By Rhonda Quintana, Chief Revenue Officer, Ceresti Health (July 13, 2026)‍

A consistent theme is emerging in my conversations with Medicare Advantage and accountable care executives. Many organizations have worked the familiar levers — coding accuracy, pharmacy, post-acute utilization, network performance — and are now looking for the next meaningful source of clinical and financial improvement. One answer is already inside their attributed population; people living with dementia and the family caregiver who is carrying the weight.

Dementia is still too often treated as a narrow clinical category rather than a population-health risk multiplier. It typically accounts for 6–9% of a Medicare population but a far larger share of its total cost. According to the Alzheimer’s Association’s 2026 Alzheimer’s Disease Facts and Figures report, an estimated 7.4 million Americans age 65 and older are now living with Alzheimer's, and average per-person Medicare payments for beneficiaries with Alzheimer’s or another dementia are nearly three times higher than for those without — and these beneficiaries have twice as many hospital stays per year.

The cost is real. But the dementia diagnosis code is only part of the story.

People living with dementia don't generate cost through cognitive decline. They generate it through the cascade that decline sets off — the untreated UTI that becomes a delirium-driven ED visit, the missed medication that destabilizes heart failure, the fall no one saw coming, the readmission that follows a discharge plan no one at home could execute. The disease is cognitive. The cost is operational. That distinction is the entire strategy.

Standard care assumes patients can manage their own conditions — and people with dementia can't. That gap, not the disease itself, is what drives the cost. You cannot reverse the disease. You can absolutely change what happens around it.

The overlooked mechanism: the family caregiver

Traditional care management is usually designed around patient engagement. Dementia changes that equation. As cognitive impairment progresses, the family caregiver often becomes the person observing changes, managing medications, coordinating appointments, and deciding whether a new symptom leads to a call to the care team or a trip to the emergency room.

An activated family caregiver — equipped, coached, confident, and connected to a care team —is not a softer, feel-good version of care management. It is a core part of the care infrastructure. It is how you move spend out of the hospital and back into the home. The strategic opportunity is to make that support systematic rather than episodic. Organizations that figure this out don't just improve outcomes; they convert their single most volatile population into one of their most predictable.

The results bear this out. In claims-based findings with PacificSource, a not-for-profit health plan, Ceresti's dementia management program reduced medical costs by 42% against a propensity-matched comparison group — a statistically significant $523 per member per month (p=0.0165) across 444 Medicare Advantage and D-SNP members in the program's first year.

That is why dementia is the most addressable population you have — the cost is largely avoidable, the lever is proven, and almost no one else is pulling it.

Why now

The timing is not academic. CMS payment updates are compressing margins across the Medicare landscape — Medicare Advantage and traditional Medicare alike — and dementia's avoidable acute utilization lands on each stakeholder differently: for Medicare Advantage plans, it hits medical loss ratio and Star Ratings; for ACOs, total cost of care against benchmark and shared savings; for Medicare Supplement carriers, the cost-sharing claims they cover in a commoditized market where member retention is the only real lever. A national framework has formed around comprehensive dementia care — the CMS GUIDE (Guiding an Improved Dementia Experience) Model — but the opportunity does not depend on any single program.

The organizations that will lead the next decade of value-based care are not the ones who manage risk better in the abstract. They are the ones who correctly identify which population is driving the risk — and build a real strategy around it.

Dementia is no longer a program you bolt on. It is a population health strategy, a quality strategy, and a financial strategy at the same time. The expensive population is the solvable one. The only question left is who decides to solve it first.

"One of the most expensive populations you have is also the most solvable."

The organizations getting ahead of this treat dementia as a measurable driver of performance — not a line buried in the claims report. If that's a conversation your team is having, it's one I'm always glad to join. Connect with me today. >>

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