When a patient with a wife suffering from dementia challenged UCLA geriatricians to propose a better way of care, the UCLA Health Center decided to try a few different methods.

After receiving donations and receiving the first batch of Medicare and Medicaid Innovation Center’s health care innovation grants, the health system now has a plan that has helped thousands of patients and saved Medicare funds in the past nine years.
Now, groups including the Alzheimer’s Association are pushing CMMI to explore a nationwide comprehensive dementia care demonstration that provides providers with value-based payments.
The current standard of dementia care is pay-for-service. Providers charge Medicare for every reimbursable service they provide and have no incentive to provide non-charged services that may improve treatment. Unpaid family caregivers often end up bearing most of the burden of care coordination.
Experts say the risk of finding better dementia treatments is high.Alzheimer’s disease-the most common cause of dementia-is expected to affect 7.2 million people by 2025, according to 2021 report From the Alzheimer’s Association. This is an increase of nearly 16% from the prevalence of the disease in 2021.
Alzheimer’s Association estimated Experts predict that dementia will cause medical insurance to lose US$181 billion in 2021 AduheimBiogen’s newly approved and controversial Alzheimer’s treatment, if medical insurance decides to cover it, the plan will cost as much as 29 billion US dollars a year. It is estimated that by 2021, the Medicaid program will spend $59 billion on the disease.
“If they do nothing, then we can guarantee that costs will soar,” said Nora Super, executive director of the Milken Institute’s Alliance for Better Dementia Care.
The UCLA Alzheimer’s and Dementia Care Program is one of several innovative models that have been established across the country. At UCLA Health, a nurse practitioner is responsible for coordinating the care of patients referred by primary care providers. Each patient will receive a personalized care plan, which is classified according to their stability. The project leader, Dr. David Ruben, said that patients in stable conditions receive calls every few months, while critically ill patients receive multiple calls every week. Caregivers also receive support from project staff.
The Alzheimer’s Association envisions a comprehensive nursing management model similar to UCLA Health, providing nursing coordination services, nursing staff education, psychosocial intervention, drug reviews, and other services to help strengthen care. The patient makes a treatment plan according to the complexity of the condition. The provider pays the beneficiary’s flat rate, and adjusts the reimbursement according to the patient’s way of care.
Research shows that comprehensive dementia care can lead to better health outcomes and plan savings. The UCLA Health Center’s plan reduced nursing home stays by approximately 40% and saved $2,404 in medical insurance costs per patient per year. Study in 2018. Papers in 2020 Established The number of visits to the emergency room and the length of hospital stay have also decreased, but the length of stay in hospitalization and intensive care units has not decreased.
But there are obstacles to extending these models. Ruben said that upfront costs such as recruiters make it almost impossible for many interested providers to start these programs, and the health system may even lose money due to the way reimbursements are structured. Since UCLA Health’s CMMI grants ended in 2015, the health system has mainly maintained the program through charity, foundation grants, and its own funds. Ruben said the plan charges for medical insurance, but the reimbursement covers only a small part of the cost.
“We can’t do this with the cost of medical insurance,” Ruben said.
Although early data shows savings and improved results, CMMI has not taken any action to create a national demonstration. CMMI may be affected by the following factors Recommendations of the Medical Insurance Payment Advisory Committee Super said, to implement fewer and more coordinated alternative payment models.
A CMS spokesperson said that CMMI currently does not support any model that focuses on dementia care, but prioritizes demonstrations of promoting responsible care, promoting health equity, supporting nursing innovation, addressing affordability, and helping system transformation.

The Alzheimer’s Association is lobbying CMMI to reconsider and support Alzheimer’s Comprehensive Care ActThis will encourage the agency to adopt a healthy model of dementia care like UCLA, said Rachel Conant, vice president of political affairs. The co-sponsors of the bill include members of the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee, each of which has jurisdiction over health insurance policies.

At the same time, the Medicare Advantage plan seems to be a logical place to pass Fringe benefitsHeather Dobbert, a memory care expert at the insurance company Fallon Health, educates caregivers on dementia and helps them plan for the later stages of the disease. Fallon Health’s comprehensive care plan for the elderly, the Medicare Advantage plan and its dual eligibility, and special needs plan refer patients to Dobbert’s services.
“Medicare Advantage people are the people I really want to connect with more people, because these people are usually not connected to any type of care team,” said Dobert.

Ruben said Medicare Advantage operators have been slow to adopt a comprehensive model of dementia care. However, CMS incorporated the new code for dementia diagnosis into the Medicare Advantage risk-adjusted model in 2020, so there are now financial incentives for more people to be diagnosed with dementia. Super said this may lead insurance companies to design more specific services for these patients.
Integrated care management and related alternative payment models are just an innovation that advocates of dementia hope to see. The Ministry of Health and Human Services announced in 2012 its goal of curing Alzheimer’s disease by 2025.
But research in the past few years has shown that dementia is complex and it is unlikely to be cured by panacea.This only adds importance Improve people’s quality of life Super said that although they suffer from dementia.
“My dream is that one day, every primary care institution will have a social worker with a solid knowledge base of dementia,” said Daubert. “There are too many things to do. But we have already arrived.”