Supporting Older Adults Unmet Needs, Social Determinants of Health, and Depression Care Within the Strained Landscape of Primary Care: The Care Partners Initiative

Unützer et al. examined the feasibility of partnering with community-based organizations to enhance standard collaborative care and the impact on older adults with depression. Collaborative care has demonstrated effectiveness in improving late-life depression within primary care settings. Still, clinics offering collaborative care find it challenging to address unmet needs that may impact the severity of patients’ depressive symptoms. Primary care clinics’ partnerships with community-based organizations that have dedicated training and resources to address older adults’ unmet needs and social determinants of health have the potential to strengthen depression treatment.

American Journal of Geriatric Psychiatry’s audience garners insights from the Unützer et al. study. First, mental health is fundamentally linked to our unmet needs and social determinants of health throughout our lifespan, including provisions like food, water, shelter, and other needs.¹ Addressing humans’ unmet needs can have a significant effect on a person’s mental health needs throughout the lifespan. For example, if an older adult is experiencing food insecurity, this need may outweigh their need to engage in depression care.

Unützer et al.’s real-world Care Partners Initiative addresses this inextricable link between unmet needs, social determinants of health, and mental health. The Care Partners Initiative is directly aligned with national strategic plans as presented in the recently released playbook produced by the White House’s Domestic Policy Council and the Office of Technology and Policy Playbook to Address Social Determinants of Health.² The Playbook proposes a “whole of government” approach to addressing unmet needs and social determinants of health through coordination across federal agencies. The Care Partners Initiative incorporates a similar approach as Unützer et al. brought distinct systems together to address need-based factors that may impact depression outcomes for older adults. Services included, but were not limited to, economic assistance (e.g., finding affordable housing, accessing transportation services, and applying for social security) and direct services (e.g., social support, food delivery, and peer support).

Second, the Care Partners Initiative can extend its operation beyond primary care. This approach may be a practical and sustainable integrated care model rather than colocating social care within primary care settings. Currently, primary care within the United States is inundated by workforce shortages, provider burnout, and moral injury—all of which can create challenges to adequate care. Additional considerations regarding operating outside of primary care versus co-location may include the current landscape of primary care. Private equity is engaging in primary care practice consolidation through mergers and acquisitions. For example, Amazon purchased primary-care provider One Medical and offers “Primary Care For Every Body — Get Primary Care Easily. Get a One Medical Membership for Just $99 a Year with Prime.”

This business model may impact time spent with patients, may place an overemphasis on reactive care (rather than preventative), and/or incentivize quantity over quality of care.³ Introducing an additional service into an already stretched primary care system, especially for older adults with complex health needs and late-life social challenges like retirement and bereavement, could exacerbate the existing strain on primary care practices.

Finally, Unützer et al.’s Care Partners Initiative is impeccably timed. Historically, separate systems of care have had different financing systems and have unintentionally created silos in accessing and receiving adequate mental health, physical health, aging, and social health services. In contrast, the Care Partners Initiative involves a team-based approach where offsite providers work in tandem with primary care providers and is supported by new Medicare rules announced on January 1, 2024. Specifically, Medicare has posted updates to the 2024 physician fee schedule in that physicians can have community health workers/certified peer support specialists serve as auxiliary personnel to perform covered services incident to the services of a Medicare-enrolled billing physician or practitioner. This integrated funding mechanism may further support the real-world implementation of the Care Partners Initiative.

In summary, Unützer et al. have demonstrated the potential impact of integrated systems of care to simultaneously address unmet needs, social determinants of health, and late-life depression. The Care Partners Initiative is at the forefront of care for older adults and has existing policy levers to support implementation in the real world.

DATA STATEMENT

The data has not been previously presented orally or by poster at scientific meetings.