By John Mach, MD – Chief Medical Officer, Ceresti Health

Having spent 10 years in a multidisciplinary dementia clinic, I learned firsthand what the challenges of dementia are – not just for patients and providers, but for caregivers. Dementia is a family disease. Because people with dementia can’t self-manage their chronic conditions, symptoms are masked, and too often go unreported and untreated. By the time they are identified, patients’ conditions are often advanced, dangerous and can cost two to three times higher than they would have had they been recognized earlier.

Hospitalizations are the number one driver of these costs. Infections, medication problems, shortness of breath, and heart disease – all of these lead to preventable hospitalizations. The consequences are devastating: Hospitals are disorienting for people with dementia, and they tend to get agitated, overmedicated, and are sometimes restrained in the hospital. Even after discharge, patients experience a stepwise decline in cognition and function after hospitalization from which they never recover.

The Inadequacies of the Current Healthcare System

How can health plans do a better job of helping their patients with dementia avoid hospitalizations? Alone, they probably can’t. From the health plan side, dementia has been missed. When you look through medical claims, dementia doesn’t appear because the claim is coded as pneumonia or heart failure, not dementia. Plans have systematically missed the fact people with dementia present later and sicker. As a result, dementia has not risen to the top for targeted interventions.

Further complicating cost-savings efforts is the fact that care management programs have been designed to engage individuals directly, so people with dementia are rarely in these programs.  And people can’t self-report. They can’t tell you their symptoms. That makes most programs ineffective..

That’s what excites me about the opportunity of true value-based care afforded by the GUIDE Model. Claims data hides the subtle changes in a person’s condition. But family caregivers notice those changes right away.

Launched by the Centers for Medicare and Medicaid Services, the Guiding an Improved Dementia Experience (GUIDE) model is an eight-year program that, for the first time, provides payment for caregiver support. This signals that dementia is a national priority and that caregivers are the key to improving outcomes. For value-based care organizations, including Medicare Advantage plans and Accountable Care Organizations, this is an opportunity to do something that improves quality and lowers costs.

From a clinical perspective, it is clear to see how better care and lower costs go together. Detecting subtle changes in a person’s condition – even just two or three days earlier – can prevent a hospitalization. Appetite, behavior, wandering, activity, sleepiness – these are subtle signs that something is wrong. Caregivers know when something is not normal for their loved one. With the right training, they can engage the doctor earlier and get a better result for the people they love.

Leveraging Technology to Maximize Impact

Ceresti has a technology-enabled service that puts the caregiver at the center. Through a cell-enabled, senior-optimized tablet, caregivers receive personalized education and are paired with a one-on-one coach. Caregivers use the tablet to report subtle changes in condition – which Ceresti's caregiver coaches are then able to track and advise about. 

In clinical studies, we have seen a 40% reduction in medical costs. Hospitalizations went down more than 44%. And we’ve seen these results in the span of just six months. Scalable, relatively inexpensive, and not limited by geography, this is the kind of truly remote, caregiver-centric program that embodies the best of CMS’s GUIDE model.

Caregivers are not just recipients of support; they are participants in care – the lever that changes outcomes. Dementia care has been neglected for decades, but we now have a simple, effective, and proven way to make a difference: the family caregiver.

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