Dr. James Pratty had grown increasingly frustrated with the fragmented care and inadequate support dementia patients and their caregivers were receiving.
“We saw patients who were suffering from confusion, delusions and falls,” said Pratty, senior medical officer for behavioral health and psychiatry at CareMore, a Medicare Advantage plan headquartered in Cerritos, Calif., that is owned by Anthem. “It was clear to us that a 30- to 45-minute visit was not enough time to educate the family and do the necessary interventions.”
Roughly 5.3 million Americans have Alzheimer's disease and that number is expected to jump to 7.1 million by 2025, according to the Alzheimer's Association. Costs associated with Alzheimer's are expected to balloon from $226 billion this year to as high as $1.1 trillion in 2050, the group predicts.
Providers, insurers and researchers are seeking innovative ways to better manage the complex behavioral and physical symptoms of dementia and provide the right patient and family supports, said Beth Kallmyer, vice president of constituent services at the Alzheimer's Association.
For CareMore, whose average member is 72 to 74 years old, the issue was especially pressing, Pratty said. In 2011, he and his colleagues decided to conduct a pilot project aimed at improving outcomes for dementia patients. But first they took a closer look at the care dementia patients were receiving. They found high rates of falls, high numbers of emergency department visits, high rates of hospital admissions, poor medication adherence, and poor patient and caregiver understanding of the illness.
“Their doctors are our aligned primary-care providers, and they're good doctors but they don't have the time to really explain things,” Pratty said.
He and his team identified a group of 46 dementia patients for the pilot program, called the Brain Health Program. It was based on CareMore's successful disease-management programs, which use a multidisciplinary approach to coordinate care for patients with chronic obstructive pulmonary disease, congestive heart failure, end-stage renal disease and other conditions.