GENERATIONS – Journal of the American Society on Aging
et al., in press). After deducting the costs of the program ($1,268 per participant, per year in Los Angeles, in 2013 dollars), the net cost-savings to Medicare were $1,136 per person, per year. Conclusion The UCLA ADC program is a practical and com- prehensive dementia care program that has been successfully implemented and sustained within a large healthcare system. The program recog- nizes what people and caregivers will go through together during the course of the person’s de mentia. Hence, a major focus of the program is on training (including one-on-one training with dementia care specialists, video lectures, manag- ing specific problem behaviors and situations, and referral to CBOs for additional training) and supporting family caregivers, who usually assume this role often unprepared and alone. The UCLA ADC program has been well- received by physicians and caregivers, result- ing in a long waitlist for enrollment. Moreover, it is one of the few clinical interventions for high- need older persons that has met the Centers for Medicare & Medicaid Services triple aim of bet- ter care, lower costs, and better outcomes (Ber- wick, Nolan, and Whittington, 2008). Although this model of care can reduce fee-for- serviceMedicare expenditures, current Medicare professional services billing codes do not generate sufficient revenues to cover program costs (Jen- nings et al., in press). Hence, the financial benefits accrue to the insurer and the costs are borne by the healthcare system. In contrast, Medicare Advan- tage plans, which assume the risks and benefits of costs of medical care, are positioned to break even or save money by providing these services. ‘The program also reduced Medicare costs by $2,400 per person, per year.’
For innovative dementia care models to be adopted by health systems, financial incen- tives need to be aligned with quality of care and patient/caregiver outcomes. Widespread dis- semination of the UCLA ADC will be greatly accelerated if health systems receive adequate compensation to cover the costs of providing this care. New payment mechanisms (e.g., a dementia care management bundled payment or similar value-based service) will be needed to broadly promote adoption and dissemination of demen- tia care management services provided by the UCLA ADC. David B. Reuben, M.D., is director, Multicampus Program in Geriatrics Medicine and Gerontology, and chief, Division of Geriatrics at UCLA Center for Health Sciences. He is the Archstone Foundation Chair, a professor at the David Geffen School of Medicine at UCLA, and director of the UCLA Claude D. Pepper Older Americans Independence Center and the UCLA Alzheimer’s and Dementia Care program. Leslie Chang Evertson, G.N.P., is lead dementia care specialist, Michelle Panlilio, N.P., Mihae Kim, A.G.N.P., and Kelsey Stander, A.G.N.P.-B.C., are all dementia care specialists, and Zaldy S. Tan, M.D., M.P.H., is a medical director at the Multicampus Program in Geriatrics Medicine and Gerontology. Authors’ Note The project described in this article was supported by Funding Opportunity CMS- 1C1-12-0001 from the Centers for Medicare & Medicaid Services (1C1CMS330982-01-00), the Centers for Medicare and Medicaid Innovation (its contents are solely the responsibility of the authors and do not necessarily represent the official views of U.S. Department of Health and Human Services or any of its agencies), and by the UCLA Claude D. Pepper Older Americans Independence Center, funded by the National Institute on Aging (5P30AG028748).
66 | Spring 2019
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