Maricopa County becomes the proving ground next month for a new Medicare plan for people with dementia, the first in the nation targeting the growing number of people struggling with the brain-withering disease.
Evercare, a subsidiary of insurance giant UnitedHealth Group, will offer a Medicare package that includes case management, prescription drug coverage, respite care and other services designed for dementia patients, in collaboration with the Banner Alzheimer’s Institute in Phoenix.
The plan is intended to address all aspects of the disease, including its impact on families, with the goal of keeping patients out of hospitals and nursing homes while improving their quality of life.
“We know that the person suffering from Alzheimer’s is in and out of the hospital for a lot of things that could’ve been prevented,” said Dr. Ana Fuentevilla, medical director for Evercare’s southwest region.
By teaming up with the Alzheimer’s Institute, the health plan can offer an array of services, from treatment at the Memory Disorders Clinic to support for caregivers.
“I think that it’s very likely to improve quality of life and actually save society money in the long term,” said Dr. Pierre Tariot, associate director of the Alzheimer’s Institute and director of the clinic. “It doesn’t need to be this scary, unpredictable problem.”
Case managers, who will be either nurses or social workers, are being trained at the Alzheimer’s Institute under the direction of nurse Jan Dougherty, who runs the family support program and has conducted dementia training nationwide.
Five employees will start when the program launches in January, and their caseloads will be capped at 50 families, Fuentevilla said.
In addition to the institute connection, the plan includes the Safe Return program for people who tend to wander, respite care, transportation to appointments and a revised drug formulary that lowers the co-payment for dementia-specific medications.
“I think what’s different here is that both Evercare and the folks at our institute have a different view,” Tariot said. “If you have this diagnosis, it doesn’t mean you are a diagnosis.”
Alzheimer’s and related dementia are the third-leading cause of death among older Americans, affecting 4.5 million people, including about 50,000 in the Valley. Half of those 85 and older develop the disease.
A recent study by the Alzheimer’s Association showed that Medicare spends about three times as much for people with dementia as other recipients.
In 2005, Medicare spent $95 billion on people with dementia, a figure that’s expected to increase to $160 billion by 2010.
That doesn’t include the costs to families and caregivers, who aren’t traditionally covered by Medicare.
“We want to keep the caregivers healthy and safe so we can keep people living in their homes as long as possible,” Fuentevilla said.
Evercare’s is the first special-needs plan for dementia to win federal Medicare approval.
Changes to the Medicare law in 2003 allowed insurers to carve out special plans for the frailest elderly. Evercare has more of those kinds of plans than any other provider and insures more than 12,000 Arizonans who are poor, in nursing homes or living with chronic illnesses.
Insurance companies receive higher reimbursement for patients in plans who are institutionalized or who also qualify for Medicaid.
Federal officials have been criticized for not requiring the plans, which have increased dramatically to serve nearly 1 million Medicare beneficiaries, to prove that they’re adequately serving these special populations.
Fuentevilla said Evercare and the institute are working on a plan to track outcomes and determine the program’s viability.