Measuring Perinatal Behavioral Health

Beacon, December 2, 2024

In 2023, the Bree released guidelines on best practices for addressing perinatal behavioral health. This is the first report for which the Bree has been able to consider a prospective evaluation on the uptake and effectiveness of one of it’s reports. We chose to conduct an evaluation on this report for a variety of reasons, including our access to a unique data set through our sister program, OB COAP, that can provide data on patient outcomes at an aggregate level. In 2024, we started our call for data submissions for this report to collect baseline data on current processes so that we can measure how changes associated with the adoption of our guidelines influences the outcomes for patients and the organizations that serve them.

Since it’s inception, the Bree Collaborative has addressed many topics in both the sphere of behavioral health and perinatal health. Guidelines on topics around Addiction and Dependence Treatment, Opioid Use Disorder Treatment, and Behavioral Health Integration have seen fairly wide adoption among Bree members and stakeholders. While obstetrics has also had wide adoption, the Perinatal Payment Bundle Model has met with some larger barriers. In 2022, our evaluation of past Bree topics suggest that while uptake has generally been strong the implementation of various components of these reports varies greatly.

High uptake

• Training staff on stigma and bias
• Changes to patient costs and reimbursements OR financing changes (all)
• Improvements in collaborative care workflows

Med uptake

• Screening changes (OUD/SUD use)
• Treatment changes/best practices (all)
• Changes to policies and procedures (obstetrics)

Low

• Full integration of behavioral health
• Use of metrics and data exchange (primarily patient-centric measures, behavioral health, and use in commercial contracts)
• Patient education (obstetrics)

Still, we see organizations that have been successful overall in implementing these guidelines. The Bree has recently given awards for best practices for one or more of these three behavioral health reports and the obstetrics report to Community Health Plan of Washington, HealthPoint, UW Medicine and UW Physicians, Kaiser Permanente, UnitedHealthCare, and MultiCare. As a our primary lever of implementation, the Washington State Health Care Authority has been able to integrate our behavioral health topics as well as our obstetrics topic into their Medicaid contracts through a variety of different areas of work.

What we can glean from the information we have collected so far is that interest in both mental health and pregnancy health is strong, but that many barriers still exist for full integration of care for both. Our previous evaluations also inform us about data exchange and data use as a continuing barrier for behavioral health in particular.

As the Bree evaluation program has developed we have not only been able to create more tools to measures specific report implementation, we have also started to develop strategies to pull our areas of work together and demonstrate how they intertwine and build on each other to bring transformation to the Washington State Health Care system. Our multi-year effort around the measurement of our Perinatal Behavioral Health report is one more step in this process. Over the next three years we will work with the HCA to better understand how they have implemented Perinatal Behavioral Health into contracts and continue to reach out to organizations that serve pregnant and birthing people to understand which gaps are closing and which are not.

So, how can measurement help and why is this important to measure this topic now? Those who are pregnant or who have recently given birth may be seen as indicators for behavioral health integration and tell use whether our system is improving on best practices to serve the most vulnerable people and people who are in a vulnerable time of their lives. Measurement can help identify which components of this report have the most impact and serve as a guide for iterative processes of implementation and quality improvement. It’s important to begin by measuring where we are so we can better understand how far we have gone. This topic is particularly important because Washington State as reaffirmed it commitment to safe, quality perinatal care for all and we can provide a roadmap for how to achieve and sustain that commitment.

For information on how to participate in our Baseline Data Collection effort, please visit the Current Evaluation Projects page under the Evaluation tab on our website.

Karie Nicholas, M.A., G. Dip, Measurement and Evaluation Manager