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Center for Health Services and Outcomes Research

Patient Outcomes – Other Outcomes

Comprehensive Home-based Dementia Care Coordination for Medicare-Medicaid Dual Eligibles in Maryland

The demonstration project has 3 major tasks which are being implemented in concurrent, iterative phases: (1) implement the program, “Maximizing Independence at Home” (MIND-Plus), in two community-based health service agencies to rapidly improve the ability of 600 community-living dually eligible older adults with Alzheimer’s Disease/dementia (AD) in the Baltimore region to remain at home while improving care quality, enhancing quality of life, and reducing total health care costs associated with institutional care or hospitalization; (2) develop a replicable model for nationwide diffusion of the MIND program through a web-based certification package designed to prepare for implementation, build work-force capacity through training certification modules, and provide automated self-monitoring and quality improvement tools; and (3) develop and test a detailed payment model that takes a blended approach and includes provider care management fees with provider performance incentives from division of shared savings.

We hypothesize that the MIND-Plus dementia care coordination program will (1) rapidly improve health and care quality and reduce total health care costs among Medicare-Medicaid dually eligible community-living older adults with AD, (2) drive health care system transformation by creating a new CMS-financed benefit that would shift the hub of dementia care coordination to well-trained, dementia competent, interdisciplinary teams based in community health agencies, (3) achieve a sustainable payment model that produces significant net savings and incentives provider performance. This "shovel ready" community-based model is expected to improve outcomes within 6 months and have an estimated net-saving of $12.5 million by over 3 years.

Links:

http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards-Round-Two/Maryland.html

https://clinicaltrials.gov/ct2/show/NCT02395731