Variations in Costs of a Collaborative Care Model for Dementia

Talita D. Rosa, Katherine L. Possin, Alissa Bernstein, Jennifer Merrilees, Sarah Dulaney, Jessica Matuoka, Kirby P. Lee, Winston Chiong, Stephen J. Bonasera, Krista L. Harrison, James G. Kahn

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVES: Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program. DESIGN: We applied a micro-costing analysis to calculate operational costs per-participant-month between March 2015 and May 2017. SETTING: The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC). PARTICIPANTS: Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants. INTERVENTION: A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management. MEASUREMENTS: We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start-up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs. RESULTS: Start-up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per-participant-month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per-participant-month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per-participant-month with the highest projected caseloads (90). CONCLUSION: We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628–2633, 2019.

Original languageEnglish (US)
Pages (from-to)2628-2633
Number of pages6
JournalJournal of the American Geriatrics Society
Volume67
Issue number12
DOIs
StatePublished - Dec 1 2019

Fingerprint

Dementia
Costs and Cost Analysis
San Francisco
Caregivers
Advance Care Planning
Quality of Health Care
Medicaid
Health Expenditures
Medicare
Pharmacists
Nurses
Delivery of Health Care
Education
Equipment and Supplies

Keywords

  • care navigation
  • collaborative dementia care
  • cost analysis
  • dementia care coordination

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Rosa, T. D., Possin, K. L., Bernstein, A., Merrilees, J., Dulaney, S., Matuoka, J., ... Kahn, J. G. (2019). Variations in Costs of a Collaborative Care Model for Dementia. Journal of the American Geriatrics Society, 67(12), 2628-2633. https://doi.org/10.1111/jgs.16076

Variations in Costs of a Collaborative Care Model for Dementia. / Rosa, Talita D.; Possin, Katherine L.; Bernstein, Alissa; Merrilees, Jennifer; Dulaney, Sarah; Matuoka, Jessica; Lee, Kirby P.; Chiong, Winston; Bonasera, Stephen J.; Harrison, Krista L.; Kahn, James G.

In: Journal of the American Geriatrics Society, Vol. 67, No. 12, 01.12.2019, p. 2628-2633.

Research output: Contribution to journalArticle

Rosa, TD, Possin, KL, Bernstein, A, Merrilees, J, Dulaney, S, Matuoka, J, Lee, KP, Chiong, W, Bonasera, SJ, Harrison, KL & Kahn, JG 2019, 'Variations in Costs of a Collaborative Care Model for Dementia', Journal of the American Geriatrics Society, vol. 67, no. 12, pp. 2628-2633. https://doi.org/10.1111/jgs.16076
Rosa TD, Possin KL, Bernstein A, Merrilees J, Dulaney S, Matuoka J et al. Variations in Costs of a Collaborative Care Model for Dementia. Journal of the American Geriatrics Society. 2019 Dec 1;67(12):2628-2633. https://doi.org/10.1111/jgs.16076
Rosa, Talita D. ; Possin, Katherine L. ; Bernstein, Alissa ; Merrilees, Jennifer ; Dulaney, Sarah ; Matuoka, Jessica ; Lee, Kirby P. ; Chiong, Winston ; Bonasera, Stephen J. ; Harrison, Krista L. ; Kahn, James G. / Variations in Costs of a Collaborative Care Model for Dementia. In: Journal of the American Geriatrics Society. 2019 ; Vol. 67, No. 12. pp. 2628-2633.
@article{d5b13d6fb2f74a1284692617b90e1e54,
title = "Variations in Costs of a Collaborative Care Model for Dementia",
abstract = "OBJECTIVES: Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program. DESIGN: We applied a micro-costing analysis to calculate operational costs per-participant-month between March 2015 and May 2017. SETTING: The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC). PARTICIPANTS: Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants. INTERVENTION: A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management. MEASUREMENTS: We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start-up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs. RESULTS: Start-up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per-participant-month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per-participant-month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per-participant-month with the highest projected caseloads (90). CONCLUSION: We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628–2633, 2019.",
keywords = "care navigation, collaborative dementia care, cost analysis, dementia care coordination",
author = "Rosa, {Talita D.} and Possin, {Katherine L.} and Alissa Bernstein and Jennifer Merrilees and Sarah Dulaney and Jessica Matuoka and Lee, {Kirby P.} and Winston Chiong and Bonasera, {Stephen J.} and Harrison, {Krista L.} and Kahn, {James G.}",
year = "2019",
month = "12",
day = "1",
doi = "10.1111/jgs.16076",
language = "English (US)",
volume = "67",
pages = "2628--2633",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Variations in Costs of a Collaborative Care Model for Dementia

AU - Rosa, Talita D.

AU - Possin, Katherine L.

AU - Bernstein, Alissa

AU - Merrilees, Jennifer

AU - Dulaney, Sarah

AU - Matuoka, Jessica

AU - Lee, Kirby P.

AU - Chiong, Winston

AU - Bonasera, Stephen J.

AU - Harrison, Krista L.

AU - Kahn, James G.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - OBJECTIVES: Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program. DESIGN: We applied a micro-costing analysis to calculate operational costs per-participant-month between March 2015 and May 2017. SETTING: The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC). PARTICIPANTS: Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants. INTERVENTION: A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management. MEASUREMENTS: We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start-up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs. RESULTS: Start-up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per-participant-month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per-participant-month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per-participant-month with the highest projected caseloads (90). CONCLUSION: We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628–2633, 2019.

AB - OBJECTIVES: Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program. DESIGN: We applied a micro-costing analysis to calculate operational costs per-participant-month between March 2015 and May 2017. SETTING: The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC). PARTICIPANTS: Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants. INTERVENTION: A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management. MEASUREMENTS: We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start-up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs. RESULTS: Start-up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per-participant-month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per-participant-month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per-participant-month with the highest projected caseloads (90). CONCLUSION: We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628–2633, 2019.

KW - care navigation

KW - collaborative dementia care

KW - cost analysis

KW - dementia care coordination

UR - http://www.scopus.com/inward/record.url?scp=85069890936&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069890936&partnerID=8YFLogxK

U2 - 10.1111/jgs.16076

DO - 10.1111/jgs.16076

M3 - Article

C2 - 31317539

AN - SCOPUS:85069890936

VL - 67

SP - 2628

EP - 2633

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 12

ER -