Coordinating Center on the Economics of Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias: Prevention, Treatment, and Care - Research Projects

As part of the Consortium on the Economics of AD/ADRD, the National Institute of Aging (NIA) has funded five research projects. The investigators associated with these projects will particpate in the activities of the NBER Center, which will promote cross-project collaboration. These five projects, along with summaries of their core research objectives, are listed below.

Strengthening the Dementia Care Workforce: Analyzing Economic Policies' influence on Workers and their Patients Living with Dementia  
Norma Coe, University of Pennsylvania

The long-term care industry is one of the fastest growing sectors of the economy, but also creates some of the lowest-paid and lowest-quality jobs. Precarious working conditions are costly for workers – who are disproportionately women and women of color – and the patients they care for, who have a high prevalence of AD/ADRD. This project will estimate the impact of three economic policy levers – wages, unionization, and staffing regulations – on improving the lives of the dementia care workforce and their patients.

Role of Home-based Medical Care and Telemedicine in Care and Outcomes of Dementia and Coexisting Conditions in Public and Private Medicare
Amresh Hanchate, Wake Forest University School of Medicine

Persons living with dementia often also live multiple chronic conditions which necessitate complex care regimens, but as functional impairment worsens, persons living with dementia may struggle to leave home to access medical care. Home-based medical care and telemedicine then become instrumental in enabling continuity of patient care, tailoring medical management to evolving patient needs and risks, and mitigating caregiving burden for community living persons living with dementia. Using national Medicare administrative data, the proposed study aims to examine the use of home-based medical care among persons living with dementia with private and public Medicare, its change following the 2020 expansion of telemedicine and their overall impact on patient outcomes and disparities

Disparities in undiagnosed and misdiagnosed dementia and the impact on health care utilization and costs - a novel approach using probabilistic dementia classifications 
Peter Hudomiet, RAND Corporation

Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD) often go undiagnosed or are diagnosed after substantial delays, leading to undertreatment and delays in care. This project will derive a novel AD/ADRD classification to accurately quantify AD/ADRD diagnostic errors and delays that disproportionately affect racial and ethnic minority groups and underserved populations, and to measure the impact on health care utilization and costs. The findings will inform health care policy and public health efforts to reduce disparities in diagnosis and care, improve health outcomes, and reduce avoidable health care costs for people living with dementia and their caregivers.

Care for Persons with Dementia in Medicare Advantage and Traditional Medicare: Family Spillovers and Disparities 
Lauren Nicholas, University of Colorado, Denver

Enrollment in Medicare Advantage, the managed care alternative to Traditional Medicare, covers nearly half of Medicare beneficiaries and disproportionately enrolls minorities and low-income beneficiaries. Managed care could improve the care of patients with Alzheimer's Disease and Related Dementias (ADRD) through care coordination and supplemental benefits, though regulators have raised concerns about inappropriate denials of care relative to Traditional Medicare. This project considers whether Medicare Advantage impacts potentially preventable hospitalizations, discharges without home or facility based care, transitions across sites of care, racial, ethnic, and income disparities in care, and intergenerational transfers of time and money among Medicare beneficiaries with ADRD and their families.

Impact of Medicare and Medicaid Financial Policies on Post-acute and Long-term Care for Persons Living with Dementia 
Momotazur Rahman and Cyrus Kosar, Brown University

This project addresses the role of healthcare financing and policies on health outcomes, utilization and disparities. We will leverage the past 15 years of Medicare claims and clinical assessment data and modern econometric methods to advance our understanding of how evolving healthcare financing affects post-acute and long-term care utilization and health outcomes for individuals with Alzheimer’s disease and AD-related dementias (ADRD). We examine (a) the changing utilization patterns of nursing home and home health services among individuals with AD/ADRD in the context of states’ expansion of Home and Community-Based Services (HCBS) funding and provider supply constraints due to certificate-of-need regulations; (b) the effect of Medicare Advantage (MA) in long-term nursing home care and the role of Institutional Special Needs Plans (I-SNPs); and (c) the impact of changes to post-acute care reimbursement structures on the quality of post-acute and long-term nursing home care.