A Primer on Managed Care: Multiple Chronic Conditions
The Dementia Cal MediConnect Project
By Brooke Hollister, Jarmin Yeh, Leslie Ross, Jennifer Schlesinger, and Debra Cherry
Improving dementia care via the California duals demonstration.
I n 2013, under the auspices of the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) initiated a federal demonstration to improve care and control costs for people dually eligible for Medicare and Medicaid (duals). This duals population is characterized by com- plex and, especially for a subset of the duals group, often costly healthcare needs. Compared to other Medicare beneficiaries, duals are high utilizers of medical care, comprise a dispropor- tionately high number of nursing home residents, and typically face multiple economic, educational, cultural, and linguistic barriers to obtaining qual- ity healthcare (The SCAN Foundation, 2011; Kai- ser Family Foundation, 2012; Bynum et al., 2017). The duals demonstrations integrate medical and long-term services and supports (LTSS)— benefits that are available through Medicare and Medicaid—by improving partnerships between healthcare groups and community-based orga- nizations (CBO), in an effort to limit inappropri- ate use and control costs (Kaiser Commission on Medicaid and the Uninsured, 2015).
Due to the high level of long-term-care needs for people with dementia, these individu- als are likely to benefit greatly from such inte- gration of services. It is estimated that between 19 percent and 25 percent of duals nationwide are cognitively impaired (California Department of Health Care Services and CMS, 2017; Engel- hardt, 2018; Medicaid and CHIP Payment and Access Commission, 2018). People with demen- tia incur triple the Medicare costs of other beneficiaries, costs driven primarily by hospital- izations; and twenty-three times the Medicaid costs of other beneficiaries, due to high rates of institutionalization (Bynum, 2009; Alzheimer’s Association, 2018). Through improved care coor- dination among healthcare entities, LTSS, and home- and community-based services (HCBS), this population could avoid unnecessary utiliza- tion of more costly services, delay institutional- ization, and lower overall care costs. California’s demonstration for dually eligible beneficiaries, called Cal MediConnect (CMC), provides coordinated medical, behavioral, long-
abstract Healthcare reforms aimed at lowering costs and providing quality care present opportunities for community-based organizations to partner with healthcare organizations to improve care systems for people with dementia and their caregivers. The Dementia Cal MediConnect Project is a promising approach in California’s duals demonstration for improving care delivered to low-income people living with dementia and their families. The project is a model for effective advocacy, technical assistance, and dementia training for care managers. Lessons learned from this project may be valuable for those wanting to replicate it. | key words : dementia, care coordination, duals demonstration
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