WASHINGTON – A collaborative care program that supports both Alzheimer’s patients and caregivers saved an Indiana health care system more than $1 million during its initial yearlong test period.
The Healthy Aging Brain Center (HABC) at Eskenazi Health in Indianapolis saved $2,856 per patient per year, while costing just $618 per patient to administer, Dr. Dustin French said at a briefing on Alzheimer’s disease hosted by Health Affairs. "The cost to administer the program comes to about $1.69 per patient per day – way less than the cost of a cup of coffee," Dr. French said.
The HABC creates individual care plans for patients with newly diagnosed memory disorders, including Alzheimer’s, mild cognitive impairment, and late-life depression. A team of physicians, social workers, and nurses works with the patient, caregiver, and family members. After the initial assessment, there is ongoing, unlimited support in the form of clinic visits and phone contact.
Dr. Dustin French
The individual care plans target a number of problem areas, including self-management, problem-solving, medication management, dealing with depression, managing cardiovascular risks, caregiver emotional and physical health support, transition of care across settings, and managing acute care issues.
The pilot ran from 2008 to 2009 with an initial cohort of 303 patients. A total of 1,453 patients did not enroll, mostly because the program was not being widely publicized at that point. If all eligible patients had enrolled, the annual cost savings would top $6 million, said Dr. French, the study’s primary investigator. He is a faculty member at the Center for Healthcare Studies at Northwestern University and a research scientist at Veterans Affairs Health Services Research and Development Service, both in Chicago.
The HABC patients were referred by primary care physician, self, or family member. The primary reasons for referral were memory problems (88%) or behavioral problems (12%), including wandering and agitation. The comparison group was similar in diagnosis and behavioral issues. Outcomes were cost and savings data extracted from Eskenazi Health’s accounting system and adjusted for comorbid illness, hospital charges and length of stay, and mortality (Health Aff. 2014;33:613-8).
The average risk-adjusted HABC patient cost savings was $3,474, compared with the control group. Half of that was in decreased inpatient expenses and the other half was in decreased emergency department and related outpatient costs. After subtraction of the $618-per-patient administration cost, the annual net per-patient savings was $2,865. This left an estimated net savings of $865,368 for the HABC cohort of 303 patients and $5,015,136 if all 1,756 patients had been enrolled.
The study could help lay a business foundation that might encourage payers to take notice of this kind of an intervention program, the authors noted. The current system does not encourage "the development of innovative health care delivery models" such as the one at the HABC, nor does it reimburse for caregiver support, such as telephone backup, unless it’s delivered in a remote locations.
"Reimbursement processes ... fail to address the complex needs of patients with dementia, which require multifaceted care. Unfortunately, these needs are often not fully addressed until the patient is institutionalized and the medical costs have begun to mount," the investigators wrote in their report.
The federal government may be waking up to the possibilities. The HABC program was awarded a grant from the Center for Medicare & Medicaid Innovation, which supported this study and allowed Eskenazi Health to expand the program to more than 2,000 Medicare beneficiaries with dementia or late-life depression.
"If we can do this in Indiana, anyone can do it anywhere," Dr. French said.
Dr. French had no disclosures. Several of his coauthors are employees of Eskenazi Health.
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