Dementia-Capable Care Coordination
This study describes the program requirements, workforce competencies, and barriers for dementia capable care coordination within health plans from seven states participating in the Center for Medicare and Medicaid Services demonstration programs for dually-eligible Medicare and Medicaid beneficiaries.
As of 2015, an estimated 5.4 million Americans had Alzheimer’s disease, costing the U.S. $226 billion in health care costs (Alzheimer’s Association, 2015, 2016). Medicare and Medicaid were expected to cover approximately 68% of these costs or $153 billion (Alzheimer’s Association, 2015). Persons with Alzheimer’s disease and related dementias (ADRD) frequently have other serious comorbid chronic health conditions (Bynum, 2009). People with serious medical conditions and ADRD are more likely to be hospitalized, and hospital length of stay (LOS) is longer, than people with the same conditions without ADRD.
Research Design and Methods:
Data came from contracts, policy documents, and 24 semistructured key informant interviews with national experts and leaders from community-based organizations, advocacy organizations, researchers, federal and state government, and health plans in the seven states.
Contracts included language mandating care coordination practices deemed dementia-capable, including workforce qualifications, training, and experience; dementia screening; involvement of a caregiver in the care planning process; and education, support groups, and referral resources for people with dementia and their caregivers. There was little consistency across states in their dementia capable requirements and informants questioned the dementia capability of the care coordination workforce and practice. However, promising practices and areas for improvement were identified.
Discussion and Implications:
The variability of the duals demonstrations made it difficult to compare across states. The three-way contracts were often the starting point of a process to more clearly define policies and practices in each state including workforce requirements. Efforts should be made to further adopt and translate evidence-based practices into health systems and evaluate promising practices.