After Risk-Adjustment Change, Dementia Diagnoses Increased In Medicare Advantage Relative To Traditional Medicare

Health Affairs, Journal Year: 2025, Volume and Issue: 44(1), P. 81 - 89

Published: Jan. 1, 2025

In 2020, the Centers for Medicare and Medicaid Services reintroduced Alzheimer's disease related dementias to its risk-adjustment payment model Advantage (MA) plans. Using 2017–20 data 100 percent of community-dwelling beneficiaries enrolled in Medicare, we evaluated how reintroduction dementia affected rates new (incident) diagnoses among MA relative those traditional Medicare. response change, annual incident diagnosis increased by 11.5 This increase was concentrated who were more likely have undiagnosed dementia—specifically, Hispanic or Black, ages eighty-five older, dually eligible received a Part D low-income subsidy. Only third came through chart reviews. Financial incentives detect diagnoses, particularly at high risk undetected dementia, but questions remain about potential overdiagnosis upcoding.

Language: Английский

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Hospitalization outcomes among older adults living undiagnosed or unaware of dementia

Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring, Journal Year: 2025, Volume and Issue: 17(1)

Published: Jan. 1, 2025

Language: Английский

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Association of Dementia Severity at Diagnosis with Health Care Utilization and Costs around the Time of Incident Diagnosis

Innovation in Aging, Journal Year: 2025, Volume and Issue: 9(3)

Published: Jan. 1, 2025

Abstract Background and Objectives This study provides the first analysis of heterogeneity in health care use costs by level dementia symptom severity around time incident diagnosis for a population-representative sample older Americans. Research Design Methods We used Aging, Demographics, Memory Study (ADAMS), Health Retirement (HRS), traditional Medicare (TM) claims. modeled measured Clinical Dementia Rating scale ADAMS respondents applied parameter estimates to HRS than 70 years who had claims-based 2000–2016. measures quantified levels quarters before, at, after diagnosis. reported separate results groups persons diagnosed at mild, moderate, severe stages dementia. Results increased quarter before most significantly Both declined thereafter but remained elevated relative prediagnosis. general pattern was consistent different Acute were similar across categories throughout period, whereas outpatient consistently higher among mild stage disease. Discussion Implications Findings from this provide new insights on how is associated with costs. Under current system TM, early may not substantially reduce spending

Language: Английский

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Prevalence of dementia diagnoses in a safety net health system

Alzheimer s & Dementia, Journal Year: 2025, Volume and Issue: 21(4)

Published: April 1, 2025

Abstract INTRODUCTION Older adults from minoritized and socioeconomically disadvantaged backgrounds commonly receive health care in safety net settings may be at high risk of dementia. We assessed the prevalence diagnosed dementia a large system. METHODS International Classification Disease 10th Revision codes were used to classify presence for 147,689 older with least one ambulatory encounter 2019 using electronic record data. Prevalence was calculated sample overall by age cohort, sex, race/ethnicity. RESULTS Diagnosed 0.3% 50 64 3.0% aged ≥ 65. Adults older, less likely speak English, had more medical comorbidities higher health‐care use than those without. DISCUSSION This study's estimates considerably lower other samples, which due incomplete coding or underdiagnosis setting. Highlights Six percent 10% do not have Medicare often systems; however, little information exists about this practice The Los Angeles County Department Health Services is nation's second largest municipal system provides > 30,000 annually, whom 85% are populations 60% Medicare. demographic clinical derived estimate age‐adjusted significantly expected based on national reflecting significant and/or undercoding

Language: Английский

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Differences in setting of initial dementia diagnosis among fee‐for‐service Medicare beneficiaries

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 73(1), P. 39 - 49

Published: Oct. 22, 2024

Abstract Background Accurate and timely diagnosis of dementia is necessary to allow affected individuals make informed decisions access appropriate resources. When goes undetected until a hospitalization or nursing home stay, this could reflect delayed misdiagnosis, may underlying disparities in healthcare access. Methods In retrospective cohort study, we used 2012–2020 Medicare claims other administrative data examine variation setting among fee‐for‐service beneficiaries with an initial claims‐based 2016. We multinomial logistic regression evaluate the association person geographic factors location, Cox proportional hazards 4‐year survival relative location. Results Among 754,204 newly diagnosed 2016, 60.3% were community, 17.2% hospitals, 22.5% homes. Adjusted rates significantly lower those hospitals [−16.1 percentage points (95% CI: −17.0, −15.1)] homes [−16.8 −17.7, −15.9)], compared community. Community‐diagnosed more often female, younger, Asian Pacific Islander, Native American Alaskan Native, Hispanic, had fewer baseline hospitalizations higher homecare use, resided wealthier ZIP codes. Rural likely be hospitals. Conclusions Many older adults are hospital home. These have than which indicate during acute illness care transition, at later disease stage, all suboptimal. results highlight need for improved screening general population, particularly rural areas communities social deprivation.

Language: Английский

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Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(4), P. 1223 - 1233

Published: March 20, 2024

Abstract Background Research on racial and ethnic disparities in costs of care during the course dementia is sparse. We analyzed Medicare expenditures for beneficiaries with to identify when are highest whether they differ by race ethnicity. Methods data from 2000–2016 Health Retirement Study (HRS) linked corresponding claims estimate total four phases: (1) year before a diagnosis, (2) first following (3) ongoing after year, (4) last life. estimated each patient's phase‐specific disease using race‐specific survival model monthly adjusted patient characteristics. investigated healthcare utilization service type across races/ethnicities phases care. Results Adjusted mean non‐Hispanic (NH) Black ($165,730) Hispanic ($160,442) exceeded NH Whites ($136,326). In preceding immediately initial Blacks ($26,337 $20,429) Hispanics ($21,399–23,176 17,182–18,244). The life was responsible greatest cost contribution: $51,294 (NH Blacks), $47,469 (Hispanics), $39,499 Whites). These differences were driven greater use high‐cost services (e.g., emergency department, inpatient intensive care), especially Conclusions had higher than Whites. Expenditures every phase Further research should address mechanisms such methods improve communication, shared decision‐making, access appropriate all populations.

Language: Английский

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Racial/Ethnic Disparities in Hospital Readmission and Frequent Hospitalizations Among Medicare Beneficiaries With Alzheimer’s Disease and Related Dementia: Traditional Medicare Versus Medicare Advantage

The Journals of Gerontology Series B, Journal Year: 2024, Volume and Issue: 79(7)

Published: May 10, 2024

Examine racial/ethnic disparities in 30-day readmission and frequent hospitalizations among Medicare beneficiaries with dementia traditional (TM) versus Advantage (MA). In this case-control study, we used 2018-2019 TM MA claims data. Participants included individuals 65+ 2 years of continuous enrollment, diagnosis dementia, a minimum 4 office visits 2018, at least 1 hospitalization 2019, (cases: [n = 36,656]; controls: 29,366]). We conducted matching based on health-need variables applied generalized linear models adjusting for demographics, health-related variables, healthcare encounters. was associated higher odds (OR 1.07 [CI: 1.02 to 1.12]) 1.10 1.06 1.14]) compared MA. Hispanic Black enrollees had MA, respectively 1.35 1.19 1.54]) 1.26 1.13 1.40]). lower Hispanic-White Black-White by 5.8 (CI: -0.09 -0.03) 4.4 percentage points (PP; CI: -0.07 -0.02), respectively. For readmission, there no significant difference between 1.04 0.92 1.18]), but than Hispanics 1.23 1.43]). disparity 1.9 PP -0.004 -0.01). risks hospitalizations. Moreover, substantially reduced TM.

Language: Английский

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National Institute on Aging’s Critical Support of Alzheimer’s Disease and Related Dementias Research

Public Policy & Aging Report, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 19, 2024

Journal Article National Institute on Aging's Critical Support of Alzheimer's Disease and Related Dementias Research Get access David C Grabowski, PhD Department Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA Address correspondence to: C. PhD. Email: [email protected] https://orcid.org/0000-0003-2915-5770 Search for other works by this author on: Oxford Academic Google Scholar Public Policy & Aging Report, prae020, https://doi.org/10.1093/ppar/prae020 Published: 22 November 2024 history Received: 19 July Editorial decision: 13 August

Language: Английский

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Trends in Incident Dementia Diagnosis Before and After Medicare Risk Adjustment

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(12), P. e2347708 - e2347708

Published: Dec. 15, 2023

This cohort study examines rates of new diagnosis Alzheimer disease and related dementias among beneficiaries Medicare Advantage plans vs traditional from 2016 through 2020.

Language: Английский

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