Alzheimer's Disease Under Managed Care: Implications from Medicare Utilization and Expenditure Patterns

Abstract

Current Medicare capitation payments to managed care plans may not meet the higher expected annual costs of care for beneficiaries with DAT. In turn, physicians (or physician groups) who accept capitation for Medicare beneficiaries with DAT should also consider how capitation rates are established by managed care plans and should learn ways to reduce financial risk.

Acceptability of dementia screening in primary care patients

“…With the leading edge of the baby boomers reaching 65 years in 2010, the numbers of demented patients are projected to increase rapidly. The high disease prevalence, high associated disease burden, and enormous economic impact (Ernst and Hay, 1994;Weiner et al, 1998;Martin et al, 2000;Bynum et al, 2004) make dementia a potential target for systematic screening. The enriched prevalence in primary care practices offers a potential venue to introduce systematic screening in older adults.…”

Incremental burden of congestive heart failure among elderly with Alzheimer's

“…Studies of cost of AD using Medicare data showed that the incremental annual cost of AD varied 3.3-fold, from $1500 to $5000 (Bloom et al, 2003;Martin et al, 2000;Taylor et al, 2001;Weiner et al, 1998). The cost of AD increases with the disease stage.…”

“…A literature review of multiple studies with control groups, comparable services (e.g. direct medical, nursing home, indirect and family costs), across countries, and after adjusting for inflation among the US studies, and inflation and purchasing power parity among and between the US and the non-US studies, found that annual incremental AD costs varied from about $1500 to $79,000 per person (Bloom et al, 2003;Weiner et al, 1998).…”

Medicare Cost Differences Between Nursing Home Patients Admitted With and Without Dementia

“…Since the late 1980s, more than a dozen studies have examined the cost of treating persons with Alzheimer's disease and related dementias (Bynum et al, 2004;Coughlin & Liu, 1989;Ernst & Hay, 1994;Fillenbaum, Heyman, Peterson, Pieper, & Weiman, 2001;Gutterman, Markowitz, Lewis, & Fillit, 1999;Hay & Ernst, 1987;Hill et al, 2002;Kane & Atherly, 2000;Leon, Cheng, & Neuman, 1998;Martin, Ricci, Kotzan, Lang, & Menzin, 2000;Menzin, Lang, Friedman, Neuman, & Cummings, 1999;Newcomer, Clay, Luxenberg, & Miller, 1999;O'Brien & Caro, 2001;Ostbye & Crosse, 1994;Rice et al, 1993;Richards, Shepherd, Crismon, Snyder, & Jermain, 2000;Taylor, Schenkman, Zhou, & Sloan, 2001;Taylor & Sloan, 2000;Weiner, Powe, Weller, Shaffer, & Anderson, 1998;and Welch, Walsh, & Larson, 1992). This work is important in understanding the impact of dementia on resource utilization in the health care sector, particularly for programs focused on the aged.…”