Not managing Alzheimer’s disease and related dementias is a costly proposition not just to families, but also to society, according to two recent studies.
A survey of 53 Medicare Advantage health plan executives looked at the disconnect in dementia care with health plans facing growing numbers of members with dementia but seemingly resigned to the use of insufficient solutions. They found that many organizations are moving slowly — or not at all — to better manage Alzheimer’s disease and related dementias.
“Disconnects in Dementia Care: Opportunities for Impact” from Together Senior Health includes recommendations on how plans can better manage the current and future effects of these debilitating, costly conditions.
Among their findings were that health plans recognize ADRD’s challenges but underestimate its true cost. And although most plan leaders (83%) believe they should be offering formal programs designed specifically for members with cognitive decline, most lack formal care management programs such as those in place for other, less costly chronic conditions, according to the study.
The survey results also showed that plan leaders view existing solutions neutrally or, at worst, ineffective. Despite that, they are not implementing promising nondrug modalities, according to the report.
The misalignment between perceived spending on ADRD and reality helps underscore the importance of developing comprehensive condition management standards for members with cognitive impairments, according to the report authors.
“These innovative, comprehensive approaches support brain health, nurture connections and help prevent costly care episodes — effectively bridging the divide between health plan and member,” the authors wrote. “With a focus on comprehensive, whole-person care, the best programs effectively reduce high cost healthcare events and increase quality of life.”
The report listed several “essential elements” of therapeutic interventions for dementia, including ensuring solutions are research-backed, clinically proven, dementia-specific, take a comprehensive approach and are driven by outcomes.
The survey was conducted by Sage Growth Partners in March and included leaders from national and regional health plans, Medicare Advantage or Medicaid D-special needs plans, provider-owned health plans, and tech-enabled and/or venture-backed health plans.
Covering emerging therapies saves in the long run
A study from the University of Chicago calculated that it is less costly to cover emerging Alzheimer’s disease therapies for Medicare beneficiaries in the long run, reports Fierce Healthcare.
The study concluded that providing emerging Alzheimer’s drug coverage would save Medicare and Medicaid $13.1 billion to $545.6 billion in healthcare costs over 17 years — the time it takes for therapies to undergo a coverage with evidence development process for the Centers for Medicare & Medicaid Services to approve its use.
Medicare covers drugs that may slow the progression of Alzheimer’s disease if they receive traditional Food and Drug Administration approval. Groups such as the Alzheimer’s Association, however, argue that coverage is contingent on provider participation in a registration, which they called an “unnecessary barrier.”
UC researchers calculated that a year delay in Alzheimer’s progression from mild to moderate would save $34,249 in market costs and $7,882 in non-market costs, according to the news outlet.
“As the disease progresses, treatment would become relatively less effective, increasing the cost of treatment due to disease progression, which is not captured by our assumptions, but is highly likely to happen by the delay in coverage; this renders our estimates conservative,” the researchers concluded.
The researchers urged the Congressional Budget Office to consider their findings when estimating Alzheimer’s medication coverage costs. Reducing spending on specific drugs ultimately raises total healthcare costs, they said.
