• If you are citizen of an European Union member nation, you may not use this service unless you are at least 16 years old.

  • You already know Dokkio is an AI-powered assistant to organize & manage your digital files & messages. Very soon, Dokkio will support Outlook as well as One Drive. Check it out today!

View
 

Financial Issues Team Summary

Page history last edited by Kate Tripoli 13 years, 12 months ago
I. PERSON WITH DEMENTIA, CARE PARTNERS, DEMENTIA COMPETENT COMMUNITIES    
Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Public Awareness/Community Action    

1) Promulgate a common definition of the characteristics of a dementia competent community that can be communicated and adopted by communities statewide.


2) Create a public awareness campaign (individuals and communities) that increases knowledge and awareness and decreases the stigma of dementia.


3) Create “action kits” for communities to identify their own needs and strategies to meet those needs, build capacity and identify local follow up activity. 

1) Hopefully low cost – as state agencies and others could incorporate the recommendations of the Working Group into their current work.


2) Rough estimate of $2 million for PR campaign ($500,000 creative / $1.5 million roll out).


a. To develop a firmer estimate, research costs of the Blue Cross “Do” campaign, the D.A.R.E. program, and U.S. Dept of HHS lupus ID project (www.couldihavelupus.gov)

b. Invite input from Kathleen Harrington (MBA Chair) and Jeanne Lukas (Alz Assn board member), who have professional bkgrnd in PR / communications.


3) (Not specifically discussed.) 

1) New State appropriation, if applicable.  But also explore how this could be folded into existing agency work and budgets (e.g. the MBA’s Communities for a Lifetime work).


2) Seek pro bono contributions both of the creative work (e.g. a local firm) and publicizing efforts (e.g. public service announcements; public TV and radio).


3) See item (1) above.  Also, leverage existing county gaps analysis with regard to capacity building. 

The Weimer Sager Wisconsin study suggests a return from early identification and treatment, both to the state long-term care budget, and a social return to families.  But note the “social returns” could be viewed as “funny money”.


Lakeview Ranch studies and anecdotal evidence suggest that quality community based care results in fewer nursing home utilization and hospitalizations.  Such care may not be available in all communities.


Argument can be made for a return on public awareness activities.  Three-legged stool of awareness + diagnosis + interventions, all have to be in balance for success. 

Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Resources and Navigation    

1) Ensure that MN resources for locating and navigating care options are dementia competent, inclusive of all stages of the disease and easily accessed.  In the interim, recommend that providers work with the Alzheimer’s Association and other interested parties to publicize meaningful indicators of care.


2) Develop/enhance/ improve support systems for caregivers including informal and formal resources, current strategies, and “community as caregiver” networks.


3) Design (a) web-based dementia research clearing house and (b) resource center to serve persons across the full range of cognitive function.
 

1) If we have to create a database that does not now exist, the cost will be high – e.g. pulling together existing data fields from various sources into one resource center (e.g. physicians with expertise in dementia).


a. A lower-cost idea is to identify consumer information and assistance work the state is already doing and incorporate dementia competence.


b. Consider meeting with private sector experts (e.g. David Foster’s contacts at Oracle) and/or Senior Linkage Line or mnhelp.info architects to develop firmer understanding of costs.


2) (Not specifically discussed.)


3) Laura Hemmy estimated $180K to set up research clearinghouse, $35-40K annually to run it. 
 

1) New State appropriation, if applicable.  Also explore how this could be folded into existing agency work.


2) (Not specifically discussed.)


3) Would Mayo or the U of M consider funding this?  Follow the launch of “Trial Match” next month and see how we could leverage it in Minnesota.


Consider sustainability of funding source in these (and all) recommendations.
 

Families would be big winners.  But again, be cautious about promoting “social” gains which some view as funny money.


Businesses could see worker productivity gains if there was an “easy button” for families to use in solving care related issues (i.e. less lost work time). (See “Facts & Figures” for a general discussion of productivity).


The Mittelman study shows a reduction in State long-term care costs (due to delayed nursing home admission) from caregiver intervention; see also separate DHS fiscal analysis (cost $2500 per family, offset by an estimated savings in five years).  Think creatively about a bridge-financing approach (e.g. first 2-years funded by non-state sources, with state taking over in year three and realizing the return in year 5). 

Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Research and Development    

Collect state-wide data re: frequency of cognitive impairment.


Support coordination between delivery systems and dementia researchers to collect relevant data.
 

Relatively low cost to mine existing data.   New data collection could be expensive.  New state appropriation, if applicable.  Seek to mine and leverage:
• Stratis Health’s Medicare database
• There is an “all payors” claims database but can’t legally be accessed for our purposes. Explore possible legal change.
• RESDAC
• Forthcoming Olmstead County (Mayo) and VA data (Dr. McCarten).
• Meet with MDH and DHS to understand new State data collection and reporting requirements under federal health care reform. 

Not clear that investing in a Minnesota-specific data set is advisable, especially if there would be a significant cost; not clear if it would provide anything that national data sets don’t already provide.  I.e. would be a marginal contribution.


Consider studying existing data to identify “prevalence pockets” (e.g. where greater numbers of elderly reside) and use this information to target Public Service Announcements, etc.


National Alz Assn wants all states to have BRFSS Cognitive Impairment module, but research team concluded that BRFSS wouldn’t give us good prevalence data.  Explore other avenues for obtaining data (see the list to the left). 

II. HEALTH CARE AND QUALITY OF CARE   
Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Provider Awareness    
Ensure state-wide website and awareness campaign about the importance of early ID and intervention, achieved through screening; and communicate with providers about incentives for and importance of each.

See notes above concerning a public awareness campaign.


Direct communication to physicians could occur at relatively low cost, if the Minnesota Medical Association and other such organizations are willing partners.


Need to understand and isolate the obstacles to more routine physician screening in order to estimate the cost of a targeted solution. 

New state appropriation, if applicable.


Insert early cognitive assessment into three places:
1) Minnesota Community Measurement (great stuff and low cost)


2) The newly-authorized Medicare annual wellness and prevention / planning visit (try to influence the elements of that screening)


3) “Medical home” structures. 

The Weimer Sager Wisconsin study suggests a return from early identification and treatment, both to the state long-term care budget, and a social return to families.

 

Our sense is that there is not enough data yet about non-pharmacological interventions to understand ROI.  This needs more study and discussion.  If there is promising data (e.g. ask Mayo about ‘HABIT”), we might use it to support a request for a demonstration project relating to emerging / promising practices--competitive grant.
 

Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Early ID and Screening   
Recognize importance of cognitive screening and include screening in annual exams.  See preceding row.  See preceding row.  See preceding row. 
Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Standards, Best Practices for Evaluation and Treatment of Alzheimer's Disease    

Develop a provider tool box that includes screening measures and strategies  for further evaluation.


If diagnosed, cognitive impairment becomes the organizing principle for all other care of the patient.

(Not specifically discussed.)  (Not specifically discussed.) 

The Weimer Sager Wisconsin study suggests a return from early identification and treatment, both to the state long-term care budget, and a social return to families.


Various studies reflect higher costs for treating persons with dementia than without, (greater costs for treatment of co-morbidities; more hospitalizations).  Better care coordination could help.  Exact causal links not always clear, but studies suggest we should further discuss the opportunities presented.   

Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Training and Ongoing Education of Standards and Best Practices    

Include dementia care in medical schools, academic health centers and allied health professional education;


include in continuing education; and


develop an incentive based, reward model to ensure quality education for all levels of care.
 

Cost of revising medical school curriculum not specifically discussed.  Consider consultation with U of M and UMD.

 

Incentive payment system not specifically discussed.  Existing quality standards from Alz Assn could be distributed at relatively low cost. 

New state appropriation, if applicable, to the State medical schools.
 

Higher quality care can save money in the long-run, but need to research whether there are studies specific to dementia care.


State budget-makers have been open to pay-for-performance ideas in recent years, in some cases with an eye to reducing state expenditures.
 

Recommendation  Estimate of costs?  Potential sources of funds? Leverage opportunities?  Who benefits? Likelihood of return on investment? How do we know? 
Patient-Centered Medical Home    

Include Alzheimer’s care in basket of care in multi-payer medical home model.

 
Develop “disease educator “ status and referrals and establish protocol and core curriculum for disease educators.

Provide care consistent with the patient’s needs, values, and preferences by establishing goals of care.  Financially support discussions with patients and their families about goals of care upon enrollment in a medical home.


Communicate goals of care to full health team. 

Estimate re basket of care not yet attempted, because it’s unclear what the “basket” would include.


Other disease management programs would offer examples of costs that we could compare.


Whatever the cost, it will be greater than the payment Medicare will be offering ($120 per person per year) (cf. average annual Medicare cost of $10,000). 

Explore the inclusion of a technical element related to early Alz screening in medical home models. 

Evidence exists to support the value of medical home / greater care coordination.  John Selstad to assist with compilation of these studies / reports.

 

Dartmouth study and Gunderson Lutheran study show cost savings relating to providing care consistent with a patient’s needs values and preferences. 

 

Miscellaneous Note: An independent analysis by team member Bob Power shows that caring for persons with dementia clearly costs Medicare more (3 times as much), but reimbursement for caring for persons with dementia is not proportionately higher (e.g. only 2 times as much). We should keep working on how to approach Medicare about this. Will be a tough nut to crack, but creative thinking is needed.
 



Comments (0)

You don't have permission to comment on this page.