ManagedCareSupplement3

A Primer on Managed Care: Multiple Chronic Conditions

Communication with and support of the family during hospitalization; and Follow-up call with the person or care- giver within 48 hours after discharge. Finally, individuals and their families can take advantage the following program services and resources: Consultation with neurology, geriatric psy- chiatry, psychology, or geriatrics for additional diagnostic evaluation or management of refrac- tory complications; Caregiver support groups , either commu- nity-based or provided by the health system, which provides both general and disease-specific support groups; Caregiver education through a lecture series. These webinars are archived on the pro- gram’s website (tinyurl.com/ybdmuzhc); Training videos on how to manage common behavioral problems and challenging situations (e.g., stopping driving; tinyurl.com/ya3pxhqa); Referral to CBOs for services such as deliv- ered meals, adult daycare, case management, financial and legal counseling, and transporta- ‘The UCLA ADC program is based at an academic healthcare system and partners with CBOs.’ tion assistance, as well as caregiver training. (For persons in need of financial help, the program has a voucher system to pay for a limited amount of services, such as individual counseling, com- plex case management, and adult daycare.); Monitoring and revising care plans , as needed, including active monitoring and sup- port of the caregiver’s emotional and physi- cal health. Individuals are categorized by level of acuity. Those with the highest level of acu- ity (red) (e.g., active crisis) are contacted at least monthly (some require much more frequent con- tact, including daily, at times); those with mod- erate acuity (yellow) (e.g., recent hospitalization) are contacted at least every two months; and

those who are stable (green) are contacted at least every four months; all participants are seen in person at least annually; and Adjustments to the care plan , made as deemed appropriate by the dementia care spe- cialist and communicated to the referring physi- cian; access is 24/7, 365 days a year for assistance and advice; daytime calls are handled by the de­ mentia care specialist, and night and weekend calls are managed by on-call physicians who are aware of the program. Implementation of the program is facilitated by custom-designed dementia care management software that includes case management and quality monitoring features that were created for the UCLA ADC. Program Results As of October 25, 2018, the UCLA ADC program has served 2,619 participants and their caregiv- ers. More than 200 physicians have referred patients to the program, and there is a waitlist of more than 250. Based on an analysis of the first 1,091 participants enrolled across a 30-month period from July 1, 2012, to December 31, 2014, the program provided a consistently high quality of care, and improved person and caregiver out- comes (Jennings et al., 2016). At one year, patient behavioral symptoms improved when measured by the Neuropsychi- atric Inventory Questionnaire (NPI-Q) (Kaufer et al., 2000) and depressive symptoms, as seen through the Cornell Scale for Depression in De­ mentia (Alexopoulos et al., 1988), were reduced. Caregiver depression scores from the Patient Health Questionnaire-9 (Kroenke, Spitzer, and Williams, 2001), distress related to behavioral symptoms from the NPI-Q (Kaufer et al., 2000), and strain measured with the Modified Caregiver Strain Index (Thornton and Travis, 2003) were all improved (all of these differences were statis- tically significant) (Reuben et al., in preparation). The program also reduced Medicare costs by $2,400 per person, per year, and long-term nurs- ing home placement by 40 percent (Jennings

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