Scaling Comprehensive Dementia Care.

Abstract

Despite scientific progress over the last 25 years, dementia remains one of the toughest health-care challenges. Alzheimer's disease is the sixth-leading cause of death in the United States, and the number of deaths from all related dementias may be twice as high.[i] Years of investment and research in Alzheimer's disease and related dementias (ADRD) are sowing seeds of hope. New treatments aim to slow cognitive decline and manage symptoms. However, because of the complexity of dementia, people living with dementia will likely need a combination of therapeutic treatments, coordinated care, and supportive services to help them live their lives to the fullest post-diagnosis. The Milken Institute Alliance to Improve Dementia Care convened a roundtable in June 2021. Leaders across industry, government, research, advocacy, philanthropy, health systems, and community-based organizations explored ways to improve and pay for comprehensive dementia care. Through a consensus-driven process, we produced a report that presents actionable recommendations to improve post-diagnostic care and payment policies under traditional Medicare.[i] [i] Nora Super, Rajiv Ahuja, and Mac McDermott," Milken Institute, November 2021: https://milkeninstitute.org/report/dementia-care-models-scaling-comprehensive RESULT: Based on extensive desktop research, the roundtable convening, and consultation with a working group of experts, we identified five high potential action steps. 1. Ensure all dementia-care models contain a minimum set of core elements for comprehensive care and follow a population-health approach that tiers services to level of need 2. Implement quality measures to evaluate access, utilization, and outcomes of comprehensive dementia-care models, particularly for diverse communities disproportionately impacted by dementia and their caregivers 3. Expand dementia-specific training beyond physicians and nurses to increase interprofessional coordination, provide continuous monitoring and assessment, and expand access to high-quality, dementia-care services 4. Test implementation of payment models for comprehensive dementia care in traditional Medicare, especially in underserved communities. 5. Develop mechanisms to pay community-based organizations (CBOs) for services provided to individuals living with dementia and their caregivers. Alternative payment models are needed under traditional Medicare to incentivize providers to coordinate care, pay CBOs for the services they provide, align incentives among payers, providers, and patients, and ensure those living with dementia and their caregivers receive more seamless, coordinated health- and long-term care.