Implementing a nationwide collaborative care model for patients with dementia and/or depression could potentially save billions in healthcare spending, according to a Health Affairs study.
Researchers analyzed the cost savings impact of the Healthy Aging Brain Center, a memory care clinic that is part of Indianapolis-based Eskenazi Health. Since 2008, the HABC has integrated various collaborative care model features, including a trained care coordinator who works with patients, families and primary care providers; individualized care protocols and education about self-management; resources and counseling for caregivers; and standardized tools to measure patients' biopsychosocial needs and assess the care plans' effectiveness. Forty-nine percent of the HABC's patients have dementia, 27 percent have mild cognitive impairment and 24 percent suffer from minor or major depression.
The study's authors compared 303 Eskenazi patients who received care through the HABC with 1,453 other Eskenazi patients who didn't receive care at the HABC. The researchers concluded the HABC led to net annual savings ranging from $980 to $2,856 per patient. Fifty-three percent of the savings came from reduced inpatient spending, while 47 percent came from reductions in emergency department and related outpatient care spending. The cost of HABC is just $618 per member per year or $1.69 per day. Study co-author Dustin French, PhD —an assistant professor in the department of ophthalmology and the Center for Healthcare Studies at Northwestern University's Feinberg School of Medicine in Chicago — says that "amounts to less than the cost of a cup of coffee per day to care for our most vulnerable community dwelling seniors." Additionally, the collaborative care model has other positive effects, such as reducing patients' symptoms, easing the burden shouldered by informal caregivers and enhancing quality of care, according to the study.
Given that more than 4.7 million patients in the
However, the study states the care model "has not been widely adopted because it requires an extensive redesign of the practice environment, including the development of a new workforce of care coordinators and a new payment system."
Dr. French says providers would need to adjust their delivery models and staff training to support the collaborative care model. That would involve having, for instance, pharmacists on board to optimize patients' medication. Providers would also need frontline staff members that could provide telephone support and outreach services for informal caregivers.
Additionally, he says Medicare payments must be redesigned in order for the collaborative care model to work on a larger scale. He says he and his colleagues are keeping an eye on healthcare reform efforts that are driving a shift toward the kind of payment model needed to support collaborative care. "We're going to be watching in the coming months what CMS does with the [Patient Protection and Affordable Care Act] and what the accountable care organizations are going to do with the hospital environment," he says.
The new reimbursement models will need to provide hospitals with motivation for aligning themselves with practices like the HABC so that there is a financial win-win, according to Dr. French.
"We have to think about what drives the hospitals," he says. "Hospitals may benefit with HABC through reduced lengths of stay that preserve the hospital payment for patients with related dementias. However, HABC may also altogether reduce their hospitalizations and emergency room care. That may have large financial implications."
Dr. French says we need new payment models (such as bundled payments) from the payers like CMS to align the financial incentives to provide care like HABC while preserving the financial integrity of the payer, hospital and possibly practice environment for shared economic savings. "Hospitals and the medical environment will adopt programs that have sound business and management principles, and without this, there will be little redesign of services that fully addresses the needs of our most vulnerable senior citizens," he says.
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