P3-482: Creation and implementation of the nation's first Alzheimer's disease advantage plan

Background: Alzheimer’s disease and related dementias are known to affect both the patient and the family caregiver. However, traditional models of medical care provide for limited health care benefits for the patient and virtually no care or benefits for the family. The Centers for Medicare and Medicaid Services (CMS) recently approved the first and only Medicare Advantage plan for Alzheimer’s disease and related dementias. The new “special needs population” product model incorporates specialized dementia clinical care for the patient and non-medical support for family caregivers linked to a community case management model in order to manage care of the patient and family across the health care continuum. Families are proactively educated to successfully manage day to day care and are offered a limited respite benefit. Enrollment into the Alzheimer’s Association Safe Return program and a prescription formulary to cover antidementia medications are additional unique benefits. Methods: Patients with a diagnosis of dementia are eligible for the plan. Upon enrollment, members and their caregivers undergo a detailed case review. In addition, data are collected to assess caregiver burden and depression, the patient’s cognition, patient and caregiver quality of life, functional abilities, neuropsychiatric disturbances, and health service needs. These assessments are scheduled to be completed every 6 months ove r a 2 year evaluation period and will be used to measure the success of the model of care and support. Results: Members enrolling in this new plan are intensively co-managed by the medical team and the identified case manager. This session will overview the components of the unique program that joins a health care provider with dementia specific expertise and a health insurance plan’s personalized case management model. The clinical model, training case managers on the administration of standard psychometric assessments and how to become “dementia capable,” utilizing dementia care paths to navigate care will be discussed. In addition, we will outline our plan for data collection, sharing, and how the patient and caregiver outcomes will be used to assess the program’s effectiveness. Conclusions: An innovative health care plan for dementia can assist both the patient and the family to achieve optimal outcomes.