Medicaid Savings From The New York University Caregiver Intervention for Families with Dementia

• Published in: The Gerontologist 2018-03, Vol.58 (2), p.e97-e106
• Main Authors: Foldes, Steven S, Moriarty, James P, Farseth, Paul H, Mittelman, Mary S, Long, Kirsten Hall
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Caregivers; Cognition; Cost control; Counseling; Dementia; Epidemiology; Evidence-based practice; Health care expenditures; Health problems; Health research; Health services; Human services; Medicaid; Medicine; Nursing homes; Payments
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/gnx077

Abstract Purpose of the study The economic burden of dementia is substantially borne by state Medicaid programs. We estimated savings, from the state payer perspective, from offering the New York University Caregiver Intervention (NYUCI), a well-studied caregiver support and counseling program, to eligible Minnesota Medicaid enrollees. Design and Methods A population-based microsimulation Markov model predicted and compared costs over 15 years with and without implementation of the NYUCI for family caregivers of community-based Medicaid eligibles with dementia. The model was informed by primary analysis of Minnesota Department of Human Services (MN DHS) data, and literature on the epidemiology, natural history, costs, and evidence-based management of the disease. Primary outcomes were predicted cumulative total direct costs, including medical, facility, and waiver-program payments for eligibles, and estimated costs of providing the NYUCI. Results Approximately 5–6% more eligibles with dementia would remain in the community annually from year 3 (2014) on, so that over 15 years 17% fewer would die in nursing homes (NH) if their caregivers received the NYUCI. After 15 years, MN DHS could realize savings of $40.4 million (2011 dollars, discounted at 3%) if all eligibles/caregivers enrolled. Savings were expected 5 years after implementation. Multiple sensitivity analyses, including best-and worst-case scenarios, estimated results ranging from 15-year cumulative savings of $178.9 million to a cumulative loss of $7.3 million, respectively, driven largely by assumed program effectiveness. Implications State payers can use enhanced caregiver support to moderate the growing tax burden of dementia, even without a breakthrough in the pharmacologic treatment of the disease.