Utilization of Specialized Geriatric Care Among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia: An Observational Analysis

Nikpay, Sayeh; Keohane, Laura M.; Cheng, Audrey; Braun, Kyle; Buntin, Melinda Beeuwkes; Lipworth, Loren; Stevenson, David G.

doi:10.1007/s11606-020-06460-3

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…We assessed patient receipt of dementia-relevant ambulatory care using 4 measures of ambulatory E&M visits (see above) based on recommendations in the national dementia strategy and prior research on ambulatory care of patients with dementia, as: (1) a current-year diagnosis of dementia on ≥1 E&M visit claim as evidence of treatment for dementia; ≥1 E&M visit with a (2) geriatrician, (3) neurologist, and (4) psychiatrist. 15,33 We also assessed patient receipt of other geriatric ambulatory care recommended for all older adults 34,35 as ≥1 E&M visit (5) to a primary care clinician and (6) coded as an annual wellness visit.…”

Section: Dementia-relevant and Other Geriatric Ambulatory Care Variablesmentioning

confidence: 99%

Risk Selection and Care Fragmentation at Medicare Accountable Care Organizations for Patients With Dementia

2023

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Background: Patients with dementia are a growing and vulnerable population within Medicare. Accountable care organizations (ACOs) are becoming Medicare’s dominant care model, but ACO enrollment and care patterns for patients with dementia are unknown. Objective: The aim of this study was to compare differences in ACO enrollment for patients with versus without dementia, and in risk profiles and ambulatory care among patients with dementia by ACO enrollment status. Research Design: Cohort study assessing the relationships between patient dementia, following-year ACO enrollment, and ambulatory care patterns. Subjects: A total of 13,362 (weighted: 45, 499,049) person-years for patients [2761 (weighted: 6,312,304) for dementia patients] ages 65 years and above in the 2015–2019 Medicare Current Beneficiary Survey. Measures: We assessed differences in ACO enrollment rates for patients with versus without dementia, and in dementia-relevant ambulatory care visit rates and validated care fragmentation indices among patients with dementia by ACO enrollment status. Results: Patients with versus without dementia were less likely to be enrolled in (38.3% vs. 44.6%, P<0.001), and more likely to exit (21.1% vs. 13.7%, P<0.01) ACOs. Among patients with dementia, those enrolled versus not enrolled in ACOs had a more favorable social and health risk profile on 6 of 16 measures (P<0.05). There were no differences in rates of dementia-relevant, primary, or specialty care visits. ACO enrollment was associated with 45.7% higher wellness visit rates (P<0.001), and 13.4% more fragmented primary care (P<0.01) spread across 8.7% more distinct physicians (P<0.05). Conclusion: Medicare ACOs are less likely to enroll and retain patients with dementia than other patients and provide more fragmented primary care without providing additional dementia-relevant ambulatory care visits.

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Section: Dementia-relevant and Other Geriatric Ambulatory Care Variablesmentioning

confidence: 99%

Risk Selection and Care Fragmentation at Medicare Accountable Care Organizations for Patients With Dementia

2023

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A million persons, a million dreams: a vision for a national center of radiation epidemiology and biology

Boice

Quinn

Al-Nabulsi

et al. 2021

International Journal of Radiation Biology

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Utilization of Specialized Geriatric Care Among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia: An Observational Analysis

Cited by 2 publications

References 4 publications

Risk Selection and Care Fragmentation at Medicare Accountable Care Organizations for Patients With Dementia

Risk Selection and Care Fragmentation at Medicare Accountable Care Organizations for Patients With Dementia

A million persons, a million dreams: a vision for a national center of radiation epidemiology and biology

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