Title | Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia: A Secondary Analysis of a Randomized Clinical Trial. |
Publication Type | Journal Article |
Year of Publication | 2023 |
Authors | Guterman, EL, Kiekhofer, RE, Wood, AJ, I Allen, E, Kahn, JG, Dulaney, S, Merrilees, JJ, Lee, K, Chiong, W, Bonasera, SJ, Braley, TL, Hunt, LJ, Harrison, KL, Miller, BL, Possin, KL |
Journal | JAMA Intern Med |
Date Published | 2023 Sep 18 |
ISSN | 2168-6114 |
Abstract | IMPORTANCE: Collaborative dementia care programs are effective in addressing the needs of patients with dementia and their caregivers. However, attempts to consider effects on health care spending have been limited, leaving a critical gap in the conversation around value-based dementia care. OBJECTIVE: To determine the effect of participation in collaborative dementia care on total Medicare reimbursement costs compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified secondary analysis of the Care Ecosystem trial, a 12-month, single-blind, parallel-group randomized clinical trial conducted from March 2015 to March 2018 at 2 academic medical centers in California and Nebraska. Participants were patients with dementia who were living in the community, aged 45 years or older, and had a primary caregiver and Medicare fee-for-service coverage for the duration of the trial. INTERVENTION: Telehealth dementia care program that entailed assignment to an unlicensed dementia care guide who provided caregiver support, standardized education, and connection to licensed dementia care specialists. MAIN OUTCOMES AND MEASURES: Primary outcome was the sum of all Medicare claim payments during study enrollment, excluding Part D (drugs). RESULTS: Of the 780 patients in the Care Ecosystem trial, 460 (59.0%) were eligible for and included in this analysis. Patients had a median (IQR) age of 78 (72-84) years, and 256 (55.7%) identified as female. Participation in collaborative dementia care reduced the total cost of care by $3290 from 1 to 6 months postenrollment (95% CI, -$6149 to -$431; P = .02) and by $3027 from 7 to 12 months postenrollment (95% CI, -$5899 to -$154; P = .04), corresponding overall to a mean monthly cost reduction of $526 across 12 months. An evaluation of baseline predictors of greater cost reduction identified trends for recent emergency department visit (-$5944; 95% CI, -$10 336 to -$1553; interaction P = .07) and caregiver depression (-$6556; 95% CI, -$11 059 to -$2052; interaction P = .05). CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial among Medicare beneficiaries with dementia, the Care Ecosystem model was associated with lower total cost of care compared with usual care. Collaborative dementia care programs are a cost-effective, high-value model for dementia care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02213458. |
DOI | 10.1001/jamainternmed.2023.4764 |
Alternate Journal | JAMA Intern Med |
PubMed ID | 37721734 |
PubMed Central ID | PMC10507595 |
Grant List | K01 AG059831 / AG / NIA NIH HHS / United States L30 AG060590 / AG / NIA NIH HHS / United States |