New Jersey
About the Team
The New Jersey team is composed of:
- The NJ Department of Human Services, Division of Medical Assistance and Health Services (DMAHS)
- Horizon Blue Cross Blue Shield of New Jersey (Horizon)
- RWJBarnabas Health System (RWJBH): The Newark Beth Israel Medical Center (through March 2023)
The New Jersey team is working to reduce health inequities in mood disorder diagnoses and treatment within their Black perinatal patients. New Jersey is ranked 47th in the nation for perinatal/postpartum related deaths and has one of the widest racial disparities. The Governor’s office has prioritized reducing those inequities through their Nurture NJ campaign, which was launched in 2019. Nurture NJ bolstered existing efforts to reduce inequities across the state and launched new ones, creating a supportive environment for the New Jersey LC team’s AHE initiative.
Identifying and Diagnosing the Problem
The New Jersey LC team examined all Medicaid-managed-care births from 2016 to 2018 and identified measurable health disparities in mood disorder diagnoses and treatment within their Black perinatal and postpartum patient population. They compared the results of the data to national statistics which led to the presumption that the current diagnosis and treatment process was systemically underdiagnosing black individuals.
To better understand the contributors to racial health inequities, the New Jersey LC team conducted a root cause analysis where they surveyed providers to understand barriers for their patients accessing high-quality perinatal and postpartum care and mood disorder services. The team also conducted a patient journey mapping exercise together to understand each touchpoint a patient has across partnering organizations from pre-conception to delivery.
Through the root cause analysis process, the team assessed whether the surveys used to diagnose postpartum depression and anxiety were valid for low-income, Black postpartum patients. The tools were originally developed and validated using white female subjects and have not been validated in other populations.
There is a lack of research and guidance from organizations (e.g. ACOG, CDC) on how to use the surveys across different populations, including Black perinatal Medicaid members. As a result, the team explored ways to encourage a more holistic approach that ensures providers consider more than survey results when diagnosing postpartum mood disorders.
Designing and Implementing Change
The team seeks to bolster existing behavioral health virtual support groups and establish new resources and education for patients and providers that are tailored to Black perinatal patients. The team is partnering with the Partnership for Maternal and Child Health of Northern New Jersey, a community-based organization in Newark with robust perinatal health programming to support the provider education component of their intervention. The team plans to evaluate the virtual support group and patient and provider education components and will determine a payment strategy to support efforts based upon those results.
Lessons Learned
Health inequities are deeply ingrained throughout our systems (e.g. healthcare, research, education, etc.) and oftentimes, as potential causes and solutions are explored, the size of the problem can feel insurmountable. What is more, perfection is often the enemy of progress. To not make a change is a decision to maintain the status quo. Small changes with intentional evaluation can be one way to advance equity, incrementally improving systemic health inequities.