Team: Brooke Hollister (UCSF), Susan Chapman (UCSF)
As health systems continue to evolve toward more managed care models, care managers are playing an important role in ensuring that people with Alzheimer’s disease or related dementias (ADRD) receive appropriate, well-coordinated, and cost-effective care. Research has shown that effective care management and referral to services and supports for patients with ADRD and their informal caregivers can decrease unnecessary medical services utilization, delay institutionalization, and improve the quality of life of both patients with ADRD and their informal caregivers. However, care managers are often unprepared to meet the needs of this challenging population.
The goal of this project was to systematically review and analyze care manager policies and practices within health plans participating in CMS’s demonstration programs for dual-eligible Medicare/Medicaid beneficiaries in 11 states, in order to:
- Describe the role and scope of practice of care managers in the dual-eligible demonstration projects;
- Identify any ADRD-specific training requirements of care managers;
- Examine best practices in care management of dual-eligible beneficiaries with ADRD and their caregivers; and
- Describe any changes impacting people with ADRD or their caregivers at the health system level.
Care coordinators play an increasingly important role in ensuring that people with Alzheimer’s disease or related dementias (ADRD) receive appropriate, well-coordinated, and cost-effective care. Yet, care coordinators are often unprepared to meet the needs of this challenging population.
In Dementia Care Coordination Workforce and Practices in Seven Duals Demonstration States, UCSF Health Workforce Research Center authors Brooke Hollister, PhD and Susan Chapman, RN PhD FAAN, systematically reviewed and analyzed care coordinator policies and practices within health plans participating in the US Centers for Medicare & Medicaid Services’ (CMS) demonstration programs for dually-eligible Medicare and Medicaid beneficiaries (referred to as “duals”). The research was designed to enhance knowledge of the care coordination workforce and practice requirements in duals demonstrations. The report focuses on 7 states, and examines the governing 3-way contracts between CMS, the states, and health plans or other contracted entities, as well as interviews with 24 key informants selected for their expertise in the care coordination workforce, dementia care coordination, or duals demonstration policy.
Among the authors’ key findings are that experience and training requirements for care coordinators were often broadly defined. With some exceptions, there was little specificity as to the training content or required competencies for ADRD care coordinators. Requirements and practices as defined in duals demonstrations appeared to turn on several factors: 1) workforce availability and qualifications; 2) existing state policies concerning Medicaid waivers, Medicare Advantage Programs, and Managed Long-Term Services and Supports; and 3) the stakeholder process and strength of advocacy movements surrounding the creation of the duals demonstrations in the particular state.
The authors highlight the need for a workforce of adequate numbers of dementia-capable care coordinators to serve people with ADRD and their caregivers. They conclude that promising practices for the utilization of existing workforce resources and dementia-capable training for care coordinators exist, however all demonstrations will benefit from evaluation of outcomes resulting from policies impacting people with ADRD and their caregivers.
The Gerontologist, May 25, 2017: Dementia-Capable Care Coordination in Duals Demonstration Programs: Workforce Needs, Promising Practices, and Policy.
Brooke Hollister, PhD; Jason D. Flatt, PhD, MPH; Susan A. Chapman, PhD, RN, FAAN
ABSTRACT: Background and Objectives:
This study describes the program requirements, workforce competencies, and barriers for dementia capable care coordination within health plans from seven states participating in the Center for Medicare and Medicaid Services demonstration programs for dually-eligible Medicare and Medicaid beneficiaries.
Research Design and Methods:
Data came from contracts, policy documents, and 24 semistructured key informant interviews with national experts and leaders from community-based organizations, advocacy organizations, researchers, federal and state government, and health plans in the seven states.
Contracts included language mandating care coordination practices deemed dementia-capable, including workforce qualifications, training, and experience; dementia screening; involvement of a caregiver in the care planning process; and education, support groups, and referral resources for people with dementia and their caregivers. There was little consistency across states in their dementia capable requirements and informants questioned the dementia capability of the care coordination workforce and practice. However, promising practices and areas for improvement were identified.
Discussion and Implications:
The variability of the duals demonstrations made it difficult to compare across states. The three-way contracts were often the starting point of a process to more clearly define policies and practices in each state including workforce requirements. Efforts should be made to further adopt and translate evidence-based practices into health systems and evaluate promising practices.