Systems Delivery Innovation for Alzheimer Disease

• Published in: The American journal of geriatric psychiatry 2019-02, Vol.27 (2), p.149-161
• Main Authors: Bott, Nicholas T., Sheckter, Clifford C., Yang, Daniel, Peters, Stephanie, Brady, Brian, Plowman, Scooter, Borson, Soo, Leff, Bruce, Kaplan, Robert M., Platchek, Terry, Milstein, Arnold
• Format: Article
• Language: English
• Subjects: Alzheimer disease; Alzheimer Disease - complications; Alzheimer Disease - economics; Alzheimer Disease - therapy; Alzheimer's disease; Ambulatory Care - economics; Ambulatory Care - organization & administration; care delivery; Care design; Caregivers; Delirium - economics; Delirium - etiology; Delirium - therapy; Delivery of Health Care - economics; Delivery of Health Care - organization & administration; Family; Geriatric psychology; healthcare policy; high-value care; Humans; Intervention; Organizational Innovation; Primary Health Care - economics; Primary Health Care - organization & administration
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2018.09.015

The authors describe a comprehensive care model for Alzheimer disease (AD) that improves value within 1–3 years after implementation by leveraging targeted outpatient chronic care management, cognitively protective acute care, and timely caregiver support. Using current best evidence, expert opinion, and macroeconomic modeling, the authors designed a comprehensive care model for AD that improves the quality of care while reducing total per capita healthcare spending by more than 15%. Cost savings were measured as reduced spending by payers. Cost estimates were derived from medical literature and national databases, including both public and private U.S. payers. All estimates reflect the value in 2015 dollars using a consumer price index inflation calculator. Outcome estimates were determined at year 2, accounting for implementation and steady-state intervention costs. After accounting for implementation and recurring operating costs of approximately $9.5 billion, estimated net cost savings of between $13 and $41 billion can be accomplished concurrently with improvements in quality and experience of coordinated chronic care ($0.01–$6.8 billion), cognitively protective acute care ($8.7–$26.6 billion), timely caregiver support ($4.3–$7.5 billion), and caregiver efficiency ($4.1–$7.2 billion). A high-value care model for AD may improve the experience of patients with AD while significantly lowering costs.