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Grand Rounds

Should We Financially Incentivize Interventions to Prevent Postpartum Depression?

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BACKGROUND AND PURPOSE:

  • Value-based payment (VBP) models often rely on preventative services that focus on short term cost containment (see ‘Related ObG Topics’ below for more on VBP)
  • However, the majority of savings from preventing postpartum depression (PPD) may accrue later in a patient’s journey 
  • Counts et al. (JAMA Network Open, 2022) examined whether sharing 5-year expected savings resulting from reduced PPD incidence may offer stronger incentives for prevention than traditional VBP

METHODS:

  • Decision analytic model
  • Population
    • Simulated cohort of 1000 Medicaid-enrolled pregnant individuals
    • Cohort designed to be reflective of the demographics characteristics of pregnant individuals receiving Medicaid
  • Exposure
    • Sharing 100% of 1-year actual health care cost saving
    • Sharing 50% of 5-year estimated health care cost savings with reduced PPD incidence
  • Study design
    • Health care costs for individuals receiving PPD preventive intervention, and those who were not receiving intervention, were estimated for 2020 to 2025
      • Over 1 or 5 years postpartum
      • In a variety of scenarios, e.g., varying rates of Medicaid churn (transitions to a new Medicaid managed care plan, commercial insurance plan, or loss of coverage)
    • In addition to the primary outcome, the likelihood of the health care payer realizing a positive return on investment if it shared 50% of 5-year expected savings with a clinician up front was also measured
  • Primary outcome
    • Amount of clinician incentive shared in a VBP model from providing preventive interventions

RESULTS:

  • Estimated 5-year savings with providing preventive interventions for PPD: $734.12 (95% credible interval [CrI], 217.21 to 1235.67) per person
  • Without health insurance churn, sharing 50% of 5-year expected savings could offer more than double the financial incentives for clinicians to prevent PPD vs traditional short-term VBP
    • 50% of 5-year savings: 367.06 (95% CrI, 108.61 to 617.83)
    • 100% of 1-year savings: 177.74 [95% CrI, 52.66 to 296.60)
  • There was a high likelihood of positive return for the health care payer: 91%
  • As health insurance churn increased, clinician incentives from sharing estimated savings decreased
    • With 50% annual churn: 73% reduction

CONCLUSION:

  • VBP systems for incentivizing prevention of PPD yielded higher financial incentives for clinicians when savings were shared over 5-years vs standard 1-year models
  • As health insurance churn increased, the clinician incentives decreased
  • These results support implementing policy to reduce health insurance churn and implement savings sharing as a method of improving implementation of PPD preventative services

Learn More – Primary Sources:

Comparison of Estimated Incentives for Preventing Postpartum Depression in Value-Based Payment Models Using the Net Present Value of Care vs Total Cost of Care

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Related ObG Topics:

What is Value Based Payment?
How Accurate is the Edinburgh Postnatal Depression Scale for Detecting Antepartum and Postpartum Depression?
The Four Maternal Characteristics that Predict Postpartum Depression Severity
Can Omega-3 Supplements Ameliorate Symptoms of Postpartum Depression?

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