What We’re Reading
By Joy Burkhard, MBA
Founder and Executive Director, 2020 Mom
In this issue, articles covering solutions for addressing long-standing health inequities are proposed, two new treatments are discussed and as well as cost as a significant barrier to health in the U.S. both perinatal women and men generally. Also in this issue are conflicting findings about whether patients are finding more in-network behavioral health providers. My take (and personal experience) is that they are, through virtual behavioral health companies that are contracting with insurers, like Happier Living and other virtual provider network companies.
MEDICAL COVERAGE
Those with Non-Medicaid Health Care Benefits Have Increasing Access to Mental Health Providers
A survey of commercial (private) health insurers revealed insurance companies are rapidly growing their behavioral health provider networks by actively recruiting, increasing payments and training primary care physicians to care for more behavioral health conditions.
New Legislation Calls for Creation of Model Based on Health Equity
New legislation in the House and Senate aims to increase the role of health equity in the development of value-based payment models, including a demand that the Biden administration create a model specifically on dual-eligible beneficiaries, behavioral health and maternal mortality.
The John Lewis Equality in Medicare and Medicaid Treatment Act, introduced by Rep. Terri Sewell, D-Alabama, aims to advance equity in the work of the Center for Medicare and Medicaid Innovation (CMMI).
Medicaid Postpartum Coverage Extensions: Approved and Pending State Action as of July 13, 2022
To help improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act of 2021 gives states a new option to extend Medicaid postpartum coverage to 12 months via a state plan amendment (SPA). This new option took effect on April 1, 2022 and is available to states for five years. The Centers for Medicare and Medicaid Services (CMS) released guidance on December 7, 2021 on how states can implement this new option. This graphic tracks recent state actions to implement extended Medicaid postpartum coverage, including states that have implemented a 12-month postpartum extension, states that are planning to implement a 12-month extension, states with pending legislation to seek federal approval through a SPA or 1115 wavier, and states that have proposed or received approval for a limited coverage extension.
Phantom Networks: Discrepancies Between Reported and Realized Mental Health Care Access in Oregon Medicaid
In a review of in-network providers listed in Oregon Medicaid directories, researchers found that 59-67% of mental health providers weren't actually seeing Medicaid patients. "If the majority of providers are not actually accessible, it leads to delays and interruptions in care and treatment that people need," said study author Jane M. Zhu, MD, of Oregon Health & Science University, in a statement. (Health Affairs)
Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care
Pregnancy is one of the most common reasons for a hospitalization among non-elderly people. In addition to the cost of the birth itself, pregnancy care also involves costs associated with prenatal visits and often includes care to treat psychological and medical conditions associated with pregnancy, birth, and the post-partum period.
This analysis examines the health costs associated with pregnancy, childbirth, and post-partum care using a subset of claims from the IBM MarketScan Encounter Database from 2018 through 2020 for enrollees in large employer private health plans. It finds that health costs associated with pregnancy, childbirth, and post-partum care average a total of $18,865 and the average out-of-pocket payments total $2,854. The analysis also examine how pregnancy, childbirth, and post-partum health spending among large group enrollees varies by the type of delivery.
SOCIAL DETERMINANTS OF HEALTH
Improved SDOH Data Collection, Interoperability Needed for Health Equity
Standardized SDOH Data Collection Is a Must
Standardized social determinants of health (SDOH) data collection is a must, according to panelists at an Office of the National Coordinator Health Information Technology Committee (HITAC) hearing. What else is needed? Closed-loop referral processes to inform health equity efforts. Hannah Nelson reports critical categories for data collection include race, ethnicity, sex, language, disability status, and SDOH.
TREATMENTS
Sage, Biogen Get Rolling On FDA Submission for Depression Med
Sage Therapeutics and Biogen’s zuranolone is heading off to the FDA for consideration in treating major depressive disorder (MDD) as a two-week, once-daily drug to bridge the time it takes for traditional therapies to kick in.
The companies announced that a rolling submission has been kicked off, and the application is expected to be completed in the second half of the year, according to a release.
1-Day Online CBT-Based Workshop Helped New Moms With Postpartum Depression
A 1-day interactive workshop, delivered via Zoom and based on Cognitive Behavioral Therapy (CBT), when added to “treatment as usual,” reduces symptoms of women with PPD.
RESEARCH
Don’t Stress: Maternal Stress Affects Child’s Diet
Maternal exposure to stress during pregnancy could have long term detrimental effects on their children’s diets, and thereby on health conditions related to diet – such as increased levels of obesity and obesity-related diseases – according to new research.
Brain Changes Diverge Between Men and Women
— White matter hyperintensities volume accelerate after menopause
White matter hyperintensities -- small brain lesions associated with cognitive impairment or stroke risk -- were more common in post-menopausal women than they were in men of similar age, cross-sectional data showed.
Premenopausal women and men of the same age, however, had no difference in white matter hyperintensities burden, according to Monique Breteler, MD, PhD, of the German Center of Neurodegenerative Diseases in Bonn, and co-authors.
BREASTFEEDING
There’s Nothing About Maternal Mental Health in the American Academy of Pediatrics’s Updated Policy Statement
The American Academy of Pediatrics recently released an updated policy statement on breastfeeding that suggested increasing the duration of breastfeeding to two years or more from one year or more. This is the first update to the breastfeeding recommendations in a decade.
DETECTION, SCREENING & DIAGNOSIS
National Cross-Sectional Study of Mental Health Screening Practices for Primary Caregivers of NICU Infants
This was the first study to investigate the national prevalence of routine mental health screening for parents and other primary caregivers in the NICU. We found that less than half of NICUs routinely screened parents for PPD, and nearly one-quarter of the NICUs did not screen at all. Where routine screening was provided, significant variation existed in the timing of screening and instruments used. Fathers and other primary caregivers were frequently excluded from screening, and rarely underwent site screening for symptoms of anxiety or PTSD. While the presence of mental health professionals such as psychiatrists, psychologists and mental health nurse practitioners appears to be an important facilitator for implementing screening, significant barriers related to reimbursement and a lack of funding limits their broad availability.
Study Finds the Cause Behind Women Experiencing Higher Rates of Depression Than Men
Although treatments for depression exist, sometimes these treatments don't work for many who use them. Furthermore, women experience higher rates of depression than men, yet the cause for this difference is unknown, making their illnesses, at times, more complicated to treat. Results highlight a molecular mechanism contributing to the lack of motivation often observed in depressed patients. Reduced function of proteins like Rgs2 may contribute to symptoms that are difficult to treat.
INTERRELATED
Feeling Anxious About the End of Roe v. Wade? Experts Discuss Mental Health Implications
The majority of Americans support legal abortions at least most of the time, repeated polls have shown, with 61% saying that abortion should be legal in most or all cases, according to a recent survey by the Pew Research Center.
The Facts About Abortion and Mental Health
Scientific research from around the world shows having an abortion is not linked to mental health issues but restricting access is.
More than 50 years of international psychological research shows that having an abortion is not linked to mental health problems, but restricting access to safe, legal abortions does cause harm. Research shows people who are denied abortions have worse physical and mental health, as well as worse economic outcomes than those who seek and receive them.
Meanwhile, the same research shows getting a wanted abortion does not cause significant psychological problems, despite beliefs to the contrary. In a landmark study of more than 1,000 women across 21 states, those who were allowed to obtain an abortion were no more likely to report negative emotions, mental health symptoms, or suicidal thoughts than women who were denied an abortion.
Large longitudinal and international studies have found that obtaining a wanted abortion does not increase risk for depression, anxiety, or suicidal thoughts (The mental health impact of receiving vs. being denied an abortion, Advancing New Standards in Reproductive Health, 2018).
Where the Risks of Pregnancy Meet Abortion Laws and Health Care
Even before the wave of abortion bans, medical treatment and advice for pregnancy has largely focused on fetal safety over the mother’s.
RACE
Racial Disparity in Maternal Mortality Rate “One of the Biggest Challenges of Public Health,” Harvard Expert Says
Washington — The number of women who die during or shortly after childbirth is higher in the U.S. than any other developed nation, particularly among women of color. Determining the cause of that racial disparity poses "essentially one of the biggest challenges of public health," the head of a Harvard task force studying the issue said Sunday.
"We see that as a top of the iceberg of poor health in women and poor health in Black women," Dr. Henning Tiemeier, the director of Harvard's Maternal Health Task Force, said in an interview on "Face the Nation." "And there are several reasons, there seems to [be], from poverty to discrimination to poor care for this group of women."
Pandemic Widened Disparities in Postpartum Care, Study of Boston-Area Women Finds
Black and Hispanic women in the Boston area who delivered babies during the pandemic were less likely than their white counterparts to schedule doctor’s appointments after giving birth, according to a recent study by researchers at Brigham and Women’s Hospital.
The research found that postpartum care, after dropping among all races in the first quarter of 2020, rebounded more slowly among Black and Hispanic parents.
Racism, Mistrust Exacerbate Psychiatric Conditions in Minority Perinatal Patients; New Approaches Needed to Reduce Healthcare Disparities
Deeper understanding of medical mistrust among pregnant and postpartum racial and ethnic minority women, as well as collaborative care models and community partnerships, can help to mitigate racialized healthcare disparities in this patient population, suggests a new paper in Harvard Review of Psychiatry.
TECHNOLOGY
Can Wearables Turn Temperature Into a Pregnancy Test?
Your smartwatch can ping you about an irregular heartbeat. Your phone can assess your fall risk. And now, research suggests temperature trends picked up by wearables can tell you if you’re pregnant before you even think to take a test.
RISK & PREVENTION
Regional Differences in Various Risk Factors for Postpartum Depression: Applying Mixed Models to the PRAMS Dataset
Conclusions: There was no significant difference in symptom severity scores across the 39 participating states. Most notably, postpartum depression symptom severity was associated with previous depression diagnosis and previous symptom severity, but our results also reveal novel social and education factors that contribute to the support and well-being of the mother and child.
American Men Are Sicker and Die Sooner Than Peers in Other High-Income Countries
A damning new report on the U.S. health care system says that men in the U.S. are more likely to have serious medical conditions, die from avoidable causes, and feel the system does not meet their needs than men in 10 other high-income countries. Personal income matters: U.S. men of average or below-average means were less likely to receive preventive care, more likely to have difficulty affording their care, and more likely to have physical and mental health conditions. Men in the U.S. are significantly more likely to skip or delay needed care because of cost.
The Commonwealth Fund analysis found one bright spot: U.S. men had the lowest rate of prostate cancer deaths. If you’re wondering about women, a previous Commonwealth Fund study also found poor health care access and outcomes for U.S. women of reproductive age.