A Collaborative Approach to Connecting New Mothers to Mental Health Services
By Stephanie Costa, M.D., Kingsdale Gynecologic Associates
Chair, Department of OB/GYN, Riverside Methodist Hospital
 
I have been a practicing physician in the Columbus area for over twenty years. During that time I have enjoyed cultivating a deep relationship with patients, and I especially enjoy the partnership that develops over the course of one or more pregnancies with my patients. Understandably, it saddens me to see vibrant and loving young women affected by depression or anxiety. Because of the many changes that happen in the body during pregnancy and the postpartum period, women are at risk for developing mood disorders during this otherwise exciting time.  Couple that with social expectations to be strong, multitasking superwomen, and many of my patients start to struggle during their pregnancy. This can become increasingly problematic during the postpartum time when sleep deprivation and uncertainties about parenting, not to mention any pre-existing life circumstances or stressors, also come into play.
 
When I had identified depression or anxiety in my patients in the past, I found that attempts to connect patients to resources for counseling/therapy were less than ideal. It was very difficult and time consuming to try to find an affordable and accessible therapist for patients. When I learned about the planned work between the Healthcare Collaborative of Greater Columbus (HCGC) and Perinatal Outreach and Encouragement for Moms (POEM), I felt I needed to become involved in this effort to improve women’s access to quality mental health care. 
 
The recent collaboration between HCGC, POEM, and community OB/GYN’s and Pediatricians has already been impactful.  POEM has provided an easy, streamlined referral process that has markedly decreased the amount of time our office staff has spent making mental health referrals. Once our staff has made an online referral to POEM, our patients typically have a kind voice reaching out to them within 24 hours to arrange their mental health referral. This decreases stress on the patient, and gives them a source of hope that things will improve. Because of the communication back from POEM, I am better able to follow up on a treatment plan for patients. Another important benefit is the increased screening and awareness in our office. Instead of only screening at the postpartum visit, we are now screening at the initial OB visit, at the start of the third trimester, and again postpartum. Our pediatric partners are screening for depression and anxiety when new mothers are taking their baby in for newborn checkups. With the increased screening, patients are becoming aware of symptoms and realizing how common mood disorders are. Many women have not reached out for help previously. Now, I feel we are able to better identify mood disorders and refer before symptoms escalate.
 
By identifying depression or anxiety earlier, we are hoping to not only improve how women are feeling, but also to have an impact on the health of the infant. Studies have shown that infants born to mothers with anxiety or depression are at increased risk for growth restriction, difficult deliveries, feeding issues, bonding issues, and decreased mental development. Perhaps this work will ultimately reduce the rate of neonatal morbidity and mortality in our community in addition to improving the quality of life for mothers.  I have noticed that once we have identified anxiety or 
depression in a patient, then initiated treatment, women seem to enjoy their pregnancies more, and are better able to juggle the complexities of the postpartum period. Furthermore, when patients become pregnant again, they are recognizing symptoms and enlisting the help of available resources so they are better able to handle pregnancy and life stressors.
 
It has been rewarding and invigorating to join HCGC, POEM, and pediatric colleagues to make a meaningful impact on the health and well-being of women and infants in Central Ohio. It also makes me realize that if each one of us contributes in some small way, we can create a shift toward better health for our community.

By Jenelle Hoseus, MBA, Executive Director, Central Ohio Pathways HUB
 
With its long-standing history of catalyzing collaboration, HCGC took on an exciting new program earlier this year. As of January 1, 2019, HCGC began management of the Central Ohio Community Pathways HUB.

Previously managed by the United Way of Central Ohio, the work was transferred to HCGC, and we have spent the last several months working through the details and creating processes to ensure the success of the program. Through an RFP process, six new Care Coordination Agencies (CCAs) were selected and the program went live on March 1st! We are so excited to have such an incredible group of local partners to facilitate the work of the HUB. The new CCAs are:

• The Breathing Association
• CelebrateOne
• Franklin County Public Health
• Physicians CareConnection
• PrimaryOne Health
• Wellness First (formerly African American Alzheimer’s and Wellness Association)

How the Model Works and Early Successes
The aforementioned CCAs all employ Community Health Workers (CHWs) who work in the local community to find at risk individuals and connect them to services to help them achieve better health outcomes and reduce health disparities.

The 19 CHWs and their 11 supervisors are putting in tireless effort and it’s already showing in the data. In the first twenty days of the program, CHWs have engaged 44 clients and identified 260 Pathways, or connections to care and services, to meet their needs. We are elated that the work has gotten off to such a resoundingly positive start.
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Many may know the Pathways model in the infant mortality space – where studies have shown remarkable return on investment. Buckeye Health Plan’s study of the efforts in Northwest Ohio showed $2.36 ROI for every dollar spent on the program. We fully intend to use this program for the Infant Mortality Pathway in Central Ohio, but plan to also focus on the other 19 Pathways. Our aim is to utilize all 20 Pathways available through the HUB to ensure people across the region with varying health needs can benefit from the connections made through this model. To learn more about the HUB and the 20 Pathways, visit the Central Ohio Pathways HUB page of our website.

Sharing the work of the HUB with the Community
On March 19th the HUBs from around Ohio came together to host an Advocacy Day at the Capitol to engage and educate our legislators about the work we do. Representative Mark Romanchuk (R), Minority Leader Emilia Sykes (D), and Commission on Minority Health Director Angela Dawson came to support our efforts and helped the HUB representatives with targeting messaging for legislative visits. Having their support in our attempts at the Statehouse has been invaluable and appreciated.

On April 18th, HCGC will host a Regional Learning Session focused on Population Health, where we will be holding a specific discussion around our efforts with the HUB. All six CCAs have been invited to come speak about their mission and experiences to date with the model. For more information and to register for the session, please click here.

As we look forward, we are planning to truly make a difference for those most in need in Central Ohio. The work that the CHWs are doing will go on to impact hundreds, even thousands of lives. To be able to be a part of this necessary and impactful work is an honor for the entire HCGC team.  If you are interested in learning more about the HUB, please contact me at jenelle@hcgc.org.

By Krista Stock, Vice President of Quality and Transformation, HCGC
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Earlier this month, HCGC hosted a webinar focused on exploring price and quality transparency. Jeffrey Geppert of Battelle Memorial Institute and Dominic Lorusso and Lewis Baez of FAIR Health presented about how price and quality transparency have evolved and where there is opportunity for improvement. If you missed it, you can review slides and resources by clicking here.
 
HCGC continues to ask ourselves and the community, “does higher quality equate to lower costs in healthcare?”  Related, we have been pondering questions like, “is there more we can be doing as a community with cost and quality transparency efforts?” And, “what data are most useful for consumers, employers, providers, enrollees, and others?” We believe these strategic questions will help guide HCGC improvement efforts in partnership with the community.
 
Since 2014, HCGC has been leading the quality transparency project with our provider partners to collect and share quality data for specific measures that they collaboratively identify as important for patient care. The performance data are shared among the project partners to help one another better understand how we perform as a region and to identify opportunities for improvement.
 
We initially learned from this project that the process of collecting the data is difficult. Information systems, such as electronic health records, were not primarily developed to support data collection of the clinical care processes. But, they continue to evolve and improve to help providers monitor gaps in care and ways to improve how care is delivered. Beyond the data collection, project partners learned that being transparent is a positive experience and allows all of us to gain new insights into how we can work together to make improvements within our organizations and across our community. Project organization partners, representing 140 primary care practice sites across Central Ohio, currently include:
 
Berger Health Partners
Central Ohio Primary Care
CompDrug
Concord Counseling
Heart of Ohio Health Center
Hilliard Family Medicine
Holzer Health System
Lower Lights Christian Community Health Center
Mount Carmel Medical Group
OhioHealth
The Ohio State University Wexner Medical Center-Primary Care
PrimaryOne Health
Southeast, Inc.
Syntero
 
We have new providers joining this project every year and look forward to broadening the impact this work has across the region. To learn more about who participates and the collaborative work these providers are doing in the community, please go to our website or contact me at krista@hcgc.org
 
During our webinar earlier this month, we heard that cost data are difficult to find. Recent price transparency efforts and mandates for hospitals to post their prices online are a good first step, but don’t necessarily provide a clear picture of what a patient might actually pay for a service. What can consumers do? One resource for getting cost estimates for specific healthcare services is FAIR Health. Beyond that, talking with their health plan, employer, and provider are good ways to start better understanding price and costs and to potentially avoid surprise medical bills. Recently, HCGC created a data subcommittee of our Board to look at issues of claims data, quality data, and engagement of community employers to see if there are ways we can all collaborate and translate various data sources into useable information for all of us.
 
We are excited to continue supporting transparency efforts in our community and we hope that others will join these efforts. If you are interested in learning more, please reach out and become involved.