I am Project Director at Education Development Center, a non-profit research and development organization. I prepared these public comments with Dr. Epstein-Lubow, a geriatric psychiatrist at Butler Hospital and Associate Professor at Brown University and Dr. Reuben, Professor of Medicine and Chief of the Division of Geriatrics at the David Geffen School of Medicine at UCLA. These comments are our own.
In an public comment at the January 27, 2020 meeting, we stated that the Assistant Secretary for Planning and Evaluation (ASPE) and this Advisory Council must address payment reform for dementia care and treatments. There are at least six working models in the US for dementia care that improve quality, achieve better clinical outcomes for persons living with dementia and caregivers, and some lower costs; but, dementia care using these models is not widely available.
ASPE should be aware that on Nov 7, 2019 a one-day meeting focused on "Payment Models for Comprehensive Dementia Care" convened over fifty clinicians, researchers, advocates, payers and other leaders with expertise in dementia care and healthcare payment. The conference was heldin Washington, D.C. with support from The John A. Hartford Foundation, Hebrew Senior Life, and Education Development Center. During the conference, these experts reviewed short-term solutions for payment reform and discussed next steps for accelerating the use of current and new payment models. A manuscript describing conference outcomes has been accepted for publication in the Journal of the American Geriatrics Society. The manuscript includes recommendations for improving access to comprehensive dementia care through payment reform, research, education and advancement of a population health approach to coverage based on risk and need. HHS should consider the expert recommendations in this manuscript when it becomes available.
In addition, HHS should act now to advance payment reform efforts through three activities:
Continue work previously conducted by ASPE regarding Examining Models of Dementia Care, and how they have been modified during the COVID-19 pandemic;
Convene at least one work group to address payment reform for comprehensive dementia care; and,
Begin immediately to monitor how the inclusion of dementia as a risk adjustment modifier in the CMS Hierarchical Condition Category (HCC) coding affects the definitions of populations of people living with dementia, the quality of care, the types of care received, and the health outcomes of those individuals.
These recommendations are in alignment with the National Plan to Address Alzheimer's Disease's Strategy 1.E (Facilitate translation of findings into medical practice and public health programs) and all Strategies under Goal 2: Enhance Care Quality and Efficiency.
Thank you for considering these comments.