Advisory Council April 2019 Meeting Presentation: Implementing Person-Centered Planning

04/29/2019

ADVISORY COUNCIL ON ALZHEIMER'S RESEARCH, CARE, AND SERVICES

Monday, April 29, 2019

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Implementing Person-Centered Planning to Support People Living with Cognitive Symptoms

Gary Epstein-Lubow, MD
Non-federal chair, Clinical Care Subcommittee

Clinical Care Subcommittee Non-Federal Members

  • Katie Brandt
  • Michelle Dionne-Vahalik
  • Robert Egge
  • Gary Epstein-Lubow
  • Cynthia Huling Hummel
  • Bradley Hyman
  • Allan Levey

2017 Recommendation 10

  • The Advisory Council on Alzheimer's Research, Care and Services should devote one meeting to advancing the work ASPE has conducted with RTI International on defining best practices for comprehensive dementia care.
  • Specific topics should include:
    1. an in-depth description of the Examining Models of Dementia Care report and appendices;
    2. federal agency reporting of current innovative services for persons with dementia and their caregivers;
    3. non-federal reporting from health systems and/or payers of exemplar population health solutions for dementia care; and,
    4. Advisory Council discussion of next steps to advance consensus definitions of best practice models, including measurement targets for clinical outcomes and value-based outcomes concerning cost and the care experience.
  • ASPE Response
    • The Examining Models of Dementia Care: Final Report is published and available on the ASPE and NAPA websites. As was discussed during the April 2017 NAPA Advisory Council meeting, there are a number of different directions in which to pursue future research, and ASPE would welcome the opportunity to discuss these opportunities in greater detail with the Advisory Council at-large, or with one or more of the relevant NAPA subcommittees.

April 2018 - Session 1: Advancing Consensus on Dementia Care Elements

  • Alzheimer's Association Dementia Care Practice Recommendations
    • Sam Fazio and Doug Pace, Alzheimer's Association
  • Quality Care from the Perspectives of People Living with Dementia
    • Cynthia Huling Hummel, NAPA Council Member
  • Care Planning and Health Information Technology: How to Aid Dementia Quality Care
    • Liz Palena Hall, ONC

April 2018 - Session 2: Exemplar Models Informing the Need for New Outcomes Measurement

  • Comprehensive Primary Care Plus (CPC+): Exemplar of governmental initiative
    • Laura Sessums, CMS/CMMI
  • Age-Friendly Health Systems: Exemplar of Non-governmental initiative
    • Amy Berman, John A. Hartford Foundation
    • Kedar Mate, Institute for Healthcare Improvement

2018 Recommendations 4 & 5

  • Recommendation 4: Determine a process for reaching consensus on national definitions of best practices for comprehensive care of AD/ADRD at all disease stages
    • There should be current best practices for comprehensive care of AD/ADRD at all disease stages so that persons living with AD/ADRD, caregivers, health systems and payers have similar understanding regarding diagnosis, treatment and/or services and supports; and the Advisory Council should identify an approach for outline practices for such comprehensive care.
  • Recommendation 5: Encourage further development, evaluation and use of healthcare models for AD/ADRD that align performance measures, the experience of care by persons living with AD/ADRD and their caregivers, and payment.
    • Federal agencies, states and non-governmental payers of health care services should increase the use of value-based care for persons living with AD/ADRD to pay for health care services in a manner that directly links health services payments to performance on cost, quality, and resource use metrics; this alignment will better support comprehensive person-centered care leading to improved health and quality of life for persons living with AD/ADRD.

Examining Models of Dementia Care -- ASPE & RTI

  1. Detection of Possible Dementia
  2. Diagnosis
  3. Assessment and Ongoing Reassessment
  4. Care Planning
  5. Medical Management
  6. Information, Education & Supported Decision-Making
  7. Emotional Support for PLWD
  8. Assistance with Daily Functioning for PLWD
  9. Involvement, Support & Assistance of Caregivers
  10. Prevention & Mitigation of Behavioral & Psych Symptoms
  11. Safety of the PLWD
  12. Therapeutic Environments, including Modifications
  13. Care Transitions
  14. Referral and Coordination of Care and Services that Match the Needs of the PLWD and Family Caregivers and Collaboration Among Agencies & Providers

https://aspe.hhs.gov/report/examining-models-dementia-care-final-report

Why focus on person-centered planning?

  • Consensus that it's important
  • New national resources
  • Developing quality measurement
  • Care planning code recently introduced
  • Technology opportunities
  • Population health approaches are expanding
  • Priority for people living with cognitive symptoms
  • Potential topic for update to National Plan

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