Maureen Hennessey, PhD, CPCC, CPHQ | SVP, Director of Value Transformation
May is Mental Health Awareness Month, and it’s an important moment to focus on an issue that remains widely misunderstood and under-addressed: depression among older adults.
Rooted in stereotypes about aging, it is a common belief that depression is a normal sign of growing older. But in fact, depression is a health condition responding to antidepressant medication and/or psychotherapy (e.g., cognitive-behavioral therapy), delivered in-person or via virtual telehealth. Depression symptoms may include hopelessness, loss of interest in formerly pleasurable activities, irritability, concentration difficulties, sleep problems, and suicidal thoughts. Individuals experiencing isolation, impairments in functioning (e.g., self-care activities), and financial worries are particularly vulnerable to depression.
But when depression in older adults is minimized or misattributed to aging, older adults may miss opportunities for screening, diagnosis, treatment, and follow-up.
Depression screening and evidence-based treatment potentially decrease hospitalization risks and avoidable emergency department visits, and increase disability-free survival, all clinical and cost metrics of concern to Medicare Advantage (MA) plans, whose typical beneficiaries are ages 65 or older. Yet, depression among older adults is often underdiagnosed, misdiagnosed, and subsequently treated inadequately or left untreated.
The good news is that even as CMS reduces its overall set of quality measures for MA Star Ratings, one landmark mental health measure is being added that may help to close these gaps. For the first time in the history of MA plan measurement, a mental health screening process measure is being added to the quality data set: Depression Screening and Follow-Up.
The measure joins another existing mental health-specific measure, Improving or Maintaining Mental Health, a patient-reported outcome measured through the Health Outcomes Survey. That measure carries a weight of 1 in the 2026 Star Ratings and will be elevated to 3 in the 2027 Star Ratings. This increased focus on mental health, including screening and offering older adults intervention for depression, is a milestone to celebrate.
The depression screening and follow-up measure becomes effective in Measurement Year (MY) 2027, affecting Star Ratings in 2029. It is presently a 2026 Part C Display Measure, using NCQA HEDIS MY 2024 specifications. With HEDIS depression screening rates ranging from 10-20% among Medicare beneficiaries, and follow-up rates under 70%, the addition of this measure to the MA quality program is long overdue.
MA plans and networks should now prepare for better performance and maintain or improve Star Ratings linked to value-based payments. Of note, since CMS is reducing the number of Star Rating quality measures, fewer measures raise the stakes per measure, further emphasizing the importance of MA plans' performance on mental health quality measures.
Fortunately, there is an array of best practices, plans, and providers that pharmaceutical manufacturers can implement, as well as ways they can support their efforts. Many of these practices can improve depression screening and care for adults across the lifespan.
Provider and delivery system best practices include:
Integration of screening within primary care visits, using evidence-based screening tools. Examples of tools include the PHQ-9 and the Geriatric Depression Scale.
Development of collaborative, behaviorally integrated care delivery models that include:
Primary care and behavioral health care clinicians, including clinicians with geriatric care expertise (for care or consultation)
Workflows for screening all adults, consistent with USPSTF guidelines
Pathways for intervention, referrals, and securing safety
Identification and addressing care barriers (e.g., stigma, transportation, financial)
Engagement methods with patients, families, and caregivers customized to circumstances (e.g., culture, cognition, preferences)
Follow-up to track adherence, success of referrals, and treatment intervention
Health plans are implementing or evolving approaches that include:
Population health models to identify and stratify older adults at risk for moderate to severe depression, with follow-up to monitor referrals, adherence, and treatment outcomes
Adequate in-person and virtual networks for the timely treatment of behavioral health conditions, including streamlined referral and appointment acquisition models
Special consideration to the use of telehealth, since it may improve care access for older adults facing mobility or transportation challenges, and has been found equally effective for older and younger adults when delivered via a telehealth platform
Network education on the depression screening follow-up quality measure and best practices across the lifespan
Screening for depression and referrals, integrated within plan physical and behavioral health care and condition management services
Screening and addressing social barriers to depression care
Engagement methods with patients, families, and caregivers customized to circumstances (eg, culture, cognition, preferences)
Posting website information about ways to get help during a mental health crisis, including the 988 Lifeline
Manufacturers can support providers and plans through:
Preparing field teams with information for knowledgeable customer engagement (e.g., quality playbooks)
Offering education resources for payers and providers about:
The new MA depression quality measure
Examples of successful practices for performance improvement
Training primary care teams with modules to increase knowledge and confidence in:
Depression screening
Patient motivation
Evidence-based treatment
Depression and co-morbidity management
Culturally appropriate resources for patients and families to provide information about:
Depression
Evidence-based treatment choices
Stigma reduction
Recognition that human brains are wired for social connection. Deliver holistic, socially engaging hubs for patients and families with portals designed to encourage:
Trust, inspired by problem-solving to remove barriers and improve medication access
Confidence, inspired by customized support for medication uptake and adherence
Empowerment, with curated resources for older adults and their caregivers
Mental Health Awareness Month highlights both tenacious gaps and hopeful momentum in depression care, and the healthcare ecosystem has opportunities to accelerate better outcomes among older adults.
With depression screening and follow‑up now elevated within the MA Star Ratings, success will rely on operational readiness. Focused investment by all stakeholders in Stars‑aligned quality tools, patient resources, and field readiness can deliver better mental health outcomes.
When providers, payers, and manufacturers support earlier identification, timely follow‑up, and sustained patient engagement, the result will be stronger Star performance and older adults enjoying healthier lives.