National Plan to Address Alzheimer's Disease: 2018 Update. Strategy 2.E: Explore the Effectiveness of New Models of Care for People with Alzheimer's Disease and Related Dementias

10/19/2018

Work is underway at a number of agencies to identify models that provide more effective and efficient care for people with AD/ADRD. Models that improve health and quality of life for people eligible for both Medicaid and Medicare (dual eligibles) are also of great importance to the AD/ADRD population, as approximately 19% of the dual eligible population has some form of dementia.

(UPDATED) Action 2.E.1: Evaluate the effectiveness of relevant Innovation Center models for people with Alzheimer's disease and related dementias

The Innovation Center has tested several models that can include testing payment and service delivery models for improving care for Medicare beneficiaries with AD/ADRD. Several awards under the Innovation Center's Health Care Innovation Awards (HCIAs) round 1 and round 2 were focused on people with AD/ADRD and their caregivers. The Innovation Center is evaluating the effectiveness of the HCIAs, including those that focus on people with AD/ADRD.

CMS is in the process of completing the evaluation of HCIA round 2. Final evaluation results for the HCIA round 2 are anticipated to be available at the end of 2019.

For more information, see:

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(UPDATED) Action 2.E.2: Evaluate the effectiveness of the Independence at Home Demonstration

The Independence at Home Demonstration is testing a payment incentive and service delivery model that uses physicians and nurse practitioners to coordinate home-based primary care with LTSS. CMS has released the results from Year 2 of the demonstration.

For more information, see:

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(UPDATED) Action 2.E.3: Develop a supported decision making model as an alternative to guardianship

The National Resource Center for Supported Decision-Making (NRC-SDM) builds on and extends the work of Quality Trust's Jenny Hatch Justice Project by bringing together vast and varied partners to ensure that input is obtained from all relevant stakeholder groups including older adults, people with IDD, family members, advocates, professionals and providers. The NRC-SDM partners bring nationally recognized expertise and leadership on SDM, representing the interests of and receiving input from thousands of older adults and people with IDD. They have applied SDM in groundbreaking legal cases, developed evidence-based outcome measures, successfully advocated for changes in law, policy and practice to increase self-determination and demonstrated SDM to be a valid, less-restrictive alternative to guardianship.

For more information, see:

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(COMPLETED) Action 2.E.4: Analyze new payment and service options for Medicare-Medicaid dual eligible beneficiaries

ASPE is currently engaged in a project to produce targeted research briefs on options for expanding the Program of All-Inclusive Care for the Elderly (PACE). PACE was established as a permanent Medicare and Medicaid benefit by the Balanced Budget Act of 1997, and it attempts to help nursing home eligible older adults avoid institutional care by providing them with an appropriate, tailored mix of coordinated acute care and HCBS. PACE is designed for the frail elderly. To be eligible, participants must be 55 or older and certified by their state of residence as being eligible for nursing home level of care. The PACE Innovation Act gives the Secretary of HHS the authority to test changes to the PACE model, such as serving individuals under the age of 55, and people who do not meet the current nursing home level of care criteria, but may be at risk of entering a nursing home. The anticipated deliverables for this project include four research briefs that address the policy implications, benefit design, and financing structure of an expanded PACE program, including a descriptive analysis of subpopulations of dual eligible beneficiaries under age 55. Nationally, nearly half (49% comp) of PACE participants have been diagnosed with dementia, therefore lessons from the PACE model may have strong applicability to the field of dementia care broadly. Reports are expected by December 2018.

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(NEW) Action 2.E.5: Understand the role of certified community behavioral health clinics in providing access to care

In April 2014, the Protecting Access to Medicare Act created the Certified Community Behavioral Health Clinic (CCBHC) demonstration. The demonstration establishes a standard definition for CCBHCs and allows states to develop new prospective payment systems (PPS) that reimburse CCBHCs for the total cost of providing comprehensive services to all individuals who seek care. ASPE is managing a 5 year evaluation of this demonstration to answer research questions on how the CCBHCs improve access to care, whether they implement a full scope of services, how they improve the quality of care, whether the PPS covers the full costs of care, and how the demonstration impacts costs and utilization in Medicaid. Reports to Congress are due annually, and interim reports and a final report will be posted on ASPE's website.

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