Case finding strategies for depression in Green Ribbon Health's Medicare Health Support program

Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 authorized the development and testing of voluntary chronic care improvement programs, now called Medicare Health Support (MHS), to improve the quality of care and life for Medicare Beneficiaries living with multiple chronic illnesses such as complex diabetes and/or congestive heart failure. The authorizing legislation requires that MHS organizations, like Green Ribbon Health (GRH), help beneficiaries manage all their health problems. Major depressive disorder is a serious, prevalent and costly chronic disease, that causes considerable suffering among beneficiaries and GRH has committed to incorporate evidence-based depression management strategies into its MHS program. To date, GRH has screened over 22,000 beneficiaries for depression using the PHQ2 assessment. While prior research indicates that the point prevalence of depression among people with chronic medical illnesses is significant (15% to 25%), GRH found different rates of prevalence depending on the mode of screener administration: Using a telephonically administered PHQ2, only about 5% of this population screened positive for depression, but mailed PHQ2 rates were over 14%. These findings cannot be explained by differences in population characteristics. Rather, significant variances in screening rates across nurse were found while variances in depression diagnoses across nurse were minimal. The findings suggest that nurses had a direct impact on the delivery and/or interpretation of beneficiaries' responses, and that the administration method of depression screening tools matters. The presentation will discuss these findings in the context of how to better identify co-morbid depression in large Medicare populations.