Advisory Council May 2021 Meeting Presentation: Advancing Reimbursement

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

Monday, May 3, 2021

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Advancing Value-Based Reimbursement for Dementia Care

Nora Super, Executive Director, Alliance to Improve Dementia Care
Senior Director, Milken Institute Center for the Future of Aging

Milken Institute Alliance to Improve Dementia Care

• Alliance to Improve Dementia Care
  • Research
  • Health Systems
  • Industry
  • Philanthropy
  • Government
  • Community-based Organizations
  • People living with dementia and caregivers
  • Advocacy
• Areas of Focus:
  • Health and Economic Disparities
  • Workforce Development and Capacity Building
  • Payment for Collaborative Dementia Care Models
    • Roundtable June 7, 2021
• Cross-Sector Collaborative:
  • The Alliance to Improve Dementia Care includes 60+ leading organizations across eight key stakeholder groups, including people living with dementia and caregivers

Alliance Overview: Publications to Date

• "Reducing the Cost and Risk of Dementia"
• "Better Brain Health through Equity: Addressing Health and Economic Disparities in Dementia for African Americans and Latinos"
• "Building Workforce Capacity to Improve Dementia Detection and Diagnosis"
• See https://milkeninstitute.org/centers/center-for-the-future-of-aging/alliance-to-improve-dementia-care

Alliance Overview: Strategy to Accomplish Goals

• Convene diverse organizations
  • Partner with leaders from health systems, industry, research, advocacy, philanthropy, community-based organizations, and government.
  • Engage policymakers and connect with leading stakeholders to advance recommendations to improve brain health and dementia care
• Collaborate with federal agencies and policymakers
  • Integrate public- and private-sector efforts to advance scalable solutions.
  • Work with federal advisory boards, government leaders, and decision makers to overcome long-standing care and financing barriers.
• Identify gaps in care
  • Spotlight gaps in training, resources, care delivery, and supportive services.
  • Mobilize industry leaders to create solutions to optimize the workforce, build systems capacity, and integrate services and support.
• Propose policy and systems solutions
  • Advance payment and delivery models to align care preferences and incentives.
  • Develop and promote policies that build a dementia-capable workforce and system across the care continuum.

Scaling Collaborative Dementia Care Models Roundtable -- June 7

• Objective:
  • Develop recommendations and a roadmap to advance testing and implementation of a new payment model for collaborative dementia care in Medicare fee-for-service.
  • The recommendations that emerge will inform a report to be released during Q3 2021.

Key Questions

• What are the core elements of collaborative dementia care models?
• What are the key lessons learned from implementation of collaborative dementia care models in health systems?
• How can dementia care models be applied to diverse and low-income populations?
• What community services and supports are needed to support collaborative dementia care?
• What barriers exist to implementing collaborative dementia care models?
• What levers are needed to drive payments to primary care providers, health systems, community-based organizations (CBOs), and caregivers?
• Should a new alternative payment model (APM) for dementia care management be established, or should initial adoption be developed as part of an existing model currently being tested by the Centers for Medicare and Medicaid Innovation (CMMI)?
• What evidence is required to affirm the readiness for implementing an APM?
• What billing codes, procedures, and infrastructure are needed or need to be better utilized, including to ensure that this is available to a diverse population such as rural and underserved communities?
• How can we ensure CBOs are reimbursed for the services they provide?

Collaborative Dementia Care Core Elements

• Core elements of care models help improve care, delay transitions from the home to nursing homes, and reduce the impact on family caregivers.
• Essential elements of proposed collaborative dementia care models
  • Continuous monitoring and assessment
  • Ongoing care plan
  • Psychosocial interventions
  • Self-management
  • Caregiver support
  • Medication management
  • Treatment of related conditions
  • Coordination of care
• Source: Lees Haggerty, K., Epstein‐Lubow, G., Spragens, L.H., Stoeckle, R.J., Evertson, L.C., Jennings, L.A. and Reuben, D.B. (2020), Recommendations to Improve Payment Policies for Comprehensive Dementia Care. J Am Geriatr Soc, 68: 2478-2485. https://doi.org/10.1111/jgs.16807

Comprehensive Dementia Care Payment Structures

Payment Models for Comprehensive Dementia Care
Payment Structure	Viable aspects of the payment structure
Fee-for-Service	Fee-for-service currently does not cover all elements of comprehensive dementia care
Medicare Advantage	Medicare Advantage supports chronic disease, which can be leveraged to support comprehensive dementia care
Bundled Payment	Bundled payment currently does not cover all elements of comprehensive dementia care
Medicaid, Federally Qualified Health Centers, and Rural Settings	Telemedicine and other strategies for reaching remote populations can be leveraged to improve access to care

Source: Lees Haggerty, K., Epstein‐Lubow, G., Spragens, L.H., Stoeckle, R.J., Evertson, L.C., Jennings, L.A. and Reuben, D.B. (2020), Recommendations to Improve Payment Policies for Comprehensive Dementia Care. J Am Geriatr Soc, 68: 2478-2485. https://doi.org/10.1111/jgs.16807

The Path Forward: Policy Recommendations

• To advance collaborative dementia care models
  • Scale testing and implementation of new payment models for collaborative dementia care in Medicare fee-for-service, especially in underserved communities
  • Develop core components of collaborative dementia care models that are congruent with cultural norms, including caregiver support
  • Adapt collaborative dementia care models to Medicare Advantage and dual-eligible plans
  • Increase opportunities for payment to community-based organizations (CBOs)
  • Provide appropriate services to all patients with varying levels of need
  • Expand technology approaches through broadened telehealth availability and use of remote patient monitoring