Conference Presentation, Fireside Chat, Panel, Statement
Reducing the Cost and Risk of Dementia
Milken InstituteNora Super, Michael Belleville, Jennie Chin Hansen, Kevin Crain, Jeff Huber, Shari Ling, Sarah Locke, Ian Cramer, Orion, Alan Stevens, Jill Lesser
- Report Launch and Strategic Goals: The Milken Institute released the report Reducing the Cost and Risk of Dementia, establishing five goals to improve brain health, including risk reduction, early diagnosis, workforce competency, supportive communities, and evidence-based interventions.
- CMS Payment Innovation (Sherry Ling): The Centers for Medicare & Medicaid Services (CMS) has introduced new billing codes and payment opportunities to reimburse clinicians for cognitive impairment screening and diagnosis.
- CMS acknowledges that payment is a necessary but insufficient lever; systemic change requires broad engagement across all sectors.
- Workforce and Community Gaps: A panel of experts highlighted critical failures in current care models, specifically the lack of preparedness in the healthcare workforce and the absence of coordinated support plans at diagnosis.
- Mike Belleville (Patient Advocate): Diagnosed with Lewy Body Dementia (formerly misdiagnosed as early-onset Alzheimer's) at age 52, he described an initial clinical interaction that provided only medication and no referrals, leaving families to navigate care alone.
- Caregiver Reality: Without immediate support structures, many families rely on informal networks or "Dr. Google" to manage the disease, often leading to delayed intervention and increased caregiver distress.
- Geriatric Emergency Department (GED) Expansion (Jenny Chin Hansen): A collaborative effort among four medical societies created a national accreditation program for Geriatric Emergency Departments to improve care for older adults with cognitive decline.
- Growth Metrics: Accredited GEDs increased from 8 to 105 within 18 months of the program's launch.
- Financial Sustainability: Approximately 90% of these hospitals are sustaining GED initiatives without major external funding, driven by early data showing reduced hospitalizations and fall rates.
- San Francisco Initiative: A regional effort aims to accredit an entire community of hospitals to prevent patient diversion to non-accredited facilities during emergency transfers.
- Operational Changes: GEDs feature modified environments (soothing lighting, separate entrances) and trained staff to reduce the trauma of emergency care for those with cognitive loss.
- Triage and Transport Innovation (Sherry Ling): CMS is testing the Emergency Triage, Treat, and Transport (ET3) model to allow paramedics to either treat patients on-site or transport them to preferred care locations rather than the nearest hospital.
- Goal: The initiative seeks to reduce unnecessary emergency department utilization and improve patient outcomes for complex older adults.
- Financial Sector Engagement (Kevin Crane, Bank of America): Financial services are integrating dementia and caregiving support into core business models due to the prevalence of the issue across 40 million US households.
- Workplace Disconnect: While 88% of employers claim to offer caregiving benefits, fewer than 30% of employees are aware of them.
- Economic Impact: Women caregiving often face a median retirement savings gap ($30,000 vs. $100,000 for men) due to workforce interruptions.
- Fraud Detection: Financial institutions are training staff to identify early signs of cognitive decline through irregular financial behaviors, such as unusual withdrawal patterns.
- Employee Support: Bank of America has established a Gerontologist on staff and offers legal and counseling support to assist employees with power of attorney and care placement decisions.
- Home Care Workforce Development (Jeff Huber, Home Instead): The company focuses on providing personalized care to 26 million people globally, with two-thirds of clients having dementia-related needs.
- Personalized Care Model: Training emphasizes understanding the unique life history of the patient (e.g., a former engineer's textbook) to de-escalate behavioral resistance and maintain dignity.
- Outcome Metrics: Home care participation correlates with lower rates of emergency room visits, hospital admissions, and readmissions, as well as extended time at home.
- Public Resources: Home Instead offers free training toolkits, mobile apps, and "Champions of Aging" service programs to the public and organizations to expand the dementia-capable workforce.
- Community Activation: The "I'mReadyToCare" platform engages the public through text-based missions to combat social isolation and educate communities on aging issues.
- Barriers to Early Screening: Experts identified significant hurdles to implementing routine cognitive screening, including the lack of definitive evidence linking screening to improved long-term outcomes as required by the US Preventive Services Task Force.
- Psychological Stigma: Many individuals resist screening due to fear of diagnosis, stigma, and uncertainty regarding available interventions.
- Systemic Fragmentation: Current healthcare systems treat care episodes in isolation rather than as a continuous life trajectory, making it difficult to track subtle cognitive changes over time.
- Quality of Life Focus: Panelists emphasized that the primary value of early diagnosis is allowing individuals to make informed decisions about their remaining life (e.g., "get busy living or get busy dying") rather than solely focusing on medical management.
- Research Participation: New barriers exist in clinical trials where patients must have a caregiver present, creating conflict for those with working spouses or limited support networks.
- Advocacy Call: Participants urged the industry to treat dementia as a holistic life issue rather than a purely medical diagnosis, advocating for policy changes that support long-term care and financial security.