Turning Mental Health Signals into Measureable HOS Improvement

As CMS refines the Medicare Advantage Stars program, the Health Outcomes Survey (HOS) has emerged as a critical driver of plan performance. Unlike process measures, HOS directly captures whether health plans are improving member health over time, making it a unique predictor of plan quality. The mental health components have become particularly significant. Studies show 20-30% of Medicare Advantage members experience depression or anxiety, with half remaining undiagnosed or untreated.

Members with untreated mental health conditions score lower across all HOS domains. And, research from Health Affairs confirms that addressing mental health gaps improves not only HOS scores but also drives measurable gains across HEDIS, CAHPS, and medication adherence measures. For Stars leadership, HOS improvement demands longitudinal engagement that changes behaviors and outcomes. There’s no way to predict which members will be surveyed, so plans must create positive experiences for their entire population.

Read on to find out how one national health plan moved from reactive HOS management to proactive, measure-level execution, and achieved:

• 5% increase in annual wellness visits; 81% of which occurred after the engagement.
• 27.6% received a new depression diagnosis, supporting early identification and care.
• 3.2% higher positive responses to B11A question in the PE VAT survey.

Stopping a Ripple Effect

One national plan knew that members with depression scored significantly lower across all HOS measures, but traditional care management wasn’t moving the needle. These members weren’t just scoring lower on mental health questions, it was creating ripple effects across physical health status measures, preventive care, and quality of life assessments. The plan launched a six-month pilot that began in July 2025 for 340,000 members identified as at risk of scoring low on the IMMH HOS measure. The strategy: proactively engage all members with personalized support, removing barriers and normalizing mental health conversations.

To move HOS scores, the strategy was anchored in the following principles:

• Members with or without a diagnosis of depression face different barriers to action.
• Members without a depression diagnosis would have a different engagement strategy than those that had a depression diagnosis.
• Beyond clinical indicators, the program needed to overcome emotional blockers like stigma, low self-efficacy, and lack of resource knowledge.
• Engagement must feel supportive, not intrusive and focus on calls-to-action about improving mental health.

The Decision Logic

MedOrion’s approach is to tackle the measure itself, with member engagement as a natural output of that strategy. “Predictive analytics identifies risk, but that’s only the starting point,” says Shai Levi, Chief Product Officer at MedOrion. “To improve HOS, we had to identify what specific barriers each member faces. And then, for this program it was about encouraging proactive conversations with their primary care provider. Helping members recognize early warning signs that were worth discussing. And, providing reassurance, resources and clear next steps. “

First, the program identified each member’s clinical profile. Some have diagnosed depression needing treatment support. Others have multiple chronic conditions increasing depression risk. The next layer is understanding what the circumstances are within that clinical profile. What’s happening in each member’s life right now? Newly diagnosed with a chronic condition? Recent loss of a spouse? Managing multiple conditions while caregiving? Stopped taking medications or missed appointments? These factors drive timely, relevant support.

After identifying both the clinical and situational indicators of any measure, the program needs to tackle the behavioral profiles of a member. Does stigma prevent seeking help? Do they lack knowledge about covered benefits? Are they struggling with transportation or digital literacy barriers? These inputs, overlayed with embedded Stars measure logic, create a unique outreach strategy for each member based on a series of approved plan messages and channels.

Every Member, Every Time

The program began with digital outreach to all members, using behavioral signals to determine optimal message, timing, and channel. For members with significant unmet mental health needs, proactive telephone outreach uncovered barriers:

• Low Self-Efficacy members (16%): Overwhelmed managing multiple conditions, didn’t know where to start
• Resourced Members (22%): Had means but lacked awareness that mental health benefits were fully covered
• Chronic Illness and Isolation (34%): Wanted support but faced barriers like rural location or transportation
• Engaged with Limited Resources (28%): Actively managing health but struggling with literacy or digital access

MedOrion created tailored pathways for each segment. For low self-efficacy members, messages emphasized small steps and normalized conversations. For resourced members, communications highlighted ease of access. For isolated members, outreach focused on telehealth and transportation assistance.

From Diagnosis to Treatment

This targeted program successfully normalized mental health conversations and drove sustained behavior change. For the 27.6% percent of the population without a previous depression diagnosis, receiving one during this engagement is a critical first step towards long-term improved outcomes.

“Getting members to open up about mental health is the foundation,” explains Dave Burianek, Chief Strategy Officer at MedOrion. “Diagnosis leads to treatment, treatment leads to better outcomes, and better outcomes lead to improved HOS responses. But none of that happens without first removing behavioral barriers.”

Beyond that direct mental health impact, the membership showed meaningful improvements in health behaviors correlating with positive HOS outcomes:

• For the initial “low efficacy” segment, along with an 8% increase in annual wellness visits, there was a 5% increase in breast cancer and colorectal cancer screenings and a 3% increase in diabetic eye exams.
• For those experiencing chronic illness, there was an improvement in getting specialists appointments. And for those that had limited resources, they also saw a 3.5% increase in annual wellness visits.

These cross-measure improvements reinforce that addressing mental health creates a halo effect across the entire member experience, which is exactly what HOS measures.