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Building Plans to Act on Alzheimer’s

Minnesota can do better with care delivery and supports

Act on Alzheimer's logoHealth care organizations in Minnesota are planning how to advance care and support for people with dementia and their caregivers. More than 135 health care leaders from across Minnesota participated in a working session, at the ACT on Alzheimer's Health Care Leadership Summit on September 29, to explore creative solutions for improving dementia detection and care, and influencing the national discussion around this disease.

ACT on Alzheimer’s is a statewide, multidimensional collaboration seeking large-scale social change and building community capacity to transform Minnesota’s response to Alzheimer’s disease. A signature goal is to help health care providers and systems become dementia capable.

People with dementia and their caregivers at the summit asked that Alzheimer's have similar care standards for diagnosis and follow-up as other chronic diseases and conditions, like heart disease, cancer, and pregnancy. Research shows that delayed diagnosis and failing to connect people to supports often results in preventable crises.

The summit’s call to action was clear: We need early detection and a team approach using care coordination to avoid more preventable crises and improve quality of life and care for people living with dementia.

“Early detection and diagnosis are important in making the cognitive and emotional transition from wide-ranging, independent self-directed activities to collaborative shared activities,” said Marv Lofquist, PhD, a person with dementia, diagnosed early and living well to his full capacity for over four years with the support of his wife.

Nearly everyone has been affected personally or professionally by dementia—every 66 seconds someone develops Alzheimer's. Building Plans to Act on Alzheimer's Minnesota can do better with care delivery and supportsThe risk is highest for older African Americans, Latinos, and women.

Alzheimer’s Provider Practice Tools

Tools and resources for health care providers and systems developed by Act on Alzheimer's.

Clinical Provider Practice Tool: Protocol for managing cognitive impairment and guiding decisions for screening, diagnosis and disease management.

Delivering the Diagnosis [Video]: Portrays physician-to-patient interaction for delivering an Alzheimer’s diagnosis.

After a Diagnosis: Action steps and tips to share with individuals and their family when a dementia diagnosis is made.

Care Coordination Practice Tool: Supports patient care coordination, includes a dementia care plan hecklist.

Managing Dementia Across the Continuum: Protocol for treating, managing and supporting persons with mid- to late-stage dementia.

Electronic Medical Record Decision Support Tool: A template for implementing a standardized approach to all aspects of dementia care within the health record.

“We know how to do this, and we have the tools,” said Penny Wheeler, CEO of Allina Health. “We just need to ACT. The time is now.”

Wheeler's message was that we all need to be part of the solution to reframe the challenge of dementia and focus on value-based care. We need to improve personal outcomes and experience, and reduce unnecessary utilization.

Summit attendees committed to implementing new action steps within their organizations after the event, including:

  • Establish standardized protocols for identification, diagnosis and care coordination
  • Implement use of the MiniCog screen for cognitive impairment in Medicare annual wellness visits, during clinic rooming process, and in all hospice and home health admissions
  • Embed dementia algorithm in the electronic health record
  • Form a care team and navigator to support people with dementia
  • Pilot a dementia chronic care management program
  • Develop a clinical pathway similar to other chronic diseases for home health patients
  • Incorporate dementia awareness into grand rounds
  • Identify a physician champion
  • Explore how dementia is incorporated into risk models

Shari Ling, MD, deputy chief medical officer, Centers for Medicare & Medicaid Services (CMS), Center for Clinical Standards and Quality, outlined the national perspective at the summit, conveying the role dementia plays in value-based care. She reviewed the current billing codes applicable to Alzheimer’s detection, diagnosis, and post-diagnostic care, as well as potential reimbursement opportunities through the proposed changes to the 2017 Medicare Physician Fee Schedule.

Minnesota can do better with our care delivery and supports, and is coming together to take action.