A Break-Even Analysis for Dementia Care Collaboration: Partners in Dementia Care

Morgan, Robert O.; Bass, David M.; Judge, Katherine S.; Liu, C. F.; Wilson, Nancy; Snow, A. Lynn; Pirraglia, Paul A.; Garcia-Maldonado, Maurilio; Raia, Paul; Fouladi, Negin; Kunik, Mark E.

doi:10.1007/s11606-015-3205-x

Cited by 14 publications

(42 citation statements)

References 21 publications

(34 reference statements)

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“…Their team consisted of four CTNs and one coordinator . The Partners in Dementia Care (PDC) provided care coordination services for veterans with dementia . PDC showed an intervention cost of $65 to $80 per‐dyad‐month at a caseload of 100 to 120 dyads per CTN .…”

Section: Discussionmentioning

confidence: 99%

“…The Partners in Dementia Care (PDC) provided care coordination services for veterans with dementia . PDC showed an intervention cost of $65 to $80 per‐dyad‐month at a caseload of 100 to 120 dyads per CTN . The program included one coordinator and one care consultant who was either a nurse or social worker .…”

Section: Discussionmentioning

confidence: 99%

“…PDC showed an intervention cost of $65 to $80 per‐dyad‐month at a caseload of 100 to 120 dyads per CTN . The program included one coordinator and one care consultant who was either a nurse or social worker . The Healthy Aging Brain Center (HABC) reported operational costs of $52 per dyads‐month for a caseload of 101.5 dyads per care coordinator including only staff‐related costs .…”

Section: Discussionmentioning

confidence: 99%

“…Collaborative dementia care programs aim to improve patient care coordination, consistency, and quality of patient care through a collaborative multidisciplinary approach centered on patients and caregivers . Depending on patient caseload and type of services offered, the costs of such programs varied from $624 to $1416 per participant per year . Some of these programs result in cost savings for healthcare systems through targeted care management that reduces acute care utilization .…”

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confidence: 99%

“…[6][7][8][9] Some of these programs result in cost savings for healthcare systems through targeted care management that reduces acute care utilization. [6][7][8][9] However, due to fragmented healthcare systems in the United States, organizations that implement collaborative care models may not realize the cost savings themselves. For example, Medicare would save money when hospital use is reduced, whereas a fee-for-service outpatient system would not.…”

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confidence: 99%

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Variations in Costs of a Collaborative Care Model for Dementia

Rosa

Possin

Bernstein

et al. 2019

J American Geriatrics Society

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OBJECTIVES Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program. DESIGN We applied a micro‐costing analysis to calculate operational costs per‐participant‐month between March 2015 and May 2017. SETTING The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC). PARTICIPANTS Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants. INTERVENTION A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management. MEASUREMENTS We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start‐up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs. RESULTS Start‐up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per‐participant‐month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per‐participant‐month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per‐participant‐month with the highest projected caseloads (90). CONCLUSION We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628–2633, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Variations in Costs of a Collaborative Care Model for Dementia

Rosa

Possin

Bernstein

et al. 2019

J American Geriatrics Society

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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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