Program screens members for postpartum depression

Info, follow-up calls, referrals prevent other problems

Members of Blue Cross Blue Shield of Missouri’s Postpartum Depression Screening Program consistently give the St. Louis-based health plan patient satisfaction scores in the 90th percentile.

Since the program was launched in November 2001, more than 25,000 women have been screened for postpartum depression and received information and resources about the illness and treatment options.

Postpartum depression is common and affects between 10% and 13% of all women who have given birth or experienced an adverse obstetrical outcome to a pregnancy, but treatment for women suffering from the condition often is underutilized, reports Pat Jones, RN, BSN, project manager for the postpartum depression program for Blue Cross Blue Shield of Missouri (BCBSMo).

"Postpartum depression doesn’t affect a huge number of members, but can have devastating effects on the mother and those around her. Even though the volume of cases is small, we felt we had the tools and the ability to develop a program that could make a difference in the lives of our members, says Kathleen McDarby, RN, MPH, senior health service analyst for BCBSMo.

If left untreated, the condition can last for at least a year. Treatment includes a combination of medication, talk treatment, and self-help strategies. With treatment, the symptoms improve more quickly. Women who have postpartum depression have trouble with daily activities of self-care and child care. Postpartum depression potentially can affect the infant, other children in the family, and the couple’s relationship.

The health plan has developed an algorithm to pull medical claims to identify women who qualify for the program. The process is performed on a weekly basis.

"We examine claims from every woman with any type of medical claim that has an obstetric background, whether it’s a normal birth, a premature birth, a stillbirth, or any other condition. This makes our program unique because many programs do not include women who have had an adverse outcome to the pregnancy or a premature infant," McDarby says.

Members who are identified from claims data receive a letter explaining the postpartum depression program, a brochure listing the causes and symptoms of the condition, with a section on grief and loss, and the Maternal Mental Health Survey, a 10-question screening tool.

About 33% of the women who receive the survey completed it and sent it back in the self-addressed, postage-free envelope supplied with the survey.

An outreach specialist scores the surveys and gives the names of members whose scores are positive to Jones, who contacts the members by telephone.

Members who screen negative for postpartum depression also receive a letter informing them that their score is normal at this time, but should they develop any of the listed signs and symptoms, they should contact their medical provider promptly.

"We thank them for participating and remind them not to ignore the symptoms if they do occur in the future," Jones says.

"There is no formal script for my outreach calls. Instead, each member is approached as an unique individual. The questions I ask are determined by how they answer the survey questions and my general impression from talking with them. However, with every member, I assess for their own safety and the safety of their child," she explains.

When she calls a member who screened positive for postpartum depression, Jones has a list of three behavioral health providers at hand. The providers have been contacted by the outreach specialist to make sure they have appointment slots available.

If Jones’ assessment determines that the members need professional help, she encourages them to accept a referral to a behavioral health provider.

"I give them options to choose from a list of behavioral health providers so they are involved in the decision-making process," she adds.

About 40% to 50% of the members choose to go back to an established provider, either their primary care physician or their obstetrician, because they feel more comfortable with a known provider, Jones adds.

"Some members recognize the extent of their depression and will accept a referral. Very few of these members are already in treatment, so it’s usually a starting point for them," she says.

Jones asks the members to call her back after they make an appointment, and many of them do. She makes a follow-up call three months later to see how the treatment is going and to see if the member needs more referrals for behavioral health services.

"Once I’ve made that three-month call and the member is not in need of further behavioral health services, I consider them graduated from the program. I leave the member with the knowledge that they can call me if they feel like they need further assistance with referrals," Jones says.

In most cases, within three to six months of treatment, the member’s symptoms have lessened or may have resolved.

"Most members will remain in treatment for six to 12 months. At that point, most members have had their medication titrated down to a lower dose and therapy visits are less frequent. In general, postpartum depression is usually easily resolved when identified and treated early," Jones says.

The postpartum depression program was developed by Blue Cross Blue Shield of Missouri’s quality management department in collaboration with behavioral health.

They worked with Blue Cross Blue Shield of Missouri’s internal communications and graphics department to produce the brochure.

The content of the brochure was reviewed by the plan’s quality improvement peer review panel, which includes network physicians, obstetrician/gynecologist, psychiatrists, family practitioners, and pediatricians.

"We received positive feedback from all of them. The psychiatrists were particularly complimentary about the brochure," McDarby says.

The program has been accredited under disease management standards for URAC. It’s been so successful that it’s been expanded to other programs and Blue Cross Blue Shield plans in other states.