Making the Business Case for Value-Based Dementia Care

Sawyer, Robert John; LaRoche, Ashley; Sharma, Sakshi; Pereira-Osorio, Carolina

doi:10.1056/cat.22.0304

Cited by 3 publications

(5 citation statements)

References 26 publications

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“…34 Importantly, these program costs are borne by the health system while the cost savings are realized by Medicare, which underscores the importance of advancing value-based care arrangements that align the incentives of payers and health care systems, or adequately covering program costs via new payment models. 18 On July 31, 2023, Medicare introduced the Guiding an Improved Dementia Experience (GUIDE) Model 35 that will provide a monthly per-beneficiary payment to support collaborative dementia care for patients with Medicare FFS and their caregivers.…”

Section: Discussionmentioning

confidence: 99%

“…There are over 20 health systems that have implemented the Care Ecosystem model nationally, reinforcing the need for programs that focus on providing caregiver support and offering additional information about the effectiveness of these models in different health settings . Importantly, these program costs are borne by the health system while the cost savings are realized by Medicare, which underscores the importance of advancing value-based care arrangements that align the incentives of payers and health care systems, or adequately covering program costs via new payment models . On July 31, 2023, Medicare introduced the Guiding an Improved Dementia Experience (GUIDE) Model that will provide a monthly per-beneficiary payment to support collaborative dementia care for patients with Medicare FFS and their caregivers.…”

Section: Discussionmentioning

confidence: 99%

“…Studies demonstrate that these programs can decrease use of emergency department (ED) services, delay long-term care placement, improve guideline-based quality indicators, improve quality of life for people with dementia, and reduce caregiver strain and depression . Select programs have also examined changes in cost associated with program implementation in smaller cohorts of patients . However, rigorous attempts to tie these programs to reductions in total health care spending have been limited, leaving a critical gap in the conversation around value-based dementia care.…”

Section: Introductionmentioning

confidence: 99%

“…2,[10][11][12][13][14] Select programs have also examined changes in cost associated with program implementation in smaller cohorts of patients. [15][16][17][18] However, rigorous attempts to tie these programs to reductions in total health care spending have been limited, leaving a critical gap in the conversation around valuebased dementia care.…”

mentioning

confidence: 99%

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Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia

Guterman,

Kiekhofer,

Wood

et al. 2023

JAMA Intern Med

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ImportanceCollaborative dementia care programs are effective in addressing the needs of patients with dementia and their caregivers. However, attempts to consider effects on health care spending have been limited, leaving a critical gap in the conversation around value-based dementia care.ObjectiveTo determine the effect of participation in collaborative dementia care on total Medicare reimbursement costs compared with usual care.Design, Setting, and ParticipantsThis was a prespecified secondary analysis of the Care Ecosystem trial, a 12-month, single-blind, parallel-group randomized clinical trial conducted from March 2015 to March 2018 at 2 academic medical centers in California and Nebraska. Participants were patients with dementia who were living in the community, aged 45 years or older, and had a primary caregiver and Medicare fee-for-service coverage for the duration of the trial.InterventionTelehealth dementia care program that entailed assignment to an unlicensed dementia care guide who provided caregiver support, standardized education, and connection to licensed dementia care specialists.Main Outcomes and MeasuresPrimary outcome was the sum of all Medicare claim payments during study enrollment, excluding Part D (drugs).ResultsOf the 780 patients in the Care Ecosystem trial, 460 (59.0%) were eligible for and included in this analysis. Patients had a median (IQR) age of 78 (72-84) years, and 256 (55.7%) identified as female. Participation in collaborative dementia care reduced the total cost of care by $3290 from 1 to 6 months postenrollment (95% CI, −$6149 to −$431; P = .02) and by $3027 from 7 to 12 months postenrollment (95% CI, −$5899 to −$154; P = .04), corresponding overall to a mean monthly cost reduction of $526 across 12 months. An evaluation of baseline predictors of greater cost reduction identified trends for recent emergency department visit (−$5944; 95% CI, −$10 336 to −$1553; interaction P = .07) and caregiver depression (−$6556; 95% CI, −$11 059 to −$2052; interaction P = .05).Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial among Medicare beneficiaries with dementia, the Care Ecosystem model was associated with lower total cost of care compared with usual care. Collaborative dementia care programs are a cost-effective, high-value model for dementia care.Trial RegistrationClinicalTrials.gov Identifier: NCT02213458

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia

Guterman,

Kiekhofer,

Wood

et al. 2023

JAMA Intern Med

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“…It is important that care planning incorporates processes for updating plans as new health care options become available, along with new information available from continuous monitoring and tracking of progress on goals. Effective care plans help tailor care to patient goals and preferences during acute, episodic care, as well as during health maintenance and care transitions, helping both patients and clinicians better manage multimorbidity and prevent additional impairments (Baker et al, 2016 ).…”

Section: Comprehensive Care Planningmentioning

confidence: 99%

From precision medicine to precision care: Choosing and using precision medicine in the context of multimorbidity

Bierman¹,

Burke²,

Comfort³

et al. 2023

Camb. prisms Precis. med.

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Rapid advances in precision medicine promise dramatic reductions in morbidity and mortality for a growing array of conditions. To realize the benefits of precision medicine and minimize harms, it is necessary to address real-world challenges encountered in translating this research into practice. Foremost among these is how to choose and use precision medicine modalities in real-world practice by addressing issues related to caring for the sizable proportion of people living with multimorbidity.Precision medicine needs to be delivered in the broader context of precision care to account for factors that influence outcomes for specific therapeutics. Precision care integrates a person-centered approach with precision medicine to inform decision making and care planning by taking multimorbidity, functional status, values, goals, preferences, social and societal context into account.Designing dissemination and implementation of precision medicine around precision care would improve person-centered quality and outcomes of care, target interventions to those most likely to benefit thereby improving access to new therapeutics, minimize the risk of withdrawal from the market from unanticipated harms of therapy, and advance health equity by tailoring interventions and care to meet the needs of diverse individuals and populations.Precision medicine delivered in the context of precision care would foster respectful care aligned with preferences, values, and goals, engendering trust, and providing needed information to make informed decisions. Accelerating adoption requires attention to the full continuum of translational research: developing new approaches, demonstrating their usefulness, disseminating and implementing findings, while engaging patients throughout the process. This

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Long‐term effects of collaborative dementia care on quality of life and caregiver well‐being

Possin,

Dulaney,

Sideman

et al. 2024

Alzheimer's & Dementia

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INTRODUCTIONCollaborative dementia care models with care navigation, including the Care Ecosystem, improve outcomes for persons living with dementia (PLWDs) and their caregivers. The effects of continuous care over long periods have not been studied.METHODSIn this randomized clinical trial with 456 PLWD–caregiver dyads with high caregiver burden, we evaluated the cumulative 5‐year treatment effect on PLWD quality of life, health care utilization, caregiver depression, self‐efficacy, and burden.RESULTSFive‐year participation was associated with higher quality of life, lower caregiver depression, and higher caregiver self‐efficacy (all p’s < 0.05) with a trend for lower burden (p = 0.07). Treatment effects were most robust during the first 2 years. The effects on emergency department visits and hospitalizations were not significant.DISCUSSIONThe benefits of collaborative dementia care on PLWD quality of life and caregiver well‐being are sustained for 5 years, and the dyads may experience the greatest benefit during the first 2 years.Highlights Collaborative dementia care with care navigation was evaluated over 5 years using a randomized clinical trial. The care was associated with better quality of life for the person with dementia and well‐being for the caregiver. The most robust treatment effects were in the first 2 years.

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Making the Business Case for Value-Based Dementia Care

Cited by 3 publications

References 26 publications

Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia

Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia

From precision medicine to precision care: Choosing and using precision medicine in the context of multimorbidity

Long‐term effects of collaborative dementia care on quality of life and caregiver well‐being

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