Health Plan Weekly, a subscription-based service of AIS Health, featured Dr. Michael Brodsky, L.A. Care's medical director for behavioral health and social services in "Medicaid Plans Take Aim at Maternal Mental Health Issues". The piece highlights L.A. Care's partnership with Maternal Mental Health Now, which was used as a case study in the recent Institute for Medicaid Innovation report on this topic.
From Health Plan Weekly, November 19, 2018:
Medicaid Plans Take Aim at Maternal Mental Health Issues
by Leslie Small
Not only are low-income women disproportionately affected by maternal behavioral health disorders such as depression and anxiety, they also face "unique barriers to diagnosis and treatment," according to a new report.
But because many of these women are enrolled in Medicaid programs, managed care plans can play a key role in helping identify at-risk populations and connecting them to treatment, per the Institute for Medicaid Innovation report.
Just ask L.A. Care Health Plan, which opted to support a community-based nonprofit organization called Maternal Mental Health Now (MMHN). Recognizing that fragmentation of the medical and behavioral health care systems is a significant barrier to addressing maternal behavioral health, MMHN established a collaborative care model for perinatal depression and anxiety at three medical clinics serving vulnerable populations in Los Angeles, the report said.
All of the clinics were able to improve the rate of identification of women at risk for perinatal mood and anxiety disorders by applying quality improvement approaches, and another "notable accomplishment" was the establishment of screening in pediatric clinics, the report added.
L.A. Care Offers Funding, Support
As for L.A. Care, the insurer has co-sponsored MMHN's provider education training and its annual fundraising gala, participated in the organization's policy roundtable, and provided a grant to help address health disparities in the African-American population, Michael Brodsky, M.D., the insurer's medical director for behavioral health and social services, tells AIS Health.
"Since we're a Medicaid-focused health plan, we have quite a large population of young mothers and young babies," he says. "It's in our interest...in terms of providing good health care and improving health outcomes, to make sure that moms are feeling good about before birth and after birth — and that they have the mental wellness to provide the right kind of postnatal care to have their kids start to reach developmental milestones and grow and thrive."
In general, Medicaid MCOs face a variety of barriers when trying to coordinate medical and behavioral care for pregnant women and new mothers, Brodsky adds. "One of the first barriers is making sure there's a level of awareness among new moms and among the providers — both in the obstetric community and the pediatric community — to make sure that screening is ongoing for these conditions," he says.
Once at-risk patients are identified, then there are access barriers to receiving treatment — like having transportation to appointments and the time to schedule them. Plus, in Los Angeles County specifically, there's still a "fair amount of stigma" about mental health treatment," Brodsky says. Finally, there's the issue of whether mothers are receiving adequate follow-up and are supported as their children grow — a barrier L.A. Care addresses by tackling social determinants of health such as stable housing and access to nutritious food.
Provider Education Is Key
In Brodsky's view, though, one of the most important steps an MCO can take is to help promote provider education about the issue of maternal mental health. To that end, L.A. Care will hold its second behavioral health-focused provider education program this upcoming May.
"We try to keep our networks well informed about topics that we think are not adequately covered, and maternal mental health definitely is in that category," he says.
L.A. Care is not the only Medicaid MCO to take on the issue of maternal behavioral health. The report also highlights:
Pittsburgh-based Gateway Health Plan, which is in the planning stages of an effort to team up with Women's Behavioral Health of Allegheny Health Network, with the organizations aiming to lessen barriers that prevent new and expectant mothers from receiving treatment for behavioral health disorders — and potentially increase the volume of perinatal women screened for such disorders. To achieve that, the organizations are planning to send a mobile unit staffed with behavioral health clinicians to either meet individual members or visit designated sites in the community. They're also aiming to deploy iPads at certain high-volume physician practices that will use telemedicine to screen mothers in need of perinatal behavioral health services.
California-based Health Plan of San Joaquin, which is creating the Perinatal Mood Identification and Coordination Program to decrease the incidence of prenatal and postpartum depression among its members. The program will identify at-risk members using a risk-stratification tool, coordinate behavioral health treatment for them through partnerships, and create and manage a registry that can track referrals to treatment and document follow-up.
BlueCare Tennessee, which created the CaringStart Maternity Program, an initiative focused on enrolling pregnant members in the appropriate level of BlueCare's Maternity Population Health program. Pregnant members are given a mini health risk assessment, and those whose responses indicate high-risk behaviors are enrolled in BlueCare's High-Risk Maternity program. Along with receiving assistance finding an obstetric care provider and scheduling a prenatal visit, patients are also assigned a case manager who helps develop and implement an individualized care plan. Through the program, BlueCare has seen a 17% improvement in the patient engagement rate among high-risk patients and a 3.9% increase in timely postpartum visits.