April 9, 2025
We track Healthcare Effectiveness Data and Information Set (HEDIS®) measures related to prenatal and postpartum care visits and depression screening to help ensure our members receive appropriate care. To support quality care, we encourage you to talk with our members about attending all care visits during and after pregnancy. Learn more about the measures below, as well as tips to close gaps in members’ care.
Prenatal quality measures
- Prenatal Care measures the percentage of deliveries in which members had a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment with Blue Cross and Blue Shield of Illinois.
- Prenatal Depression Screening and Follow-Up measures the percentage of deliveries in which members were screened for clinical depression during pregnancy using a standardized instrument and received follow-up care within 30 days if the screening was positive.
Postpartum quality measures
- Postpartum Care measures the percentage of deliveries in which members had a postpartum visit on or between seven and 84 days after delivery.
- Postpartum Depression Screening and Follow-Up measures the percentage of deliveries in which members were screened for clinical depression during postpartum period using a standardized instrument and received follow-up care within 30 days if the screening was positive.
Tips to close gaps in prenatal and postpartum care
- Check with our members to ensure that initial prenatal visits are scheduled within 14 weeks gestation with an OB-GYN, primary care provider or other prenatal practitioner.
- Ultrasound and lab results alone aren’t considered a visit for the prenatal care measure. The results must be combined with an office visit with an appropriate practitioner.
- A pap test doesn’t count as prenatal care for this measure. It is acceptable for postpartum care as evidence of a pelvic exam.
- A postpartum visit must take place on or between seven and 84 days after delivery. Be aware that post-operative visits within six days after discharge don’t count as a postpartum visit. Members who have cesarean sections should be reminded to schedule their postpartum care visit during the C-section post-op visit.
- Data for the prenatal and postpartum care measures is collected from claims and chart review for prenatal and postpartum services performed by an OB-GYN, midwife, family practitioner or other PCP. Services provided during telehealth visits, e-visits and virtual check-ups are eligible for reporting to meet the measures.
Tips to close gaps in depression screening and follow-up
- Perform an age-appropriate depression screener, such as the Patient Health Questionnaire (PHQ)-9 or -2, or the Edinburgh Postnatal Depression Scale, during a member’s pregnancy and postpartum care.
- If the depression screening is positive, follow up within 30 days with one or more of the following, as appropriate:
− Additional evaluation for depression
− Suicide risk assessment
− Referral to a practitioner qualified to diagnose and treat depression
− Pharmacological interventions
− Other interventions or follow-up for the diagnosis or treatment of depression
- Coordinate care between behavioral health and other health care providers.
Provider resources
- Preventive Care Guidelines for providers
- Behavioral Health Clinical Practice Guidelines for providers
- Earn continuing education credit through our webinar on Maternal Mental Health. Sign in here (registration required) to access the recording.
- Watch our video for providers on prenatal and postpartum depression screening.
- March of Dimes® courses on maternal mental health offer continuing education credit through May 13, 2025. Learn more.
- The Texas Pediatric Society offers courses and resources on postpartum depression and NICU pediatrics. Learn more.
Resources to share with members
- Perinatal Wellness Guidelines
- Video for members on prenatal and postpartum depression screening
- For our Federal Employee Program® members, a video on the importance of prenatal and postpartum care
- Information about Special Beginnings®, our maternity program for members that supports early identification of pregnancy risk factors, education and help managing high-risk conditions
HEDIS is a registered trademark of the National Committee for Quality Assurance.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.