Disease Management Update
Volume V, No. 46
April 2, 2009

Dear Healthcare Intelligence Network Client,

An estimated 2.4 million to 4.5 million Americans have Alzheimer's disease (AD), an irreversible, progressive brain disease that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks of daily living. This week's DM Update looks at the healthcare costs for patients with AD and dementia and a link between a patient's memory and parental history of dementia.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. AD and Dementia Triple Healthcare Costs
  2. Disease Management Q&A: The Medical Home’s Price Tag
  3. HealthSounds: ROI, PFP and the PCMH
  4. Parental Dementia May Lead to Poor Memory in Middle-Aged Adults
  5. Survey of the Month: Managing Care Transitions Across Sites
  6. Tobacco Cessation and Prevention Programs

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1. AD and Dementia Triple Healthcare Costs

Total healthcare costs are more than three times higher for people with AD and other dementias than for other people age 65 and older, according to the Alzheimer’s Association’s 2009 Alzheimer’s Disease Facts and Figures. In the new report, total healthcare costs are calculated as per person payments measured from all sources. Medicare payments alone are almost three times higher for people with AD and dementia than for others age 65 and over; Medicaid payments alone are more than nine times higher.

“With the country facing unprecedented economic challenges and a rapidly aging baby boomer population, now is the time to address the burgeoning Alzheimer crisis that triples healthcare costs for Americans age 65 and over,” said Harry Johns, Alzheimer’s Association CEO. “It is widely understood that addressing healthcare is key to the country regaining its financial footing,” continued Johns. “And there is no way this can be done without improving Medicare and Medicaid, which Alzheimer’s directly impacts. A strategy to immediately confront Alzheimer’s has the potential to save millions of lives and billions of dollars by reducing the burden on Medicare and Medicaid.”

With family members providing care at home for about 70 percent of people with AD, the ripple effects of the disease can be felt throughout the entire family. According to Facts and Figures, in 2008, nearly 10 million Alzheimer caregivers in the U.S. provided 8.5 billion hours of unpaid care valued at $94 billion. In addition to the unpaid care families contribute, the report also reveals that AD creates high out-of-pocket health and long-term care expenses for families. Out-of-pocket costs that are not covered by Medicare, Medicaid or other sources of insurance are 28 percent higher for Medicare beneficiaries with AD than those without. Individuals with AD and other dementia living in nursing homes or assisted living facilities incurred the highest out-of-pocket costs — an average of $16,689 a year.

To learn more about this research, please visit:

2. Disease Management Q&A:The Medical Home’s Price Tag

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Lesley Reeder, R.N., B.S.N., quality improvement specialist for the Colorado Department of Health Care Policy and Financing.

Question: How much does it cost for an office to implement the medical home model? Have you created a financial model for local physician offices?

Response: (Lesley Reeder) I would recommend Dr. Richard Baron’s research related to those cost estimates. Dr. Baron, a practicing internist and chair of the American Board of Internal Medicine Board of Directors, estimates that we can expect to see about 27.5 percent over the current annual FFS reimbursement per full-time physician in a practice.

For more details on improving your medical home, please visit:

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3. HealthSounds Podcast: ROI, PFP and the PCMH

Aetna's practice of sending its providers periodic "care considerations" — detailed clinical data that identify opportunities to improve care — has been formalized in its patient-centered medical home (PCMH) pilot with Partners in Care (PIC), explains Dr. Don Liss, the regional medical director of Aetna's mid-Atlantic region. PIC providers' engagement with the care considerations is now a factor in the PFP aspect of the pilot. Dr. Liss shares some short-term indicators that demonstrate that the PCMH is working as well as his longterm view for medical home ROI, which can vary greatly for payors and providers.

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4. Parental Dementia May Lead to Poor Memory in Middle-Aged Adults

People who have parents diagnosed with AD or dementia perform less well on formal memory testing when compared to people of the same age whose parents never developed AD or other dementia. This is true even in middle-aged persons who do not have a diagnosis of clinical stroke or dementia, according to a Boston University School of Medicine (BUSM) study.

Researchers are following three generations of participants to study the risk factors and earliest biomarkers of AD, stroke and other cardiac and neurological diseases. The first generation has been followed since 1948. Since both the parental and offspring generation are enrolled as study participants, researchers could accurately identify which parents did or did not develop AD or other dementia in their lifetime. Among persons who were carriers of the ApoE e4 gene, those who had parents with AD or other dementia scored significantly worse on tests of verbal memory and visual memory than persons who did not have parents with AD.

“Parental dementia and Alzheimer’s disease were significantly associated with poorer performance in verbal and visual memory tasks,” said senior author Sudha Seshadri, M.D., associate professor of neurology and co-director of the Medical Education for Neurology Residency Program at BUSM.

Researchers further concluded that the result in persons with parents who have AD is equivalent to approximately 15 years of brain aging. The effect was largely limited to those study participants who have the ApoE e4 gene, which supports the idea that the gene is probably at least partially responsible for the transmission of AD risk between generations.

To learn more about this research, please visit:

5. Survey of the Month: Managing Care Transitions Across Sites

Planning a patient's care transitions and closing the gaps in care from one healthcare setting to another can have a significant effect on health outcomes, likelihood of readmission and ER visits, cost to patients, providers and insurers, and the burden on caregivers and family members. Please share your organization's experiences with care transitions by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

6. Putting out the Addiction: Tobacco Cessation and Prevention Programs

By funding an expansion of children's healthcare coverage with a 61-cent tobacco tax per cigarette pack, the U.S. government is doing their part in the crusade for tobacco cessation and prevention. Now, HIN examines how over 220 wellness companies, behavioral healthcare providers, PCPs, DM organizations, employers, health plans and hospital/health systems are contributing to the area of tobacco cessation and prevention.

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Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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