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According to a study conducted by UCSF, a telecare program designed to enhance outcomes for dementia patients while reducing the strain on unpaid caregivers also leads to a surprising reduction in Medicare expenses. Published in JAMA Internal Medicine, the study, led by UCSF, compared the Medicare costs of 780 dementia patients. These patients were randomly assigned in a 2:1 ratio to either receive support from the Care Ecosystem program, which included both medical and practical assistance, or to continue with their usual care over a 12-month period. Both groups were similar in terms of age, severity of dementia, other illnesses, and age of the caregiver, who was typically a spouse or adult child.
The researchers discovered that the average monthly Medicare cost per patient in the Care Ecosystem was $526 lower than for those receiving standard care. Starting in July 2024, the UCSF telecare program, along with similar initiatives, will be accessible to dementia patients residing at home or in assisted living facilities, provided they are covered by Medicare fee-for-service or have dual Medicare and Medicaid eligibility.
Navigators play a crucial role in assisting with medications, transportation, daycare, and respite care. The Care Ecosystem was introduced by UCSF in 2014 and has been replicated by over 25 organizations, including health systems, specialty practices, and community-based groups. This program connects patients and caregivers with a navigator, who acts as a central hub and addresses issues as they arise by relaying instructions from clinicians and other experts. Navigators handle a wide range of concerns, from medication and symptom management to daycare placement, respite care, transportation, and home safety strategies.
This study follows the announcement on July 31, 2023, by the Centers for Medicare and Medicaid Services regarding GUIDE, a payment model that will provide funding to UCSF and other institutions offering similar telecare services. By the time GUIDE is launched, it is anticipated that over 100 healthcare organizations will offer these services.
GUIDE holds the potential to significantly impact the lives of a substantial portion of the 6 million Americans living with dementia, as well as the 11 million family members and friends who provide unpaid care, stated senior author Katherine Possin, PhD, from the UCSF Department of Neurology and co-founder of the Care Ecosystem. Possin, who is also associated with the UCSF Weill Institute for Neurosciences and the Global Brain Health Institute, emphasized that providing continuous support to dementia patients can exact a heavy emotional, physical, and financial toll on unpaid caregivers. This program aims to shift the caregiver system from a crisis-oriented approach to a proactive one.
“The patients most likely to benefit from the Care Ecosystem are those with moderate-to-severe dementia and those who have caregivers suffering from caregiver depression,” noted first author Elan Guterman, MD, from the UCSF Department of Neurology and the Philip R. Lee Institute for Health Policy Studies. Guterman explained that their research revealed considerable savings, likely due to avoiding unnecessary visits to the ER, for patients who engaged with a navigator. Patients who frequented the ER more often were also more likely to derive benefits from working with a navigator.
For patients without a caregiver, the navigator will assist in identifying a willing family member or friend to participate in the program. Additionally, the navigator may aid in setting up a conservatorship or arranging long-term living placement if necessary.
This study builds upon prior research conducted by UCSF, which found that the percentage of caregivers in the Care Ecosystem program experiencing moderate-to-severe depression decreased from 13.4% to 7.9% over the course of a year, in contrast to an increase in depression among caregivers in the standard care group. Furthermore, quality of life for patients in the Care Ecosystem was reported to be higher.
Possin expressed hope that the Care Ecosystem, along with other programs covered by GUIDE, will inspire optimism for patients with dementia and their families. While the new medications for Alzheimer’s disease represent a promising advancement for patients in the earliest stages, Possin emphasized that “care navigation will improve quality of life for people with dementia and their caregivers across all stages of disease,” and these benefits come without side effects or other burdens.
