Grand Rounds

Should We Financially Incentivize Interventions to Prevent Postpartum Depression?

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

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

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

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

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