GENERATIONS – Journal of the American Society on Aging

term institutional, and HCBS through man- aged care organizations. Building on a funding opportunity through the federal Administration for Community Living (ACL), the State of Cali- fornia’s Department of Aging partnered with Alzheimer’s Los Angeles (LA) to design an inter- vention to improve identification and care of duals with dementia in ten CMC health plans. In coordination with the Alzheimer’s Associa- tion’s Northern California and Northern Nevada chapter and Alzheimer’s San Diego, the fol- lowing were provided: advocacy and technical assistance to the health plan, and state and fed- eral decision-makers; training on dementia and its care to care managers; and disease educa- tion and support services to plan members with dementia and their caregivers. Health plans, CMS, and the state’s Medicaid agency were presented with a business and quality rationale to address the needs of people living with dementia and their caregivers. This included data about the disproportionate costli- ness of this population, typical gaps in care, and the likely poor outcomes for the demonstration if the needs of people with dementia were not met. Alzheimer’s LA developed key advocacy talking points, which were delivered by representatives of all three Alzheimer’s organizations in their interactions with the identified champions and decision makers (the business and quality case, and the key advocacy talking points are on the Alzheimer’s LA website) (Alzheimer’s Los Ange- les, 2018). Alzheimer’s organizations also were active at the state and local levels in the meetings of duals demonstration stakeholder groups. While time- intensive, these activities allowed the organi- zations to network with the health plans, learn about the CMC implementation process, and cre- ate alliances with other advocacy organizations. Forming informal alliances with prominent and respected CBOs invested in CMC helped rein- Advocacy and Technical Assistance to Create System Change

force messages, provided additional opportuni- ties to network with health plans, and raised the profile of the project’s advocacy agenda. Additionally, the demonstration offered sev- eral policy levers upon which the project was built. While levers differed across states, in Cal- ifornia, the three-way contract between CMS, the state, and each participating health plan ‘Between 19 percent and 25 percent of duals nationwide are cognitively impaired.’ required dementia training for care managers, and caregiver identification and engagement in care planning (Hollister, Flatt, and Chap- man, 2017). Furthermore, through state-level advocacy, additional requirements were added, including a question about cognitive impair- ment in the mandatory Health Risk Assessment, which is administered to all CMC members. Care manager training Alzheimer’s LA developed a two-part training program for care managers focusing on demen- tia-capable care coordination. It was delivered locally by three Alzheimer’s organizations. The first tier, an eight-hour training, was delivered to nearly 500 care managers in CMC health plans. It presented basic information about dementia; taught how to administer the AD8 (a validated cognitive screening tool); provided strategies for dealing with challenging behaviors; explained the essential role of family/friend caregivers; and reviewed services offered by local Alzheimer’s organizations. An additional second tier, a twelve-hour training, was offered to care managers who were designated to become dementia care spe- cialists. The dementia care specialists would serve as experts in dementia care and a resource for care managers when confronted with chal- lenging issues with this population. One hun- dred and nine care managers went on to become

74 | Spring 2019

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