CMS Adds Depression to Star Ratings
If you’re a Medicare Advantage plan leader, you’re probably aware of the cut-point outlook around KDE, COL-E, GSD, and CBP measures. And if you’re not, let’s talk!
But here’s one you’re probably not yet tracking: Depression Screening and Follow up (DSF-E) has been added to Stars rating system in 2027. As a long time behavioral health advocate, I’m both excited and worried about the addition of this measure. Here’s why: The HEDIS metric for DSF-E is made up of two parts:
- Depression Screening. The percentage of persons who were screened for clinical depression using a standardized instrument.
- Follow-Up on Positive Screen. The percentage of persons who received follow-up care within 30 days of a positive depression screen finding.
For the first part, it’s easy to screen members. There are a bounty of software vendors out there doing this work, and most EMRs now support this functionality. There are apps, voice recognition technology, and even pencil and paper for the analog brethren.
Then there’s part two. The follow up on an positive result. That can mean a referral, medication, or simply closing a follow up screening. But this must also happen. And 30 days is not an arbitrary deadline. The sooner an individual gets into treatment, the more likely they are to adhere to it, and adherence is still the best predictor of outcomes.
The measurement is calculated by the percentage of each part, so if you screen 100% of your members, but only 10% actually get follow-up care, your score is: 110/2, or 55%. That’s a bad report card, but behind that number is also a person who does not get the care they need.
In the US, 10.4% of the population is impacted by Major Depressive Disorder (MDD) at any given time. Rates of depression are even higher in elderly populations and those with co-occurring chronic physical conditions, so this is an even greater impact in MA and D-SNP organizations. In addition to the suffering and the bad report card, higher total cost of care is also associated with unaddressed depression. Not to mention the potential for progression to more serious illness or self-harm, and the ultimate cost to society.
The need is easy to find. Getting people into treatment is much harder. There is already a significant shortage of mental health professionals in much of the US, and if 2026 keeps on pace, we’re going to need a lot more. And the therapeutic alliance is key. Human to human treatment is still the most effective.
But there are options. Embedding behavioral health services into primary care is a well proven model, and some of the most promising and scalable interventions include peer based support, trained community health workers, and even a tiny number of good quality technology solutions in the space. Look closely though, as most of the tech-only offerings today are either unproven or underpowered to the need. We can expect that to change, but clinical rigor is still absent for most. Reach out for a list of some of the well supported approaches if you’re interested.
As you’re planning around DSF-E, choose partners that can reliably screen during an existing encounter if at all possible and make the referral. Primary care is ideal, but remember that providers often have busy schedules, patients presenting with a host of issues, and limited resources to make the handoff. We should be thinking about every encounter, including a lab follow up as an opportunity to screen and refer for closure.