04/08/2024
Prenatal and postpartum care contributes to the long-term well-being of new mothers and their infants, according to the American College of Obstetricians and Gynecologists. We encourage you to talk with our members about the importance of attending all care visits during and after pregnancy.
We track the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures related to our members’ maternal health:
Prenatal and Postpartum Care measures the percentage of deliveries in which members:
- Had a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment with Blue Cross and Blue Shield of Texas.
- Had a postpartum visit on or between seven and 84 days after delivery.
Prenatal and Postpartum Depression Screening and Follow-Up measures the percentage of deliveries in which members:
- Were screened for clinical depression during pregnancy and the postpartum period using a standardized instrument, and
- Received follow-up care within 30 days if the screening was positive.
Tips to Close Gaps in Prenatal and Postpartum Care
- Check with our members to ensure that initial prenatal visits are scheduled in the first 12 weeks of pregnancy with an OB-GYN, primary care physician or other prenatal practitioner.
- A postpartum visit must take place on or between seven and 84 days after delivery. Be aware that post-operative visits within six days after discharge don’t count as a postpartum visit. Members who have cesarean sections should be reminded to schedule their postpartum care visit during the C-section post-op visit.
- Data for this measure is collected from claims and chart review for services performed by an OB-GYN, midwife, family practitioner or other PCP. Services provided during telehealth visits, e-visits and virtual check-ups are eligible for reporting to meet the measure.
Tips to Close Gaps in Prenatal and Postpartum Depression Screening and Follow-Up
- Ask members during their pregnancy and postpartum to complete an age-appropriate depression screener, such as the Patient Health Questionnaire (PHQ)-9 or -2, or the Edinburgh Postnatal Depression Scale.
- If the depression screening is positive, follow up within 30 days with one or more of the following, as appropriate:
− Additional evaluation for depression
− Suicide risk assessment
− Referral to a practitioner qualified to diagnose and treat depression
− Pharmacological interventions
− Other interventions or follow-up for the diagnosis or treatment of depression
- Coordinate care between behavioral health and other health care providers. Consider case management.
Resources
- Preventive Care Guidelines for providers
- Perinatal Wellness Guidelines for members
- Earn continuing education credit: Watch a recording of our webinar Maternal Mental Health: Pregnancy and Postpartum. Sign in here (registration required) to access the recording.
HEDIS is a registered trademark of the National Committee for Quality Assurance.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.