By Joy Burkhard, MBA
The U.S. Preventive Services Task Force (USPSTF) recently released a draft recommendation addressing screening women at risk in order to provide counseling as preventive care: Perinatal Depression: Preventive Interventions. You might recall following the 2015 American College of Obstetrics and Gynecology recommendation to its members to screen for maternal depression and anxiety, the Task Force issued a similar recommendation in 2016. The USPSTF recommendations consider volumes of research, and they matter not just because it’s a comprehensive review, but because the Affordable Care Act requires that health insurers cover the preventive services recommended by the Task Force.
We Convened a Group to Review the New Draft Guideline
In response to receiving the Task Force’s latest draft statement on preventive screening, 2020 Mom hosted a call with several researchers, national non-profit organizations and associations to review the recommendations together, with each organization being encouraged to submit comments independently. Overall, the recommendations were met with enthusiasm about intent as well as with some concern regarding implementation (which the USPSTF doesn’t consider).
Evidence Gathering is Thorough
At least one in our group had received the 60+ page comprehensive review of research surrounding both risk factors and treatment, like cognitive behavioral therapy, proven to mitigate risk of perinatal depression for those who may have increased risk. In our field, it can be challenging to collate research given the use of different terms used for the disorders and groups of disorders we address. The USPSTF FINDS research. The purpose of their public comment periods are primarily to ensure research hasn’t been missed.
The group we convened to review this preventive screening recommendation discussed and acknowledged several things:
1. How grateful we all are for the incredible momentum in the field at this time.
2. Whether prevention is the right term or if risk mitigation might be a more appropriate frame.
3. The need for a standardized screening tool to assess risk.
4. The urgent need to build up the therapy base which, right now, isn’t large and dispersed enough to address the volume of women who are already suffering from maternal mental health disorders.
Once the final USPSTF guideline is released, health insurers must cover such screening at zero dollars copay. Like the USPSTF’s original recommendation to screen for maternal depression, there is no requirement for insurers to increase reimbursement rates. However, when insurers do decide to take note and announce that rates are increasing to providers like OBGYNs (who are considered primary care providers during pregnancy and the early postpartum period), they will be sending the message to OBGYNs that the health care system expects them and supports them in screening and directing treatment and preventative care.
If insurers don’t act directly and proactively (which generally hasn’t happened as this provider financing need simply isn’t thought of by those who implement required changes to benefit plans), this request and push should come from our collective field, driven by the American College of Obstetrics and Gynecology.
Treatment Build Up is Critical
It’s time to build up treatment in our communities and states. And it’s time to think of how to scale, and scale fast. All of us should be outreaching our local hospitals, and large hospital health systems. Given that 99% of U.S. births happen in hospitals and all OBGYNs are affiliated with hospitals, these are ideal providers to scale outpatient preventive and group therapy services (and inpatient services).
The surge of interest that we’ve all been working for is here, it’s finally here.
If you have ideas you’d like to share, we want to hear them! Please share them with us in the comment field below.