A new report on how health plan leaders view Alzheimer’s disease and related dementias reveals that despite awareness of skyrocketing costs, health plans are “like a deer in headlights,” unsure how to address the immense financial, physical and emotional tolls of the disease.
Sage Growth Partners, a Boston-based healthcare research, strategy and marketing firm, released the report Tuesday. Commissioned by Together Senior Health, a digital therapeutics and brain health company, the report is based on survey responses from more than 50 senior leaders of health plans and value-based care organizations.
The report notes a disconnect between cost perceptions and realities around ADRD, leading to “a pattern of inaction.” Key findings include plans waiting for a sign, but missing the fact that ADRD is the fourth most costly chronic condition; payers unprepared for growing demand for expensive new drugs; and plans underutilizing alternatives to drugs.
“Fortunately, healthcare leaders are beginning to recognize the urgency of addressing ADRD and acknowledge that they must develop and enact dementia-specific strategies,” Sage Growth Partners CEO Dan D’Orazio said in a press release. “However, our recent findings show that organizations are surprisingly slow to implement cost-effective and outcome-oriented approaches.”
Among the report’s findings was that 77% of participants cited ADRD as an urgent priority, yet only 4% said that their organizations have a strategy in place. And although 45% of respondents said that they would make ADRD a higher priority in response to new treatments, only 12% reported making changes in anticipation of lecanemab’s (Leqembi) projected $90,000 annual cost.
Respondents said that increasing costs are the most common driving force behind adopting nonpharmaceutical interventions for ADRD, with 70% saying that they would be motivated to act if ADRD spending exceeded other high-cost conditions. Centers for Medicare & Medicaid Services data reveal that ADRD ranks as the fourth most costly condition, behind stroke, heart failure and chronic obstructive pulmonary disease. One-fifth of respondents, however, said that ADRD doesn’t even fall on their radar of top 10 priorities, revealing that health plan members with ADRD remain underserved, according to the report authors.
And although 69% of participants said that they are looking for innovative, nondrug interventions, 75% acknowledged that plans rely on existing care management tactics, such as referrals to outside support programs. Respondents said that they are looking for an evidence-based, outcome-oriented approach to managing dementia but that the traditional modalities being used today do not fit those criteria, according to the report.
“With nearly 7 million people in the United States currently living with Alzheimer’s disease or other dementias, healthcare costs related to these individuals will continue to have a significant impact on payers and families,” Together Senior Health CEO Alissa Meade said in a statement. “As clinical evidence accumulates around the promise of virtual, nonpharmacologic therapies to improve care, reduce the impact of cognitive decline and lower costs for individuals with Azheimer’s disease and other dementias, it is critical that health plan leaders reconsider what’s now possible.”
