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From “all-in-one” healthcare appointments to coordinating women’s care for convenience, here’s how providers and researchers say plans and providers can prioritize
If you want women to prioritize their health, try to make it easier for them, says Kathryn Babich, MD, an obstetrician-gynecologist at Park Nicollet Health Services in St. Louis Park, Minnesota, who noticed that a lot of women weren’t coming in for their annual physicals. That meant these women-many of them young working women and women with children juggling careers-weren’t getting their blood tested, they weren’t getting mammograms and Pap smears, and they weren’t getting eye exams if they needed them.
BabichPark Nicollet’s solution was to ask clinical staff to sign up to work at the clinic on Saturday mornings. During this time, female patients have access to 13 different services, including mammography, wellness visits, eye exams, mental health, physical therapy, and mental health-all of which are co-located in the same health center. Babich laughs when she says that young women, in particular, often come in wearing their pajamas, but she’s just glad that they’re there.
One great example of the positive effect of preventive health screening is the Pap test, she says. As recently as the 1940s, cervical cancer was a leading cause of death among women of childbearing age in the United States. After the introduction of the Pap test in the 1950s, the U.S. incidence of cervical cancer and death rates between 1955 and 1992 declined by more than 60%.
From “all-in-one” healthcare appointments to coordinating women’s care for convenience, here are more ways providers and researchers say plans and providers can prioritize women’s health.
University of Pittsburgh Medical Center (UPMC) has taken a service-line approach to standardizing care across its hospitals that serve patients throughout Pennsylvania and parts of New York and Ohio, says Maribeth McLaughlin, RN, chief nursing officer and vice president of patient care services at Magee-Womens Hospital of UPMC.
McLaughlinOne area UPMC has focused on is reducing the rate of C-sections-and part of the health system’s success has involved building decision-support tools within the EHR to guide clinicians based on national standards, she says.
Reducing C-section rates is important because it reduces maternal mortality rates, but vaginal birth is just better for mothers and babies, McLaughlin says. Just as important are the discussions doctors have with pregnant mothers about their birth plans. In these conversations, clinicians need to discuss with women their wishes and expectations-and educate them about the fact that vaginal births lead to safer deliveries. Still, it’s important to talk to women about when their clinical team may need to deviate from the birth plan in order to provide the best outcome for the mother and her child, says McLaughlin.
As a result of its pathways-focused approach, Magee-Womens Hospital of UPMC’s repeat section deliveries rate is 16% better than the National Perinatal Information Center/Quality Analytic Services (NPIC/QAS) benchmark, and the hospital’s vaginal birth after caesarian (VBAC) rate is 75% percent better than the NIPC/QAS benchmark.
Cost is important here, too. A repeat caesarian section is 10% more costly than a VBAC, says a UPMC spokesperson.
Women around the country are working hard to manage work-life balance, and it can be difficult to get them to make preventive care a priority, says Babich. “Women are notorious for putting themselves at the bottom-whether they’re young, at midlife, or later in life,” she says. “They typically have children depending on them, a husband, and then work. All of this requires a lot of work. And a lot of the time, women just don’t come in for their preventative care and screenings,” she says.
One way to encourage more preventive care is through patient education, says Babich, particularly among the newly insured who may be unaware of the types of preventative care services they need and are entitled to.
Women need more guidance in order to stay healthy, Babich adds. One way providers can help is by educating women on how often they need to have their cholesterol tested, how often to come in for a Pap smear, how often to come in for a mammogram, and when they should get a colonoscopy, based on their family history, she says.
And coordinating care for women is very helpful, says Babich. “Women are balancing everything, and they don’t have time to take three-and-a-half days out of their schedule for various appointments. If they’re moms, they don’t want to be dragging their kids into the physician’s office. That’s why we need to coordinate care-either with technology with the EHR or a dedicated women’s health center where they can get all their care in one place.”
ShepherdIf Jessica Shepherd, MD, an obstetrician-gynecologist and director of minimally invasive gynecology at the University of Illinois at Chicago, could ask payers for one thing, it would be this: Learn more about how health issues such as fibroids and endometriosis impact women’s lives. Insurance companies need to realize how much time women are taking off work as a result of fibroids and endometriosis, and a lot of this isn’t documented in their patient history. Still, payers require a great deal of documentation in order to reimburse for hysterectomies and myomectomies, she says.
The fact is, if a woman is bleeding because of either of these conditions, she’s likely to take the day off from work, says Shepherd, who is also founder of “Her Viewpoint,” a web-based community for women’s health issues. Chances are, woman probably won’t go to the doctor’s office to be treated-and that means the occurrence isn’t being documented.
Endometriosis is a tough disease to diagnose and treat, she says. One of the successful treatments for endometriosis is to put women on birth control without placebo, which means women receive continuous hormones. In effect, those women are going through their pack of birth control pills more quickly than if they were taking placebo pills for a week. Despite that, many payers refuse at first to pay for the additional birth control pills.
SalganicoffWith all the clinical trials and research done on heart disease, most of that research is based on how men experience the disease-and that informs how heart disease is treated in this country, says Alina Salganicoff, vice president and director of women’s health policy at the Henry J. Kaiser Family Foundation. She points out that the way heart disease manifests itself within women is different, even down to the way women’s blood vessels get blocked. “We know that sex is a very important determinant of how women experience health and outcomes, so we must pay for this research,” she says.
Aine Cryts is a writer based in Boston.