Innovative, coordinated brain care could save billions of health care dollars

April 8, 2014, Indiana University

Studies have shown that a new patient and caregiver centered model of innovative, coordinated brain care for older adults improves health outcomes and quality of care for those with cognitive impairment. A new study from the Regenstrief Institute, Eskenazi Health and Indiana University Center for Aging Research implementation scientists who developed the Healthy Aging Brain Center care model shows that such care also produces impressive cost savings.

The Healthy Aging Brain Center generated an annual net cost savings of up to $2,856 per patient at Eskenazi Health, according to the authors of "Healthy Aging Brain Center Improved Care Coordination and Produced Net Savings," published in the April issue of the peer-reviewed journal Health Affairs. They note that with an estimated 4.7 million Medicare beneficiaries with Alzheimer's disease, if the Healthy Aging Brain Center care model were to be implemented nationwide, the potential annual cost savings could be in the billions of dollars.

Implementing the collaborative care model for patients with dementia and depression, which often occur together, reduces patients' behavioral and psychological symptoms, diminishes the burden on patients' informal caregivers and enhances the quality of care delivered to the patient.

"One in eight older Americans has Alzheimer's disease, according to the Alzheimer's Association. By redesigning how these vulnerable individuals are cared for and then implementing this new model, we can improve their lives and the lives of their caregivers, simultaneously saving an enormous of amount of health care dollars—conceivably billions of dollars," said Malaz Boustani, M.D., MPH, who developed the Healthy Aging Brain Center care model.

Dr. Boustani is a Regenstrief Institute investigator and an IU Center for Aging Research scientist. He is also director of the Eskenazi Health Healthy Aging Brain Center, chief innovation and implementation officer for IU Health and chief operating officer of IU Center for Health Innovation and Implementation Science.

Patients receiving Healthy Aging Brain Center care are given an initial cognitive assessment including neuro-psychological testing, a brain imaging test, medication review and structured neurological and physical evaluations. The staff then helps both the patient and family caregivers develop a personal treatment plan that typically includes recognizing potentially harmful medications, prescribing new medications, initiating brain and physical exercise regimens, training in problem solving, and working on reducing stress to improve daily life.

Physicians, nurses, social workers and other staff members work closely with both the older adult and family caregivers—in the exam room and in the home, as well as over the phone and via email—to deliver care to improve both brain and physical health. The Healthy Aging Brain Center care model also provides additional resources to the primary care physician for more effective and efficient management of the patient's dementia and/or depression; reduces emergency department visits and hospitalizations; and encourages use of medications that are not harmful to older brains.

The study described in the Health Affairs paper was conducted at Eskenazi Health, one of the nation's five largest safety net health systems. The average age of participants was 72. Two-thirds of the Healthy Aging Brain Center participants were women. Three-quarters of the non-Healthy Aging Brain Center study participants were female.

"The U.S. medical reimbursement system, which promotes volume and specialty care, is broken and needs financial overhaul. Medicare and Medicaid spent about $142 billion in 2013 for Alzheimer's and other dementias. Economic pressures on these government programs will intensify in the coming years with the growing number of baby boomers. Currently up to a third of states' Medicaid budgets are consumed by long term care costs—costs that also will continue to rise unless something is done," said study first author Dustin French, Ph.D., assistant professor in the Northwestern University Feinberg School of Medicine and a research scientist with the Veterans Affairs Health Services Research and Development Service in Chicago.

"We have demonstrated that the comprehensive care provided by the Health Aging Brain Center care model shows a net savings in the first year of implementation and meets the complex care needs of seniors with Alzheimer's and other dementias," French said. "The future of Medicare and Medicaid will require more disease management programs like the Healthy Aging Brain Center care model that show net financial savings while meeting patient and caregiver preferences and quality of care goals."

Eskenazi Health, the Regenstrief Institute, the IU Center for Aging Research and the IU Center for Health Innovation and Implementation Science are testing the expansion of the Healthy Aging Brain Center program by evaluating its ability to develop and deploy a robust workforce training program that can produce a team of care coordinators and care coordinator assistants who have the required skills to deliver the Healthy Aging Brain Center care model for dementia and depression, conduct both individual case management and population health management, and monitor the process and outcome of care within a team structure.

"The Eskenazi Health Healthy Aging Brain Center is a wonderful example of when doing something that is best for the patient, it also can benefit the entire health system," said Lee Livin, MBA, executive vice president of strategy and business development at Eskenazi Health. "Our challenge has been touching more lives. The new home-base model will allow us to serve more patients and do so with extremely positive benefits to patient care."

Explore further: Back to basics: Redesigning systems of care for older adults with Alzheimer's disease

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