Alzheimer’s disease (AD) is a leading cause of death for older adults in America and one of the principal causes of decline in quality of life for seniors living with the cognitive illness. The National Institute on Aging estimates that over 5 million Americans are living with AD and that number is expected to triple by 2050. Despite the prevalence and severity of the disease, failure to diagnose in the earliest stages occurs on a massive scale—in an estimated 40-80% of cases.
There is no cure for Alzheimer’s disease, but starting treatment as soon as possible can make a significant difference in slowing progression. Many primary care providers practice with the assumption that patients would rather not know they are in the early stages of AD—consequently, many of these clinicians do not conduct simple, inexpensive cognitive tests. One potential channel to address this issue is establishing a system of incentives for early screening procedures. In exploring this idea, “Early Detection and Treatment of Alzheimer’s Disease,” a runner-up in the Better Government Competition, proposes that the state create incentives for early detection through reimbursement at a rate of 150%, sponsoring training sessions, providing continuing education credits to participating staff, and creating a simple online platform for Medicaid billing.
The state of Wisconsin has implemented a policy based off of the work of the Wisconsin Alzheimer’s Institute, whose success serves as the source of inspiration for this proposal and has brought about widespread use of helpful tools in early detection: the animal naming screen and Cognistat. The animal naming screen, in which a patient names as many animals as they can remember in 60 seconds, can be conducted by personnel without an advanced degree. The Cognistat works as a second step for testing if a positive indicator comes from the animal name screen and requires more training to administer but is still relatively inexpensive. Early detection and subsequent treatment of AD, which can be achieved through the use of these simple preliminary tests, lowers the time spent in a nursing home by an average of 1.5 years.
The expected costs of each diagnosis is $2,530, which pales in comparison to the cost of the traditional diagnosis protocol of $5700 and even more so the cost of Alzheimer’s progressing with no intervention. In addition to the obvious human costs of Alzheimer’s, there are large fiscal costs associated with the disease. Even conservative estimates of the cost of the illness in the U.S. exceed two hundred billion dollars annually. AD patients incur costs 60% higher than those of non-AD patients in the Medicare program. Individuals with AD are also more likely than their non-AD counterparts to be placed in a nursing home facility, which make up 34.6% of state Medicaid spending nationwide.
The replication of Wisconsin’s policy in Massachusetts could potentially save the state millions in Medicaid costs. The positive results experienced in Wisconsin would only be multiplied in Massachusetts where Medicaid expenditures spent on long term care reached $4.63 billion in 2015, 2.5 times larger than Wisconsin’s.