The proposed reimbursement changes, outlined in the newest issue of  Health Affairs , greatly expand the scope of services offered to patients and even provide residual benefit to caregivers. Through these changes, quality of life for patients could be improved, relocations to nursing homes can be delayed, and caregivers' stress can be significantly reduced.

"Collaborative care models will get a strong return on investment to CMS through cost savings on patient care, however, that is just the beginning," says Malaz Boustani, MD, MPH, a Regenstrief Institute research scientist and lead author of the  Health Affairs  paper . "We are not just reducing expenditures on CMS, current patients, we're also providing a future return on investment." These caregivers could enter the system at the health deficit. with lower stress. " 

Health Innovation

Dr. Boustani is also director of the Center for Health Innovation and Implementation Science, a collaboration between the Indiana University School of Medicine, the Indiana Clinical and Translational Sciences Institute and Regenstrief. He is the Richard M. Fairbanks Professor of Aging Research at the IU School of Medicine and a clinician at the Sandra Eskenazi Center for Brain Care Innovation.

Studies have shown collaborative care models, which use a multidisciplinary team of specialists to manage and coordinate holistic care for people with Alzheimer's disease and related dementias, to be among the most effective methods of care, providing better outcomes for patients and reducing costs to healthcare systems by thousands of dollars per patient, per year. However, Medicare currently does not reimburse for the wide range of evidence-based services that are offered as part of collaborative care.

Examples of effective models exist. Dr. Boustani and colleagues developed and have tested for nearly a decade, a dementia care model – the Aging Brain Care (ABC) model which includes care coordination for diseases like depression and heart failure that often co-occur with dementia, offers families a highly qualified team of diverse experts to provide wraparound services and coordinate care, and activates services for caregivers that could help reduce stress and avoid burnout.

"Collaborative care models lead to better health and better lives for patients and caregivers as well as lower costs for hospitals and Medicare," says Dr. Boustani. "If we get their family member eligible for care, they will benefit, and it will help them enter the Medicare system in better health.

In the new payment model being advocated, patients who have moderate to severe dementia, patients with mild dementia whose caregivers present high levels of stress, would be eligible to receive coordinated services such as medication management, dementia care, care navigation support, and complementary support for diseases that commonly co-occur with Alzheimer's and related dementias. In addition, unpaid caregivers would receive access to mental health services and support groups. Reimbursement to providers for these services would be tied to performance-based metrics.