From 3M Health Information Systems
Alzheimer’s disease and value-based aging
More than 50 million people worldwide and 6.5 million Americans are living with Alzheimer’s disease. It is responsible for up to 70 percent of dementia cases and represents a significant social and economic burden to patients, family caregivers and the health system.
Alzheimer’s disease (AD) is primarily a disease of the aged. It afflicts 5 percent of people aged 65-74, 13.1 percent of people aged 75-84, and one-third of people 85 and older. Since only five to six percent of people with AD develop symptoms before the age of 65, most Alzheimer’s patients in the United States are insured by Medicare.
The cost of Alzheimer’s disease
According to the Alzheimer’s Association, three fourths of people with Alzheimer’s disease and other dementia will be admitted to a nursing home by the time they are 80 years old compared to only four percent of the general population. The high cost of nursing home care contributes to the large proportion of seniors with Alzheimer’s that are dual eligible for Medicare and Medicaid. Nearly one in four seniors with Alzheimer’s and other dementia are dual eligible compared to only 10 percent of all seniors.
The Alzheimer’s Association reports that people 65 and older live an average of four to eight years and often up to 20 years after diagnosis and cost the U.S. economy an estimated $321 billion. The cost of Alzheimer’s is similar to the $327 billion price tag for diabetes, yet there are four times as many people in the U.S. diagnosed with diabetes compared to Alzheimer’s. This means the per person cost to treat Alzheimer’s is four times greater than treating diabetes.
Value-based aging is the application of value-based care to the elderly. The primary difference from a traditional value-based care approach is that it recognizes the costs and benefits associated with unpaid informal care provided by family and friends. An emphasis on home-based care can validate, as well as alleviate, the burden of family members that care for their loved ones with Alzheimer’s.
Quality measures also need to address the concerns faced by Alzheimer’s patients. These extend beyond the traditional measures of emergency department visits, hospitalizations, readmissions and unnecessary medical procedures. These should also include such measures as polypharmacy use, falls and unintentional injuries, potentially preventable complications that result from inpatient and outpatient procedures, as well as patient and caregiver reported events related to activities of daily living, social engagement and patient autonomy.
Approaches to care
Health care providers are increasingly recognizing the importance of offering comprehensive and coordinated care to their patients with Alzheimer’s disease. The Alzheimer’s and Dementia Care (ADC) program offered by the University of California, Los Angeles supports primary care practices by providing nurse practitioner co-management for their patients. ChenMed uses an integrated team approach including a primary care provider, pharmacist, dietician and dentist to address the multi-faceted issues Alzheimer’s patients face.
Multiple conditions that co-occur with Alzheimer’s, most notably diabetes, cardiovascular disease, depression and inflammatory bowel disease, need to be managed along with addressing the cognitive issues associated with the disease. Treatments available to treat cognitive decline are limited, costly and not without controversy. The U.S. Food and Drug Administration (FDA) recently authorized two different drugs to treat cognitive decline in Alzheimer’s patients. However, one of them was authorized against the recommendation of the FDA’s own scientific advisory panel, and the other may be linked to patient deaths.
The number of people living with Alzheimer’s disease will increase with life expectancy. This will continue to burden systems that are ill-equipped to deal with the complexities of cognitive decline. The current approach of relying on unsupported and unpaid caregivers until the patient needs institutional care is both inhumane and unsustainable. Federal and state governments, as well as Medicare Advantage and Managed Medicaid payers have the opportunity to shape the future of value-based care to serve the needs of a complex and growing population, as well as the family members that care for them.
Steve Delaronde is senior manager of product, population and payment solutions at 3M Health Information Systems.