Payer adds depression screen to prenatal program
9% of participants screened scored positive
One payer found that adding a postpartum depression screen to its prenatal program struck a chord with new mothers. In fact, 99% of new mothers who received the postpartum depression screening packet reported thinking the program was a great idea, and roughly 10% reported that before receiving their packets, they were unfamiliar with the condition.
Since adding a postpartum depression screening and treatment program to its HumanaBeginnings prenatal program, Louisville, KY- based Humana has seen 40% of women members who received the tool participate in the program. Humana contracted with Magellan Behavioral Health in Columbia, MD, to provide the postpartum depression screening to its members. Magellan has mailed more than 1,800 personal letters, educational brochures, and Edinburgh depression scales to Humana members in the immediate postpartum period.
"This impressive return rate is a great indica-tion that women are looking for information and answers about this serious yet often unrecognized illness," says Arthur Lazarus, MD, vice president and corporate medical director for behavioral health for Humana. "We’re very pleased that Humana is successfully reaching out to more women who have little or no knowledge of postpartum depression and providing them with important resources that they can use to improve their health."
Lazarus says Humana recognizes that a disproportionate number of covered health care services were going to women members. "Although pregnancy is not a disease, it’s the number one most frequent condition in any health plan. We know we have a high volume of births, and with a 10% to 15% incidence of postpartum depression nationally, we felt this program would reach a significant number of members," he says. "If we can reach even one woman and prevent tragic consequences, we will count the program a success. And we have significant evidence through member testimonies that the program is working as we hoped."
In a letter to Magellan, one Humana member wrote: "I suffered in silence with the birth of my first child from postpartum depression. This survey could reach out to those who don’t understand what’s happening to them or how to make it better. I applaud Magellan and Humana’s participation in this program."
"We receive a list of new mothers from Humana every two weeks. That list has the mothers’ names, addresses, and telephone numbers," notes Kary L. VanArsdale, EdD, regional prevention coordinator for Magellan.
Those mothers are sent a packet that includes the following:
- an introductory letter;
- the depression scale;
- a brief demographic survey that includes questions about past history of depression, marital status, number of children, employment, and age;
- an educational flip-sheet on postpartum depression which includes self-help information and numbers to call for further help;
- a return envelope addressed to Magellan.
Treatment is encouraged, not forced
Women who screen positive for depression are contacted by telephone by a Magellan care manager who encourages them to receive further evaluation and to schedule an appointment with a network provider, notes VanArsdale.
"We try to make an appointment within the next couple of days. Although our intervention ends once the appointment is made, we do follow-up with providers to see whether members keep their scheduled appointments and to see how many members followed through with treatment," she says.
Humana receives a monthly report from Magellan that lists how many members were sent packets, how many returned packets, and how many screened positive. "This program ends with referral to treatment. We’re not collecting outcomes," explains Lazarus. "This is a screening and intervention model consistent with prevention. It’s similar to an immunization program. You identify members at risk for disease who need immunizations. You immunize the person. You expect the medicine to be efficacious."
Magellan and Humana both have taken steps to encourage women to participate in the screening program. "We’ve been using touches like handwritten thank you notes to help personalize the process and encourage responses," says VanArsdale. "In addition, Humana has printed articles about the program in its member newsletter. We’ve been delighted to see that in recent months, the survey response rate has increased to more than 50% in some markets."
Of Humana members screened to date, 9% screened positive for postpartum depression, says VanArsdale. In addition, 14% reported a past history of depression.
"We know that past depression is a risk factor for depression before, during, and after pregnancy and that underrecognition and undertreatment are serious problems that affect maternal and infant outcomes, as well as the mother’s significant other," adds Lazarus.
Humana recently launched a pilot effort in Florida to offer the postpartum depression screen through a telephonic interactive voice response (IVR) method. "We’re anxious to compare the response rate to the IVR system to that of the paper and pencil screen," says Lazarus. "Basically, we’ve taken the depression scale and automated it so that members can use their telephone keypad to answer the questions. Members who test positive are immediately transferred to a Magellan care manager."
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