Act Now Or Pay Later: The Cost Of Late Dementia Diagnosis

February 4, 2020




Act Now Or Pay Later: The Cost Of Late Dementia Diagnosis
February 1, 2020  |  Corinne Kuypers-Denlinger

Two years ago, the Alzheimer’s Association released a report, Alzheimer’s Disease: Financial and Personal Benefits of Early Diagnosis, which was covered by Bloomberg News (see Spotting Alzheimer’s Early Could Save America $7.9 Trillion), CBS News, and other major media outlets while stirring up a hornet’s nest among academic researchers. Academics asserted that the report was flawed in many ways, wasn’t sourced, and wasn’t peer reviewed. I don’t know if it was or it wasn’t or the validity of the report, but maybe it had the affect intended by the association, getting people to pay attention. Dementia care costs—a lot. One 2019 estimate puts the annual cost at $290 billion, a figure that doesn’t factor in the economic impact of unpaid care giving (see 2019 Alzheimer’s Disease Facts & Figures). Those costs are certain to rise as the population ages (see Dementia Increases Medicare Costs By Over 100%).

People should pay attention. Not just consumers – also executives of provider organizations, payers, and policy makers. Dementia is the sixth leading cause of death, yet it’s rare for dementia to be diagnosed in the early stages when it might be more cost-effectively managed. Consumers aren’t routinely screened nor is care coordinated such that dementia might be detected earlier. And most people diagnosed with dementia are not diagnosed by a specialist (see 85% of Individuals With Alzheimer’s & Other Dementia’s Receive A Diagnosis From A Non-Specialist).

Economic modeling data published in the much-debated report show that early diagnosis during the mild cognitive impairment (MCI) stage can avoid some costs and lower others. I’m not sure if the $7.9 trillion in the report is the right number but it makes common sense. Part of the controversy is whether there are interventions that, post diagnosis, would actually improve the trajectory of consumer quality of life or reduce costs. But there are two types of drugs for Alzheimer’s disease (see Medications For Memory) – and more are in the pipeline (see FDA To Review Adlarity As Skin Patch Treatment For Alzheimer’s Dementia). And, an emerging body of research shows that the cognitive decline of Alzheimer’s and other dementias can be reversed with individualized lifestyle interventions (see Reversal Of Cognitive Decline: A Novel Therapeutic Program and Individualized Clinical Management Of Patients At Risk For Alzheimer’s Dementia).

The good news: Calls for better screening and treatment of dementia are growing, including among physicians who are increasingly frustrated by a general belief that the disease is a “disorder the medical profession can’t do anything about” (see Breaking Down Barriers to Early Alzheimer’s Disease Diagnosis). Also, UsAgainstAlzheimer’s through its Brain Health Partnership, is engaging industry stakeholders across health care to coalesce around its call for a National Medicare Dementia Prevention Strategy to align payers, provider organizations, and communities to address brain health (see Creating An Optimal System Of Brain Health Care In The United States and AARP Invest $60 Million To Fund Research For Cures To Dementia and Alzheimers).

What does this mean for specialty provider organization executives? First, there is a role to be part of the solution by encouraging consumers to be screened. There is not much that can or will be done without acknowledging the issue at hand – the push for screening for depression, addiction, trauma, and more illustrates that point.

Second, there are new service line opportunities here. One is creating integrated care coordination models to manage the broad array of conditions—for the consumer and their caregivers—associated with dementias. Carol Greenlee, M.D., national faculty for the Transforming Clinical Practice Initiative, suggests a medical neighborhood model. The medical neighborhood concept is the term for an expanded patient-centered care model where primary care and specialty provider organizations, hospitals, and other clinicians work together in partnership to provide complete and coordinated care, taking integrated care to a whole new level. Dr. Greenlee believes that medical neighborhoods can improve referrals and care coordination, which influences outcomes for consumers with all types of diseases, including dementia (see Managing Referrals Amid Minefields, Breakdowns and Improving the State of Collaborative Care). “We need to figure out how to best co-manage,” says Dr. Greenlee. Adding, “there is a spectrum of need and we need a spectrum of roles played by specialty care providers.” That spectrum might even include robots that can identify Alzheimer’s disease in brain scans six years before a clinical professional’s diagnosis (see A Deep Learning Model To Predict A Diagnosis Of Alzheimer Disease By Using 18F-FDG PET Of The Brain).

Another opportunity is building on the growing body of research and creating services that offer personalized disease management programs for consumers diagnosed with dementia. It appears from the early research that the programs that will be most successful will be built on use of motivational interviewing and person-centered planning. These are core skills for many provider organizations.

In one way or another dementia affects us all – provider organizations, payers, policy makers, and consumers – all of whom at one time or another will be caring for a family member with dementia, will receive a diagnosis of dementia, or will be paying higher health care costs to cover the millions of diagnosed consumers. It behooves us all to pay attention.

Learn more about dementia from these resources in the OPEN MINDS Circle Library:

  1. 85% Of Individuals With Alzheimer’s & Other Dementias Receive Diagnosis From A Non-Dementia Specialist
  2. Dementia Cases To Triple Worldwide By 2050
  3. Dementia Increases Medicare Costs By Over 100%
  4. Fruit Street Telehealth Platform Selected For Clinical Trial To Reduce Cognitive Decline & Dementia Risk
  5. 52% Of Wisconsin Medicaid Beneficiaries With Down Syndrome Over The Age Of 55 Also Have Dementia
  6. Brain Training Reduces Dementia Risk By 48%
  7. New Zealand Framework For Dementia Care
  8. Dementia Risk Score At Age 50 Predicts Dementia Development By Age 70
  9. New Australian Augmented Reality App Helps Dementia Sufferers
  10. In-Home Sensors May Detect Early Dementia Signs In Elderly

And join me at The 2020 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 13 for the session, “Population Health Management For The Complex Consumer Market: How To Utilize Data To Coordinate Services Across The Care Continuum” featuring James Stewart, president and chief executive officer, Grafton Integrated Health Network & OPEN MINDS advisory board member.