As American society ages and Alzheimer's and dementia besets seniors and their caregivers, there may be ways to make life better until new treatments arrive.
CareMore, a California-based subsidiary of for-profit Blue Cross Blue Shield giant Anthem, is boasting of some positive results from a small pilot program for Alzheimer's and dementia patients.
Acquired by Anthem in 2011 for $800 million, CareMore has been plying a multi-disciplinary, technology-supported primary care approach to mostly Medicare Advantage populations, as well as some Medicare-Medicaid dual eligibles.
Recently, the health plan tried to tackle life and healthcare needs for dementia patients through a Brain Health Program.
"Patients with dementia and Alzheimer's are profoundly mismanaged," argues James Pratty, MD, CareMore's senior medical officer for behavioral health and psychiatry. "After some struggle, they are given diagnoses, but little else in terms of guidance and support. This results in costly and unhelpful diagnostic workups, and countless avoidable emergency room visits and hospitalizations. Meanwhile, the patient often suffers from profound feelings of loneliness, isolation and hopelessness."
Pratty led a team at CareMore that developed a model of care for seniors with Alzheimer's and dementia that is showing some positive early signs. The approach tries to identify "brain health patients" early and assign them to multi-disciplinary teams that work on everything from falls prevention and medication adherence to legal documentation and nutrition. The teams also collaborate with caregivers, who often can be the patient's adult children, and train them in symptom management and other aspects of the disease.
The pilot program enrolled 34 patients, among whom previously there were 10 ER visits and 24 falls. After the second year, there were no ER visits or hospitalizations and only 14 percent had reported any kind of fall. More than 60 percent of patients' caregivers also took an active role in monitoring medications.
One positive outcome, for instance, can be helping patients stay at home or with family, if that's what they want. "Without this program my mother would have spent her last year or years living with and being cared for by strangers," said Yvonne Eisner, whose mother participated in the program and ended up dying at home rather than a nursing home.
CareMore is now in the process of "scaling the program system-wide," to more than 100,000 patients. Pratty said.
"Over time, scientific breakthroughs will enable us to identify and treat patients with dementia and other forms cognitive decline in ways we never imagined before," he said. "Until that day, we need better systems of care that address the holistic needs of patients and their families. If our early experience is any indication, these systems will deliver better clinical outcomes--and, more importantly, better support for patients and families."
More than 5 million Americans suffer from symptoms of dementia. The number is bound to increase as more Baby Boomers retire and seniors live longer.