American College of Obstetricians and Gynecologists3 and American Academy of Pediatrics.4 The Centers for Medicare & Medicaid Services5 also released an Informational Bulletin highlighting the critical role of Medicaid reimbursement for screening and treatment of mothers, thus providing incentives for health care providers to address this important condition in mothers who may not be their primary patient.
Why quality measures?
Perinatal depression is often missed. Nearly 60% of women with symptoms do not receive a diagnosis, and 50% of women with a diagnosis do not receive treatment. Women often get care in different settings before and after pregnancy. Insurance coverage gaps, particularly among those with Medicaid, create additional challenges to care for this vulnerable population.
Quality measures can encourage better care. HEDIS is a set of national performance measures used to compare health plans and drive improvement in important facets of health care delivery. NCQA recently added a suite of depression measures to HEDIS that address key facets of depression screening and management in adolescent and adult health plan members. Successful adaptation of the depression measures to address perinatal depression will allow plans and providers to build quality improvement programs to target an important public health problem with intergenerational impacts.
Because of the shifts in women’s care and insurance coverage during this vulnerable period, the use of measures that encourage access to data across plans, providers and systems is highly desirable. The HEDIS Depression measures to be adapted for perinatal women harness multiple electronic data sources, encouraging shared decision-making between patients and providers at the point-of-care to promote quality improvement.
For more information about this project, leave us your email address in the comments section below. We’ll have the project’s point person contact you.
1 U.S. Preventive Services Task Force: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1
2 American Psychiatric Association: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103063/
3 American College of Obstetricians and Gynecologists: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression
4 American Academy of Pediatrics: http://pediatrics.aappublications.org/content/126/5/1032
5 Centers for Medicare & Medicaid Services: https://www.medicaid.gov/federal-policy-guidance/downloads/cib051116.pdf
The California Health Care Foundation is working hard to ensure that all low-income Californians can get the care they need, when and where they need it, and at a price they can afford. CHCF is especially focused on strengthening Medi-Cal, which covers one in three Californians and is the cornerstone of California’s safety net. As part of its focus on high value care, CHCF is currently funding projects to better understand maternal mental health care in California, and to explore ways that it can be improved. CHCF’s maternal mental health work is part of a CHCF-wide focus on behavioral health.
About Zoma Foundation
The Zoma Foundation, a Denver-based foundation created by Ben and Lucy Ana Walton, was founded in 2016. Early childhood development is a focus area of the Foundation which is committed to reducing social-emotional and cognitive disparities in children from pregnancy through age 5 in the greater Denver metro area. The Foundation addresses four areas of support for families toward this goal: Mental health for parents, infants and toddlers; Parent and family awareness of early childhood development; Child maltreatment prevention and care; and Catalytic tools and initiatives.