Diagnosed prevalence of Alzheimer's disease and related dementias in Medicare Advantage plans

Jutkowitz, Eric; Bynum, Julie; Mitchell, Susan L.; Cocoros, Noelle M; Shapira, Oren; Haynes, Kevin; Nair, Vinit; McMahill‐Walraven, Cheryl N.; Platt, Richard; McCarthy, Ellen P.

doi:10.1002/dad2.12048

Cited by 20 publications

(26 citation statements)

References 17 publications

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“…One‐year KPSC disenrollment rates are similar for members with (12%) and without (11%) ADRD, contrasting with aggregated nationwide MA plan data (2014–2015), where disenrollment rates for beneficiaries with an ADRD diagnosis were double those without (9.0% vs. 4.2%) and combined disenrollment and plan switching for both groups were much higher (28.7% in ADRD vs 27.0%) 17 than in KPSC. It is important to also note that the prevalence of ADRD (5.5%) in this health plan is comparable to published rates from other MA plans 18,19 …”

Section: Discussionsupporting

confidence: 78%

Patterns of incident dementia codes during the COVID‐19 pandemic at an integrated healthcare system

Borson

Chen

Wang

et al. 2021

J American Geriatrics Society

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Background The COVID‐19 pandemic delayed diagnosis and care for some acute conditions and reduced monitoring for some chronic conditions. It is unclear whether new diagnoses of chronic conditions such as dementia were also affected. We compared the pattern of incident Alzheimer's disease and related dementia (ADRD) diagnosis codes from 2017 to 2019 through 2020, the first pandemic year. Methods Retrospective cohort design, leveraging 2015–2020 data on all members 65 years and older with no prior ADRD diagnosis, enrolled in a large integrated healthcare system for at least 2 years. Incident ADRD was defined as the first ICD‐10 code at any encounter, including outpatient (face‐to‐face, video, or phone), hospital (emergency department, observation, or inpatient), or continuing care (home, skilled nursing facility, and long‐term care). We also examined incident ADRD codes and use of telehealth by age, sex, race/ethnicity, and spoken language. Results Compared to overall annual incidence rates for ADRD codes in 2017–2019, 2020 incidence was slightly lower (1.30% vs. 1.40%), partially compensating later in the year for reduced rates during the early months of the pandemic. No racial or ethnic group differences were identified. Telehealth ADRD codes increased fourfold, making up for a 39% drop from face‐to‐face outpatient encounters. Older age (85+) was associated with higher odds of receiving telecare versus face‐to‐face care in 2020 (OR:1.50, 95%CI: 1.25–1.80) and a slightly lower incidence of new codes; no racial/ethnic, sex, or language differences were identified in the mode of care. Conclusions Rates of incident ADRD codes dropped early in the first pandemic year but rose again to near pre‐pandemic rates for the year as a whole, as clinicians rapidly pivoted to telehealth. With refinement of protocols for remote dementia detection and diagnosis, health systems could improve access to equitable detection and diagnosis of ADRD going forward.

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Section: Discussionsupporting

confidence: 78%

Patterns of incident dementia codes during the COVID‐19 pandemic at an integrated healthcare system

Borson

Chen

Wang

et al. 2021

J American Geriatrics Society

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“…First, we are unable to validate the accuracy of diagnoses, including mental health diagnoses and dementia subtypes in Medicare claims data that may not include all new cases of dementia 43 . Second, our analyses did not include Medicare Advantage enrollees, who tend to be healthier with lower rates of ADRD 44–47 and more likely to initiate mental health care than fee‐for‐service Medicare enrollees even after adjusting for sociodemographic characteristics and mental and physical health 48 . Third, information was not available concerning clinical suicide risk factors such as lifetime history of self‐harm, 21 proximal stressful life events, 49 social disconnection (e.g., marital status, loneliness), 50 and access to lethal means.…”

Section: Discussionmentioning

confidence: 99%

Suicide risk in first year after dementia diagnosis in older adults

Schmutte

Olfson

Maust

et al. 2021

Alzheimer's & Dementia

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Introduction Receiving a diagnosis of Alzheimer's disease or related dementias (ADRD) can be a pivotal and stressful period. We examined the risk of suicide in the first year after ADRD diagnosis relative to the general geriatric population. Methods We identified a national cohort of Medicare fee‐for‐service beneficiaries aged ≥ 65 years with newly diagnosed ADRD (n = 2,667,987) linked to the National Death Index. Results The suicide rate for the ADRD cohort was 26.42 per 100,000 person‐years. The overall standardized mortality ratio (SMR) for suicide was 1.53 (95% confidence interval [CI] = 1.42, 1.65) with the highest risk among adults aged 65 to 74 years (SMR = 3.40, 95% CI = 2.94, 3.86) and the first 90 days after ADRD diagnosis. Rural residence and recent mental health, substance use, or chronic pain conditions were associated with increased suicide risk. Discussion Results highlight the importance of suicide risk screening and support at the time of newly diagnosed dementia, particularly for patients aged < 75 years.

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“…However, the sickest and most costly patients are more likely to disenroll from MA. [22][23][24][25] Using Medicare Beneficiary Survey data from 2010 to 2016, Park et al found only small differences in healthcare utilization of ADRD patients in MA compared to TM. 18 No study to date has examined MA and ACO care of persons with dementia, a high-cost and high-need population.…”

Section: Discussionmentioning

confidence: 99%

Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare

Teno

Keohane

Mitchell

et al. 2021

J American Geriatrics Society

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Background/Objective: Medicare Advantage (MA) and Accountable Care Organizations (ACOs) operate under incentives to reduce burdensome and costly care at the end of life. We compared end-of-life care for persons with dementia who are in MA, ACOs, or traditional Medicare (TM). Design, Setting, and Participants: Retrospective study of decedents with dementia enrolled in MA, attributed to an ACO, or in TM. Decedents had a nursing home stay between 91 and 180 days prior to death, two or more functional impairments, and mild to severe cognitive impairment. Measurements: Hospitalization, invasive mechanical ventilation (IMV) use, and in-hospital death in the last 30 days of life reported in Medicare billing. Results: Among 370,094 persons with dementia, 93,801 (25.4%) were in MA (mean age [SD], 86.9 [7.7], 67.6% female), 39,586 (10.7%) were ACO attributed (mean age [SD], 87.2 [7.6], 67.3% female), and 236,707 (63.9%) were in TM (mean age [SD], 87.0 [7.8], 67.6% female). The proportion hospitalized in the last 30 days of life was higher among TM enrollees (27.9%) and those ACO attributed (28.1%) than among MA enrollees (20.5%, p ≤ 0.001). After adjustment for socio-demographics, cognitive and functional impairments, comorbidities, and Hospital Referral Region, adjusted odds of hospitalization in the 30 days prior to death was 0.72 (95% confidence interval [CI] 0.70-0.74) among MA enrollees and 1.05 (95% CI 1.02-1.09) among those attributed to ACOs relative to TM enrollees. Relative to TM, the adjusted odds of death in the hospital were 0.78 (95% CI 0.75-0.81) among MA enrollees and 1.02 (95% CI 0.96-1.08) for ACO participants. Dementia decedents in MA had a lower likelihood of IMV use (adjusted odds ratio 0.80, 95% CI 0.75-0.85) compared to TM. Conclusions: Among decedents with dementia, MA enrollees but not decedents in ACOs experienced less costly and potentially burdensome care compared with those with TM. Policy changes are needed for ACOs. See related editorial by Ankuda et al. in this issue.

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Diagnosed prevalence of Alzheimer's disease and related dementias in Medicare Advantage plans

Cited by 20 publications

References 17 publications

Patterns of incident dementia codes during the COVID‐19 pandemic at an integrated healthcare system

Patterns of incident dementia codes during the COVID‐19 pandemic at an integrated healthcare system

Suicide risk in first year after dementia diagnosis in older adults

Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare

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