Variations in Costs of a Collaborative Care Model for Dementia

Abstract

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

A RE-AIM Analysis of an Intergenerational Dementia Education Program

“…However, there is evidence that the costs of programs for people with dementia can reduce overtime from the start-up phase to the continuing phase of the program (likely due to economies of scale and increased efficiency once the program is up and running). For example, the costs of care-coordination programs in people with dementia decreased from between $501–$581 during the start-up phase for the program, to $142–$241 per participant per month once the programs were up and running in a stable phase (all in US dollars) ( 32 ). Therefore, similar economies of scale and increased efficiency may occur if the dementia-education program were run again in multiple regions.…”

Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use

“…Longer continuity of the CTN-dyad relationships at UNMC allowed for higher efficiency. 21 At each hub, a full-time advanced-practice nurse and social worker were co-located with the CTNs, and a pharmacist was available part-time. 21 These expert health care profes-sionals were available for situations beyond the CTN's scope, such as medical needs, problematic behavioral symptoms, complex legal or financial circumstances, and safety concerns.…”

“…21 At each hub, a full-time advanced-practice nurse and social worker were co-located with the CTNs, and a pharmacist was available part-time. 21 These expert health care profes-sionals were available for situations beyond the CTN's scope, such as medical needs, problematic behavioral symptoms, complex legal or financial circumstances, and safety concerns. The specialists addressed these situations through consultation with the CTN, direct consultation with the dyad, or care coordination with outside health care and service professionals.…”

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada

“…Dementia affects more than half of all residents who reside in assisted living facilities [ 1 – 3 ]. Older adults who live with dementia are more likely to experience injuries requiring acute care, be diagnosed with pneumonia, and encounter difficulties with eating [ 4 , 5 ]. Care for dementia is expensive and a widely cited reason for older adults requiring placement in a nursing home [ 6 – 9 ].…”