A Primer on Managed Care: Multiple Chronic Conditions

The UCLA Alzheimer’s and Dementia Care Program By David B. Reuben, Leslie Chang Evertson,

A model program provides comprehensive, coordinated, patient-centered care to people with dementia.

Michelle Panlilio, Mihae Kim, Kelsey Stander, and Zaldy S. Tan

I n the United States, an estimated 5.7 million people are affected by Alzheimer’s disease—the most common type of dementia—which touches virtually every family in some way (Alzheimer’s Association, 2018). The clinical manifestations of dementia are protean and devastating, including cognitive impairment, immobility and falls, swal- lowing disorders and aspiration pneumonia, and behavioral disturbances (e.g., agitation, aggres- sion, depression, hallucinations). Spouses, chil- dren, and other caregivers and clinicians who take on the responsibility of caring for people with these complex and demanding needs often experience stress, burnout, and illnesses. Thus, dementia can be considered a prototype of com- plex needs that span the patient and caregiver, medical and social domains, and health system and community-based organizations (CBO). Many clinicians have neither the time nor, in some cases, the skills to adequately manage many aspects of dementia, including coordinat- ing social and medical care, instructing care- givers, and counseling families. As a result, the

quality of care for dementia is poor compared to other diseases that affect older persons (Wenger et al., 2003; Chodosh et al., 2007). Community resources (e.g., the Alzheimer’s Association, local adult daycare centers) can help to improve the quality of care by providing caregiver education and support. However, these organizations are underused and poorly integrated into the health- care system. Initially funded in part by a 2012 Centers for Medicare &Medicaid Services Innovation Chal- lenge Award, the goals of the UCLA Alzheimer’s and Dementia Care (UCLA ADC) program are to provide comprehensive, coordinated, person- centered care linking the healthcare system and the community to maximize patient function, independence, and dignity; minimize caregiver strain and burnout; and reduce unnecessary costs through improved care (Reuben et al., 2013). Description of the Program The UCLA ADC program is based at an aca- demic healthcare system and partners with

abstract The UCLA Alzheimer’s and Dementia Care program provides comprehensive care based in a health system that reaches out to the community for additional social resources. The program follows a co-management model in which nurse practitioner dementia care specialists provide dementia care in partnership with primary care and specialty physicians. The resulting high quality of care has improved patient and caregiver clinical outcomes, reduced gross Medicare costs, and lowered long-term nursing home placement. New payment models will be needed to support this care and promote dissemination. | key words : Alzheimer’s disease, dementia, care coordination, caregiver support

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