Opinion: Meeting the mental health needs of the Medicare population

For the 63 million Americans who receive Medicare benefits, challenges that significantly affect their mental well-being continue to rise. Projections show the number of Medicare beneficiaries will grow by 1.5 million annually through 2029 with the majority of eligible enrollees comprised of those age 65 and older, placing urgency on the need to ensure this population has access to solutions that address their unique and evolving needs.

As humans age, we may face a variety of health challenges that can negatively affect mental health. Physical decline can lower self-sufficiency, while mounting physical and mental health issues can add stress and anxiety. Estimates suggest nearly 20% of adults over 65 will experience some form of mental health challenge, and nearly 5% will have a severe mental illness. In addition, there are societal challenges that negatively impact mental health, significantly highlighted by the COVID-19 pandemic that has increased the risk of loneliness and social isolation already prevalent within this population. Research shows that almost 25% of those 65 and older are socially isolated, with medical conditions and life changes such as the loss of loved ones or living alone as contributing factors. Loneliness and social isolation have been linked to increased mortality risk, higher rates of depression and lower treatment success for both physical and mental health conditions.

While challenges in receiving mental health services can occur at any time in life, there are nuances within older populations that we must recognize and address. From functional limitations that may impact their ability to attend in-person care, to the stigma of seeking mental health therapy, to their discomfort with technology, payers should tailor care efforts to ensure the aging population can more easily overcome obstacles. One way is providing care-integration efforts, which help payers reduce healthcare spending and improve health outcomes. Payers can also play a role in enabling integrated care efforts through initiatives with providers. Including behavioral health screenings as a component of managing chronic conditions enables early identification of mental health concerns, timely intervention, and removes barriers to care. While all individuals benefit from a whole-health approach, integration is essential as people age since they are more likely to experience multiple comorbidities.

Primary-care physicians are at the forefront of healthcare for many aging communities. Often, mental health conditions can present as physical ailments. Depression and anxiety are common among those age 65 or older, but these individuals are more likely to report physical symptoms initially. The generational stigma associated with behavioral health may discourage them from seeking help, making it vital that primary-care providers feel knowledgeable and have the tools needed to identify and refer members to care if a mental health concern is present. By prioritizing provider education, payers can deliver targeted information and assistance needed to support providers in addressing mental health with their patients.

There is also a need for innovative uses of technology and partnerships between health plans, providers and community organizations to address issues that impact the mental and physical well-being of older adults and their caregivers. In one innovative use, Centene recently launched a pilot program that proactively engages members based on data analytics and referrals. Through use of telephonic evidence-based care and education regarding virtual care appointments, the program fosters collaboration between health plans and providers to coordinate member treatment goals, processes and interventions to mitigate care gaps. By fostering these relationships, payers can support health teams as they navigate current and emerging challenges that arise among communities of Medicare patients more diligently by focusing on local social determinants of health and isolation, using whole-health approaches that match the needs of different communities.

As the number of Medicare recipients continues to grow, it is essential that we develop generationally appropriate solutions to address their unique mental health needs. Innovative solutions and policy advancements that focus on delivering improved access to high-quality, integrated care can help our nation’s aging population achieve the best health outcomes and experience life to its fullest.