Category Archives: Depression

Guest Blog Post: How the Midwifery Model Benefits Families and Payers

By: Tricia Balazovic and Dr. Steven Calvin, The Minnesota Birth Center

Childbirth is the leading reason for hospitalization in the United States.

Assuming a $10,000 savings per birth converted from cesarean to vaginal, and a reduction in cesarean rates from 30% to 20%, an employer with 25,000 covered lives and 350 births per year would see total annual savings of $350,000. This does not take into consideration additional savings from reduced neonatal care, complications and readmissions, all of which are more common for cesarean births.

From the MN Health Action Group Maternity and Infertility Employer Purchaser’s Guide.

The cost of having a baby in a hospital varies by nearly $10,000 across the United States. The analysis of 2011 data from 463 hospitals nationwide found the average bill for a maternity stay ranged from $1,189 to $11,986. Costs at hospitals with higher rates of cesarean delivery or serious pregnancy complications were much higher than those with lower rates, according to Health Affairs.

Highly variable interventional procedures (e.g., cesarean sections and early elective inductions) have been increasing dramatically over time, which is why we are committed to offering healthy, sensible alternatives. While our focus has always been on supporting the needs of our patients, in working with The Action Group on its Maternity and Infertility Employer Purchaser’s Guide, we gained a new and important perspective on the far-reaching implications these often-unnecessary procedures have on employers and other payers, too.

In our Mission Statement, we say: “The Minnesota Birth Center supports health and wellness for women throughout their life cycle in a manner that is safe and seamless. Women are encouraged and empowered through our midwife-led care model at clinics, birth centers and hospitals — which includes a medical safety net when necessary. Our core emphasis is support for the normal physiologic birth of a healthy newborn. We are committed to providing excellent clinical outcomes to satisfied women and families at a reasonable cost.”

True to our mission and complementing our work with The Action Group, we now offer the BirthBundle ® (BB), which assures access to the holistic approach of the midwifery model, coupled with complete price transparency. This innovative, comprehensive maternity and newborn service product provides better clinical outcomes to mothers at a lower cost, using a proven coordinated clinical care model that is paid as a single price for the entire prenatal, delivery and immediate newborn episode.

The BB includes the options of doula services, prenatal and parenting education, group prenatal services, water tubs for labor and birth, and self-administered nitrous oxide for pain control — all in an empowering birth environment that treats pregnancy and birth as normal events while still having an immediately available medical safety net for the rare complications.

Over 600 mothers have received care through the MBC since 2012, with high satisfaction rates and favorable clinical outcomes. Cesarean section rates are below 10 percent, and newborn outcomes are identical to those of babies born in the hospital. A majority of mothers and babies go home within 4-6 hours after birth and then have a follow-up home visit in 24-36 hours, at a cost that is substantially less than that of comparable hospital services.

With BB, we have an opportunity to start at the very beginning. We believe health care reform should start where we all did — with pregnancy and birth. The pregnancy episode is the ideal time to test new care delivery and payment models. As system changes occur and cost pressures increase, we expect the BB to become a very successful clinical and payment model across Minnesota and beyond.

Action Group members may access the Maternity and Infertility Purchaser’s Guide by logging into the Member Center from the homepage.

Guest Blog Post: Sue Abderholden Executive Director, National Alliance on Mental Illness (NAMI) Minnesota

I attended the 10th anniversary recognition event for Minnesota Bridges to Excellence where clinicians who delivered improved care resulting in better outcomes for patients with diabetes, vascular disease, and depression were honored. Delivering better care to people with these conditions can drive down the costs of health care, benefiting the people themselves and their employers.

I was especially pleased to have been invited to speak because of the attention being paid to depression. I was part of the committee that provided input into the development of the toolkit, “Help and Healing: Resources for Depression Care and Recovery.” The toolkit includes things like patient and provider talking points, treatment planning guides, and self-management techniques. Not only does it promote the involvement of family and education of the individual, it also provides information about suicide, (which has been rising in Minnesota), and recognizes that effective treatment is more than taking a pill – it involves nutrition, exercise, meditation, mindfulness and more.

Next to anxiety, depression is one of the most common mental illnesses in the U.S. According to the National Institutes of Mental Health, about 6.7 percent of U.S adults experience major depression.

While the Minnesota Health Action Group seeks to improve health, reduce health care costs and ensure the economic vitality of all Minnesota communities, reducing the impact of depression on the individual, their families and employers is equally important.

Families and employers intimately understand the impact untreated depression has on people’s lives.

As families, we watch as our loved one loses interest in once enjoyable activities, they become more distant, less responsive.

Employers see workplace productivity affected due to absenteeism and presenteeism. Employers see workers who have difficulty handling time pressures and stress, who have problems concentrating or remembering things.

Untreated mental illness results in 27 lost workdays per year, nine to sick days, and 18 to lost productivity. It is the leading cause of short-term and long-term disability. Many people with depression lose their jobs because they are unwilling to talk about their symptoms, obtain treatment, or ask for accommodations. It’s ironic since we know that work helps people get better – it provides structure, interaction with others, and a reason to get up in the morning.

So when clinicians do better at early identification of depression and improve the quality of treatment, it’s not just the patient that benefits – but their family and employer as well.

A friend of mine writes an inspiring and thoughtful blog on dealing with his depression. He recently wrote “Depression and anxiety can rob you of the desire to interact with the world:  learn nothing, do nothing, be a part of nothing. Thinking of yourself as nothing, as of no worth…or worse yet, as a drain to all that surrounds you…this is the absence of any sense of health.”

In another post, when he was really struggling with his symptoms he wrote, “During my deepest bouts with depression I cannot get myself to enjoy much of anything. And it really hurts for me not to be able to enjoy music. It’s a very weird feeling. To be so consumed with — so frustrated with, so pained by — my inability to care.

“You doubt yourself and everything you do. You are convinced you are worthless…worse than that, a drain on everyone and everything. For me, it shakes me to my core. I doubt every role I think I usually fill well: advocate, yogi, gardener, friend, husband.

“And with this doubt, comes an intense feeling of loss. I remember who I once was and what I once was capable of. And I don’t question if I will ever have that ‘me’ or those ‘capabilities’ again. In fact, I am certain I never will.”

Despite the number of people who develop depression and the effectiveness of treatment, few seek treatment. Some studies have reported that people live with their symptoms an average of 10 years before seeking help.

Think of how much pain they and their families must experience before they seek help. We do know that stigma plays a role in the reluctance to seek treatment.

People worry about what others will think and frankly, mental illnesses are the “no hot dish” illnesses – you don’t get meals brought over, there are no get-well cards or CaringBridge sites.

Starting the dialogue in every clinic, by asking a few simple questions, is how we break down these barriers, how we make it O.K. to talk about depression, thus opening the door to talking about other mental illnesses as well.

Depression, even the most severe cases, can be effectively treated. But the earlier treatment can begin, the more effective it is.

I am grateful for the work everyone involved with Minnesota Bridges to Excellence does to help people get better, to not be disabled by their depression. The outcomes are impressive, and the financial rewards are validating, but the true reward comes in having helped people recover from their depression and let them take on their roles again as a family member, friend, employee and contributing member of our communities. Providing hope for recovery is the best reward of all.

Sue Abderholden is Executive Director at National Alliance on Mental Illness (NAMI) Minnesota