On May 15, the Center for Total Health was pleased to host a meeting of the National Governors Association’s Center for Best Practices to discuss improving birth outcomes. Nancy Goler, MD, of Kaiser Permanente’s Northern California region shared an innovation called “Early Start” that has improved birth outcomes and maternal health. It has also provided a net positive cost benefit, more than paying for itself by avoiding costs associated with preterm birth.
The Early Start mission is to provide women with access to services and support to have an alcohol, tobacco and drug free pregnancy, allowing the delivery of a healthy baby. “Our goal is complete abstinence,” Dr. Goler emphasized. The success of Early Start rests on four interventions:
- Universal screening of all pregnant women
- Co-location of a licensed mental health professional in the Department of Obstetrics and Gynecology
- Linking Early Start appointments with routine prenatal care appointments
- Educating all women and clinicians
Dr. Goler described the barriers to implementing a program such as Early Start, including the challenge for hospitals to redeploy current inpatient resources to outpatient services in order to generate savings in neonatal units, and the denial and skepticism among all levels of health care providers that substance abuse and dependency is a disease that can be treated effectively. Fortunately for Dr. Goler and her dedicated colleagues, Kaiser Permanente’s size, integration, and electronic connectivity allow us to gather large amounts of data that can reveal trends and uncover statistically and clinically significant findings within our membership. By analyzing data from prenatal screening questionnaires, lab results, clinical assessments, birth records, and cost and utilization data, Dr. Goler and her team demonstrated the clinical and cost effectiveness of the Early Start interventions. The published results can be found here. The success of Early Start highlights the impact that multi-disciplinary care teams can have on patient outcomes and professional satisfaction, and the importance of full inclusion of behavioral health treatment in prenatal care.
Dr. Goler encouraged state health officials to engage physician, hospital, health systems, and health plan leaders to consider similar programs and assist them in identifying resources to make the initial investment in behavioral health staff and training, and to create the reliable teams and systems that can screen, assess, and treat pregnant women in a non-judgmental environment.
More resources from the NGA for state health policy options can be found here.
