Health plans and value-based care organizations are ill-prepared to help patients with Alzheimer’s Disease or related dementia.
Just 4% of respondents in a recent survey of 50 senior leaders working for health payers said their organization has a fully developed strategy in place to help patients with Alzheimer's disease or dementia, yet 77% said they acknowledge helping these individuals is a “very” or “highly” urgent priority. The survey’s results highlight the major disparity between what patients need and how plans are helping.
The report, from healthcare advisory firm Sage Growth Partners, was commissioned by Together Senior Health, a brain health company that partners with Medicare Advantage health plans and accountable care organizations.
The bulk of people, 45%, said their organization’s strategy is slightly developed, meaning no roadmap is in place but they are beginning to hold internal discussions. One-fifth of respondents said they have no strategy at all.
“Ultimately, plan and value-based care leaders would like to offer their members a dementia-specific, non-pharmaceutical intervention that would reduce falls, improve quality of life and decrease spend," said the report’s authors. “Fortunately, these cost-effective, nondrug approaches are becoming more readily available.”
Nearly three-quarters of payers said they’d be more likely to change their current approach toward Alzheimer's disease if they believed the cost per member exceeded those with other conditions. Yet, the report listed dementia as the fourth most costly chronic condition for plans.
Medicare payments for people with dementia is three times costlier than for beneficiaries without dementia, data from CMS (PDF) and the Alzheimer’s Association shows. Those with dementia in 94% of cases also have one or more comorbid conditions, further increasing the cost required to treat a patient with dementia. Providing coverage for Alzheimer’s therapies would save payers between $13.1 billion and $545.6 billion, according to a University of Chicago white paper.
Dementia is already a huge expenditure for plans, and new drugs like Leqembi have enormous sticker prices. Leqembi is $26,500 and people enrolled in Medicare Advantage or traditional Medicare normally owe up to $5,300.
About half of respondents said if there was greater member demand, they would be more likely to push for Alzheimer's disease and dementia as a high priority, and three-quarters of plan leaders said they still rely on traditional care management tactics instead of dementia-specific programming that involves fall prevention, social connection, caregiver health and exercise.
In October, CMS announced it would be removing the national coverage determination limiting patients’ ability to qualify for new drugs, meaning amyloid PET scans will be easier to obtain.