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Insurers Wrestle With Dementia Care Quality Standards

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U.S. health insurers would like to see any measures of dementia care quality include measures of caregiver support quality.

But, at this point, health insurers are hazy on how to measure the quality of care for people with dementia, and they are even hazier about how to measure the quality of support for caregivers.

(Related: U.S. Alzheimer’s 2017 Spending May Reach $259 Billion)

Elizabeth Cahn Goodman, a Massachusetts long-term care policy specialist, summarizes several insurers’ views on measurement of dementia care quality in a paper on insurers’ responses to a request for feedback from the health insurance community.

The U.S. Department of Health and Human Services is holding a two-day meeting on dementia care and support research this week in Bethesda, Maryland, at the headquarters of the National Institutes of Health.

Summit organizers asked for ideas both from health insurers and from other groups of stakeholders, including long-term care providers, people living with dementia, and caregivers for people with forms of dementia other than Alzheimer’s.

Seven insurers responded to the request for feedback from health insurers, Goodman writes.

The insurers all said they have tools they use to measure the health of patients, and how well the patients are functioning, but none reported using those tools to try to measure quality of care.

The insurers expressed skepticism about efforts to develop measures of dementia care quality, partly because of concerns about fuzziness, about whether proposed activities would really matter, and about possible lack of realism about costs.

“The very measures of amount amounts to ‘excellent’ dementia care are nebulous out there, and there is no clear consensus on which population needs are best addressed on a wider scale vs. simply providing care on a case-by-case basis, depending on a patient’s resources, stage of disease, co-morbidities, etc.,” one insurer told the summit organizers.

Measuring tape (Image: Thinkstock)

(Image: Thinkstock)

Insurers said that, if someone can develop a strategy for measuring the quality of care for people with dementia, they would like the quality measure to include quality of life for the patient, qualify of life for any family caregiver or other unpaid caregiver, and the caregiver’s overall stress burden, including the caregiver’s level of depression and anxiety.

Although several insurers mentioned the need to measure caregiver well-being, “none offered specific scales for that purpose,” Goodman writes.

The request feedback also included insurer comments on the idea of creating a new category of health insurance plans, such as Medicare Advantage special needs plans, aimed at people with dementia.

Insurers said that would be difficult, partly because what patients with dementia need depends on the cause of a patient’s dementia, the patient’s age, how long the patient has had dementia, the patient’s other health problems, and other factors.

Insurers “voiced concern about the lack of existing evidence regarding what the definition of value in serving this diverse community of patients/members is,” Goodman writes.

Insurers said they would like to see more research on the effectiveness of different types of caregiver training and caregiver support programs. Getting more data on caregiver support program effectiveness might help policymakers find ways to build caregiver support benefits into the Medicare Advantage program, insurers said.

Summit organizers have posted copies of many documents related to the dementia summit, including the health insurance companies stakeholder group paper, here

—-Read Add Caregiver Status to Health Records, Alzheimer’s Panel Says on ThinkAdvisor.

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