NATIONAL PLAN TO ADDRESS ALZHEIMER'S DISEASE: 2017 UPDATE. Strategy 2.H: Improve Care for Populations Disproportionately Affected by Alzheimer's Disease and Related Dementias, and for Populations Facing Care Challenges

09/01/2017

Alzheimer's Disease Initiative-Specialized Supportive Services. ACL continues to use Prevention and Public Health Funds to support 21 ADI-SSS grantees and their partners, which are located across the country and in Puerto Rico. The grantees are operating within dementia-capable systems and implementing new programs designed to provide more effective services to: (1) individuals living alone in the community with dementia; (2) individuals with IDD who have or are at-risk of developing dementia; (3) caregivers who need behavioral symptom management training or expert consultations to help them care for family members; and (4) provision of effective care/supportive services for individuals living with moderate to severe AD/ADRD and their caregivers. Grantees include a broad range of existing dementia-capable public and private entities including AD-specific organizations, academic institutions, an organization dedicated to services for the IDD community, a health system, states and several local community organizations. Grantees have tailored their programs to address service gaps in the communities they serve and use evidence-based and evidence-informed interventions to do so. ACL anticipates the continuation of the ADI-SSS program, with new funding in 2016.

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Veterans-Directed Long-Term Services and Supports. ACL and VHA continue to partner in supporting states' efforts to develop and better coordinate no wrong door systems of access to services. Together they lead the national expansion of Veteran-Directed Home and Community-Based Services (VD-HCBS) with the goal of assuring that veterans of all ages receive the care they need in their homes and communities, and are provided appropriate supports that allow them to remain there. In many cases, veterans in VD-HCBS hire individuals they are most comfortable with including family, friends and neighbors, to provide the services and supports they require. Veterans with dementia who reside in VA and community nursing facilities have been successfully transitioned back into the community with the support of VD-HCBS.

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Comparing Outcomes for Dually Eligible Beneficiaries in Integrated Care Models. ASPE has a project underway to determine the feasibility of an analysis that compares selected health outcomes and quality measures for Medicare-Medicaid dual eligible beneficiaries participating in managed care models that align Medicare and Medicaid benefits, such as Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), Medicare Advantage Fully Integrated D-SNPs, and PACE, to outcomes for dually eligible beneficiaries who are not participating in these models. Dually eligible beneficiaries are almost three times more likely to have dementia as their Medicare-only counterparts, therefore programs that serve large numbers of dually eligible beneficiaries are likely to also serve people with dementia. This study aims to better understand whether dually eligible beneficiaries fare differently in different integration models across a number of categories including but not limited to, mortality, nursing home utilization, hospital readmissions, and chronic conditions (inclusive of AD/ADRD or Senile Dementia, as identified in CMS's Chronic Conditions Data Warehouse). The project deliverables include an environmental scan of existing research comparing outcomes for dually eligible beneficiaries in Special Needs Plans and PACE to outcomes for beneficiaries who are not participating in these models, an analysis plan, and an exploratory analysis that will inform a report on the feasibility of the analysis plan given the current data available. Reports are forthcoming in 2018.

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Policy Options for Medicare-Medicaid Dual Eligible Beneficiaries. ASPE has a project underway to identify policy options for using Medicare Advantage D-SNPs as a platform to integrate care for dual eligible beneficiaries. D-SNPs are a type of Medicare advantage managed care plan that enroll only dual eligible beneficiaries and are required to provide or coordinate all Medicare and Medicaid benefits for their enrollees. Twenty-two percent of older people with dementia are duals, and the number is increasing, and this population could benefit from the coordinated and aligned care offered by D-SNPs. This project produced a report detailing policy options, considerations, and challenges for using D-SNPs as a scalable platform for broader integration of Medicare and Medicaid benefits. A report is forthcoming by December 2017.

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Analysis of Pathways to Dual Eligible Status. ASPE has a project underway to identify the frequency with which the various eligibility pathways to dual eligible status are utilized and to understand the circumstances and characteristics of individuals surrounding their transition to dual status. Individuals become dually eligible for Medicare and Medicaid programs through multiple pathways. They can become eligible for one of the programs before the other, based on age, disability, or income; or they may simultaneously become eligible for both programs. However, current understanding of these pathways remains limited. Differences in the pathways to dual eligibility have implications for Medicare and Medicaid spending and service use patterns. Understanding these differences can inform policy efforts to support the dual eligible population and individuals at-risk for becoming dually eligible. Nearly one-quarter (23%) of dual eligible beneficiaries over the age of 65 have AD/ADRD. A report is forthcoming in December 2017.

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New York State Alzheimer's Disease Caregiver Support Initiative for Under-served Communities. NYSDOH allotted $1.5 million to fund a wide range of caregiver support and respite services for caregivers of individuals with AD/ADRD, either or both of whom are members of under-served communities. Fifteen contractors, funded at $100,000 each, provide culturally-competent support initiatives and stress reduction strategies for caregivers of diverse under-served populations across the state. Contractors provide extensive outreach, intake and assessment, referral, and at least one of the following core services: support groups, education, caregiver wellness, and joint enrichment.

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Addressing Disparities in Alzheimer's Disease and Other Dementias in New York State. NYSDOH allocated $250,000 for a demonstration project with the goal of increasing AD/ADRD screenings in primary care settings for African American and Hispanic populations, to promote earlier diagnosis and treatment of AD/ADRD among these populations, and to connect those diagnosed with AD/ADRD to community support, medical services, and clinical trials. Long-term objectives include effective disease management, continued community residence, and decreased caregiver burden.

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