Creating an Optimal System of Brain Health Care in the United States

Convening Experts to Prioritize Immediate Opportunities to Advance an Optimal System of Care

THE ISSUE

Despite estimates that we spent $277 billion on dementia care in 2018 and will spend $1.1 trillion by 2050, the U.S. is not in a position to implement strategies that could reduce these costs by reducing dementia prevalence.

One reason is that public payers are shifting an increasing portion of annual care cost risk to private payers while retaining the lifetime care cost risk. A growing portion of Medicare and Medicaid beneficiaries get their coverage through private health plans, in which they enroll annually. Private payers shy away from investments in system change for which they have little evidence of a likely return within a relatively short time window.

There are also many barriers related to culture and perception. Physicians are reluctant to assess, detect, or discuss a disease for which they believe there is no solution. The misperception persists that no treatment, cure, or medical intervention for cognitive decline is available should doctors detect it. Patients do not yet have the knowledge or awareness to ask about brain health. They worry about the loss of independence and the stigma of cognitive decline.

Perhaps one of the biggest challenges is the prevailing misperception that dementia is an unavoidable affliction of old age, disconnected from people’s lifestyles or life experiences and separate from the dysregulation of other body-based biological systems such as cardiovascular, hypertension, metabolic, lymphatic, and more.

OUR WORK

We partnered with UsAgainstAlzheimer’s Brain Health Partnership to facilitate dialogue among brain health researchers, practicing providers, public health and advocacy organizations, and system leaders to review the latest evidence on risk reduction and early detection, identify evidence-based medicine initiatives around brain health, and discuss efforts to implement new care delivery and payment models for patients with cognitive decline. Experts shared their research, efforts, and ideas for optimizing brain health and reducing risk of dementia.

With input from stakeholders, ATI prepared a paper that outlined the barriers to creating a more optimal system of brain health care and highlighted key action areas and steps to prioritize to advance an optimal system of care. We facilitated a discussion with more than 40 experts to discuss these areas and refined the paper for public release.

OUR VIEW

Our discussions with experts revealed that there is a tremendous amount of work underway to build the evidence base, technology, interventions, and care models for an improved system of brain health care. Three key insights also emerged: dementia is interconnected to other diseases; modifying certain lifestyle and other health factors can reduce the risk of and/or delay cognitive decline; and dementia has a lifespan continuum, beginning in early life. These insights challenge the traditional characterization of dementia and create a foundation for prioritizing action areas for creating a more optimal system of care for brain health.  

We must prepare providers and patients to manage brain health in the context of overall health and wellness. A healthcare system with the infrastructure for assessing and communicating about brain health will be primed for quickly incorporating the latest science and key solutions as they emerge.

In preparing this consensus document, we helped the Brain Health Partnership articulate a vision for an optimal system of care in which healthcare providers help patients build brain health across the lifespan, detect cognitive decline in its earliest stage, and deliver interventions to drive better outcomes. We identified the action areas and next steps where investment in more work can make the biggest impact.