Provider adoption of cognitive assessment and care plan services and associated outcomes for people living with dementia.

Abstract

An estimated 6.7 million people are living with Alzheimer’s Disease and Related Dementias (ADRD) in America. ADRD is characterized by declines in cognition, memory, and function over time. Once ADRD has progressed to a severe state, people living with it require high intensity caregiving from family and friends or institutional care. With limited treatment options, ADRD care generally revolves around managing symptoms, long-term care planning, and supporting caregivers. In 2017, the Centers for Medicare and Medicaid (CMS) introduced reimbursement for primary care and other outpatient providers for helping people living with ADRD and their caregivers navigate this process through comprehensive care planning. The specific service is called Cognitive Assessment and Care Planning (CACP) and involves 8 domains of ADRD care and creating a written care plan for the patient. CACP is reimbursed at a higher rate than other office-based interventions to encourage widespread adoption by providers; however, less than 1% of eligible patients received CACP two years after its introduction. In my first chapter I used 100% research identifiable files of both fee-for-service Medicare claims and Medicare Advantage encounters to descriptively investigate trends in CACP receipt/delivery across patient demographics, provider specialties, and visit settings. In my second chapter, I used discrete-time survival modelling to model how awareness of CACP (peer adoption of CACP) and other provider and practice factors impact the odds of providers successfully billing for CACP. In my third chapter, I used two-way fixed effects difference-in-differences modelling to examine the effect of practice CACP adoption on hospitalization and emergency department visits for their patient population. Identifying barriers to provider CACP adoption will help to inform changes that can be made to CACP dissemination efforts and billing requirements to facilitate widespread adoption. Knowing the impact or lack thereof that CACP receipt has on acute healthcare events will help decision makers determine if the current reimbursement rate for CACP is justified, as well as if additional follow-up and support for patients who receive CACP should be incentivized.