Comprehensive Home-based Dementia Care Coordination for Medicare-Medicaid Dual Eligibles in Maryland
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Dementia
- Sponsor
- Johns Hopkins University
- Enrollment
- 342
- Locations
- 1
- Primary Endpoint
- Net cost offset (Medicare and Medicaid costs) of intervention
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
This Center for Medicare and Medicaid funded health care innovation award will implement the MIND at Home dementia care coordination program (called MIND at Home-Plus) through two community-based service agencies (Jewish Community Services, Johns Hopkins Home Care Group) to rapidly improve the ability of 600 dually eligible older adults with dementia in the Baltimore region to remain at home while improving care quality, enhancing quality of life, and reducing total health care costs. MIND at Home participants receive an in-home needs assessment followed by up to 18 months of care coordination aimed at filling unmet needs.
Detailed Description
The demonstration project has 3 major tasks which will be implemented in concurrent, iterative phases: (1) implement MIND-Plus in 2 community-based health service agencies to rapidly improve the ability of 600 community-living dually eligible older adults with 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. The investigators hypothesize that the MIND-Plus dementia care coordination program will (1) rapidly improve health \& 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 save an estimated net-saving of $12.5 million by over 3 years.
Investigators
Eligibility Criteria
Inclusion Criteria
- •diagnosis of dementia
- •community living
- •has identified study partner willing to participate
- •english speaking
Exclusion Criteria
- •situation at time of referral is a medical or mental health crisis
- •they plan to move out to another area or into a residential care facility in the next 6 months
- •they are currently on hospice.
Outcomes
Primary Outcomes
Net cost offset (Medicare and Medicaid costs) of intervention
Time Frame: 18 months
Estimated per beneficiary per year (PBPY) cost-offset of the MIND at Home-Plus program dementia care coordination program. Defined as the net financial benefit of the program to Medicare and Medicaid expenditures and calculated as the difference in the sum of all Medicare,Medicaid, and intervention costs between intervention group and the sum of all Medicare and Medicaid costs in matched comparison group from (baseline-18 months), adjusted from prior expenditures in the two year period prior to enrollment in the service program or selection into the comparison group.
Secondary Outcomes
- Change in patient quality of life at 18 months(baseline to 18 months)
- Change in neuropsychiatric behavior symptoms at 18 months(baseline to 18 months)
- Hospitalization rates(18 months)
- 30 day re-hospitalization rates(18 months)
- Change in patient depression at 18 months(baseline to 18 months)
- Change in patient unmet dementia-related care needs(baseline to 18 months)
- Time to long term care placement or death(24 months)
- Change in caregiver depression at 18 months(baseline to 18 months)
- Change in caregiver quality of life at 18 months(baseline to 18 months)
- Change in caregiver unmet dementia-related care needs(baseline to 18 months)
- Emergency department rates(18 months)
- Change in caregiver subjective burden at 18 months(baseline to 18 months)
- Change in caregiver objective burden at 18 months(baseline to 18 months)