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How Dementia Care is Reshaping Population Health Strategy · Becker’s Healthcare Podcast

• 0:00
  Hello and welcome to the Becker's Healthcare podcast.
• 0:02
  My name is Chanel Banger. And today we're
• 0:04
  gonna talk about how dementia care is reshaping
• 0:07
  population health strategy,
• 0:08
  exploring its growing impact on health care costs,
• 0:11
  the critical role of family caregivers,
• 0:14
  and what payers can do to improve outcomes
• 0:16
  while managing affordability.
• 0:18
  Joining me for today's discussion is Dirk Sonksen,
• 0:22
  CEO of Seresti Health. Dirk, thank you so
• 0:24
  much for joining me today. It's nice to
• 0:26
  be here, Chanel. Perfect. Well, to get us
• 0:28
  started out, could you please introduce yourself and
• 0:30
  share a little bit about your work in
• 0:32
  health care? Yeah. So, you know, I've been
• 0:34
  in health care for, like, forty years. I
• 0:36
  built a medical device company,
• 0:39
  engineer by training. And about a decade ago,
• 0:42
  we committed ourselves to
• 0:44
  solving the problem of how to improve the
• 0:46
  experience of living with dementia in the home.
• 0:49
  Perfect. And now that we have a sense
• 0:50
  of your background, we'll get into the discussion
• 0:52
  a bit. So dementia is one of the
• 0:55
  fastest growing cost drivers in Medicare populations,
• 0:58
  yet organizations still lack a formal strategy for
• 1:00
  it. Why is that? Yeah. So it's,
• 1:04
  I I think you could think about this
• 1:05
  as two problems.
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  One is you wouldn't have a strategy
• 1:10
  for a problem that you didn't recognize.
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  So the first challenge is,
• 1:15
  can you recognize the problem?
• 1:17
  And
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  health care organizations,
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  payers,
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  typically don't think of dementia as a condition
• 1:23
  that you can impact. So they think about
• 1:25
  diabetes. They think about the normal chronic conditions,
• 1:27
  COPD, CHF.
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  And then when you think about dementia, this
• 1:31
  doesn't make the top list.
• 1:33
  And we've talked to many people who are
• 1:35
  executives in health plans that say nobody's ever
• 1:37
  brought me dementia
• 1:39
  as a top shelf problem.
• 1:41
  So that's one of the one of the
• 1:43
  challenges.
• 1:44
  The reality is it's the second most expensive
• 1:47
  condition, Chanel, in Medicare,
• 1:50
  and it's actually impactable.
• 1:52
  Right? Now the other thing is if your
• 1:53
  health plan said, well, if you bring me
• 1:56
  dementia,
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  what do you want me to do?
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  Like, there's no treatment. Like, all these other
• 2:00
  conditions, I can give a drug or maybe
• 2:03
  some treatment. There's no treatment for dementia.
• 2:05
  So I think part of it is they
• 2:07
  don't know how to find the problem,
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  and then there's a belief there's nothing you
• 2:11
  can do.
• 2:12
  And the reality, and we'll get maybe more
• 2:14
  into this, is that the tool that health
• 2:16
  plans have in their toolbox, which is called
• 2:18
  care management,
• 2:20
  does not work for dementia.
• 2:21
  This is sort of something you gotta think
• 2:23
  about more deeply, but,
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  and I'm sure your questions will take me
• 2:26
  there. But I think the fundamental reason people
• 2:29
  are not looking at this as a problem
• 2:31
  is they can't identify it as a problem.
• 2:34
  It's easily identified in claims data if you
• 2:36
  know where to look. And then they don't
• 2:38
  have the belief that they can impact it.
• 2:41
  Got it. Got it. And now you mentioned
• 2:43
  the financial aspects of dementia.
• 2:45
  So let's stick with economics here, Dirk. Health
• 2:48
  plans are facing immense affordability pressure right now.
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  Margins are shrinking. Medical costs are rising, and
• 2:54
  future guidance from CMS has been concerning plan
• 2:57
  leadership.
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  What do these plan leaders need to know
• 3:00
  regarding how dementia affects their medical costs and
• 3:02
  MLR,
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  and what levers can Seresti help them pull
• 3:06
  to improve affordability?
• 3:08
  Yeah. So let's first of all focus on,
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  like, what is the impact of dementia on
• 3:14
  costs?
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  So if you just sort of think about,
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  like, well,
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  why is dementia expensive?
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  It's largely expensive because the person who has
• 3:23
  it loses the ability to self manage their
• 3:26
  health.
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  So, I mean, somebody who has congestive heart
• 3:29
  failure may forget to take their medications.
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  Somebody
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  who has diabetes may not understand anymore how
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  to interpret,
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  you know, a glucose measurement.
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  So the inability to self manage, if you
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  have a cut and you don't see that
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  as becoming infected, it can become septic.
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  So the reason dementia is expensive is because
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  the inability to self manage
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  leads to
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  hospitalizations for what? Unmanaged chronic conditions,
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  infections
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  that get out of control,
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  and falls. Mhmm. So that's the multiplier effect.
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  And if you look at hospitalization
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  rates
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  and you do sort of a matched comparison
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  group,
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  you will see that people who have dementia
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  and they have another chronic condition will have
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  a three to five times multiplier
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  in terms of hospitalization rate and follow on
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  costs.
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  This is all related to the inability to
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  self manage.
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  So once you sort of recognize that self
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  management is the root cause
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  of the cost, you sort of say, well,
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  how do I impact that?
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  One thing I'll tell you is engaging somebody
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  who can't self manage in care management
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  is not very fruitful.
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  Right? Because you're gonna call them and say,
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  hey. Chanel, we talked yesterday about you taking
• 4:39
  your medications.
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  And they might say, well, who are you?
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  And I don't remember.
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  So this then naturally leads to, well, who
• 4:47
  could step in to help the person with
• 4:49
  dementia self manage? And the most natural person
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  to do that is a family caregiver.
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  Right? So that's the lever that we really
• 4:56
  think is,
• 4:58
  the most impactful lever to get better outcomes
• 5:00
  for people living with dementia.
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  Absolutely. And now sticking to the subject of
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  family caregivers,
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  they often become the real decision makers in
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  dementia care.
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  What changes when healthcare organizations start treating caregivers
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  as part of their care team rather than
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  informal support?
• 5:17
  Yeah. So maybe
• 5:18
  the best I'll I'll give an example on
• 5:21
  the traditional Medicare side. So
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  CMMI, the Center for Medicare Medicaid Innovation,
• 5:27
  Chanel, stood stood up a program called the
• 5:30
  Guide Model.
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  It's only intended for traditional Medicare. So if
• 5:33
  you're on on Medicare Advantage, you're not eligible
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  for the guide model.
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  But this model is really an evidence based
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  model for dementia,
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  including the family caregiver and the care team
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  is a requirement.
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  Providing respite to the family caregiver
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  is a requirement.
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  Making the caregiver sort of part of the
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  care team
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  is a requirement.
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  Right? So this is really the way to
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  to think about providing evidence based dementia care.
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  And it essentially means you're taking the person
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  who can step into the shoes of the
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  person who can self manage, who can take
• 6:06
  over giving them medications,
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  taking them to the doctor,
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  reporting early signs
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  of changes in condition.
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  So that caregiver can have a huge impact
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  once they develop the knowledge,
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  the skills, and the confidence
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  for how to engage the health care system
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  really on behalf of their loved one who's
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  lost that ability by virtue of having dementia.
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  Absolutely.
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  And now switching gears a bit here. You
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  know, Dirk, a lot of organizations approach payers
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  with the promise of savings. Is there any
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  evidence that validates the impact family caregivers can
• 6:41
  have and the savings it can generate for
• 6:43
  plans?
• 6:45
  Yeah. So it is very true. Right? I
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  think
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  health plans in particular
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  are bombarded
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  with vendors.
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  And, you know, we represent a vendor who
• 6:54
  come and say, I can save you a
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  bunch of money.
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  My thinking is they just sort of dismiss
• 7:00
  it like, it's just another person telling me
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  I can save a bunch of money. Right?
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  So then you sort of say, well, what
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  would you have to show somebody to to
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  sort of get some credibility?
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  So, you know, my question if I was
• 7:11
  a health plan leader, I said, well, show
• 7:13
  me some data. Show me some studies.
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  What have you done? What kind of a
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  study did you do?
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  Is there a comparison group? So if you
• 7:20
  tell me you achieved something
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  right? Because think about it. If you're trying
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  to say I avoided hospitalizations,
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  it's like, how do you count something that
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  never happened? So you have to have an
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  approach
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  that sort of says, well, look, if I
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  compare myself against the group and they look
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  like the people that are in my program,
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  the people in the comparison group go to
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  the hospital, the people in my program don't,
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  I can sort of say, look, I probably
• 7:43
  caused that.
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  So having a robust study design
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  is essential,
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  and then having results
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  that achieve statistical significance,
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  p value less than point zero five. Right?
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  People would say, okay, Now I have some
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  belief that this is not just luck,
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  but that this is actually credible. Right? So
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  having more studies
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  and having statistically significant results, more people,
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  right, maybe
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  validated by somebody or published. Right? That gives
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  you the sense of credibility.
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  And, of course, the ultimate thing you can
• 8:17
  do is you can put your money where
• 8:19
  your mouth doesn't take risk. Says, look, not
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  only can I achieve cost savings,
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  but I actually guarantee them to you?
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  Right? So I think I'm just sort of
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  stating the obvious. Right? But you have to
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  come with credible studies. You have to have
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  statistically significant results.
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  And you really have to have a willingness
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  to put your money where your mouth is.
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  So in the case of Seresti, we have
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  done that. Right? We have three studies.
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  We've been sort of, I would say, auth
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  authorized by multiple actuarial teams who have looked
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  at our results, says, yes. These are real.
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  We've gotten paid when we take risk.
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  So we do believe this is the case.
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  There are now more and more studies that
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  prove cost savings of about $6,000
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  per patient per year. They're all in that
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  ballpark, 6 to $7,000.
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  Some of them are academic studies. So I
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  think there's a growing base of evidence.
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  It's not only the works that Rusty has
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  done, but there's others.
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  And I think we're at the point where
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  people are gonna say, yeah. You know, this
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  can't, like, all be false if you have,
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  you know, several peer reviewed publications all kind
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  of indicating that this is the magnitude of
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  cost savings.
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  Hypothetically, if the industry gets dementia care right
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  over the next five years,
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  what does the care model look like for
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  payers and caregivers?
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  And what's the biggest structural barrier standing between
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  where we are today and that vision?
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  It goes back to
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  recognizing the problem.
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  Because
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  think about it, you are not gonna spend
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  money on something, like, I don't have that
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  problem. Right? So we can counter people who,
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  I won't say deny the problem, but who,
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  like, who haven't looked or don't know how
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  to look.
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  So I think,
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  ultimately, the solution is
• 10:01
  there's a model of care, which is an
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  add on to
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  current care management. Current care management is direct
• 10:10
  to member or direct to patient.
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  And I would just say that's kind of
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  what care management is today. So if you
• 10:16
  talk to any care management organization,
• 10:18
  they've been doing this for thirty years. They
• 10:21
  kinda know this is what this looks like.
• 10:23
  And then when it comes to dementia care,
• 10:24
  I would say you cannot effectively engage somebody
• 10:27
  with dementia in a program.
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  This is not, like, obvious.
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  So when we talk with
• 10:33
  organizations, many times we're having to kind of
• 10:35
  get them to think about it, like, yeah,
• 10:37
  like, how would I do that? If the
• 10:38
  person can't remember me from day to day,
• 10:40
  how am I gonna engage them? Of course,
• 10:42
  some people are earlier and they would remember.
• 10:44
  Right? So it's sort of a a slope.
• 10:47
  But I believe that the model of care
• 10:50
  in the future is that if you're in
• 10:52
  this business
• 10:53
  of trying to manage care,
• 10:56
  you need to be able to manage
• 10:57
  members directly.
• 10:59
  You need to be able to manage members
• 11:01
  who have conditions where they rely on a
• 11:02
  caregiver.
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  Dementia is a great example.
• 11:06
  You know, we would suggest this is something
• 11:08
  that maybe folks should consider outsourcing.
• 11:10
  But if they try to do this themselves,
• 11:12
  you have to then say, okay. I'm gonna
• 11:14
  build a
• 11:15
  high touch, longitudinal
• 11:17
  relationship with a family caregiver.
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  Dementia could be one condition. There's other conditions
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  where people rely on a caregiver,
• 11:25
  advanced stroke, Parkinson's,
• 11:27
  traumatic brain injury.
• 11:28
  And so in my and by the way,
• 11:30
  dementia drives twenty percent of the total cost
• 11:32
  of care. Collectively,
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  people who rely on caregivers probably drive one
• 11:36
  third of health care costs,
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  but yet
• 11:39
  very few health plans
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  recognize that as an opportunity.
• 11:43
  So
• 11:44
  given where we are today in terms of
• 11:46
  cost pressures,
• 11:48
  how can you ignore,
• 11:50
  right,
• 11:51
  a 20 to 30% total cost to care
• 11:53
  opportunity and say, well, I I don't have
• 11:55
  to under I don't have to do anything
• 11:57
  here. I don't think you can do that.
• 11:59
  The other thing I just wanna emphasize, we've
• 12:01
  been talking about cost savings, but particularly when
• 12:03
  it comes to dementia,
• 12:06
  the literature suggests that half of the people
• 12:08
  who have dementia have not been diagnosed.
• 12:11
  So what is the implication for health plan?
• 12:13
  That means
• 12:14
  that you you're providing care for a population
• 12:18
  that has dementia,
• 12:19
  and you're not capturing
• 12:22
  the benefits of the risk adjusted payment you
• 12:24
  get when somebody has that diagnosis.
• 12:27
  It's about $4,000
• 12:28
  a year.
• 12:29
  So health plans
• 12:31
  can help themselves by really trying to make
• 12:34
  sure that the recapture rates are high to
• 12:36
  maximize
• 12:38
  the payments they get to provide the care,
• 12:40
  and that they they sort of do everything
• 12:42
  they can to get people diagnosed in the
• 12:43
  first place
• 12:44
  so that they can kind of slot them
• 12:46
  into the appropriate level of care.
• 12:48
  Well, Derek, you have the attention of a
• 12:51
  lot of health care leaders from across the
• 12:53
  country right now. If you were gonna share
• 12:55
  some advice to health care organizations that are
• 12:58
  just starting to think about dementia as part
• 12:59
  of their population strategy,
• 13:01
  what would you say, and where should they
• 13:03
  start?
• 13:04
  I would say, come from the place of
• 13:07
  curiosity
• 13:08
  about the opportunity that better dementia care holds.
• 13:12
  All of us have these limiting beliefs. Right?
• 13:15
  We believe things.
• 13:16
  And I think when it comes to dementia,
• 13:18
  the belief is I don't have this problem,
• 13:20
  and I don't know how to solve the
• 13:22
  problem. I think if you came from a
• 13:23
  lens of curiosity and said, let me look
• 13:26
  at my data.
• 13:27
  Let me learn how to understand the impact
• 13:29
  of dementia.
• 13:30
  It's not hard. You can look in the
• 13:32
  literature. You can talk to us.
• 13:34
  And then you'd say, oh my gosh. This
• 13:36
  really is,
• 13:37
  like, one of the most expensive conditions I'm
• 13:40
  managing. There's literature that suggests it's the second
• 13:42
  most expensive condition in Medicare. How can you
• 13:45
  ignore a condition that's the second most expensive
• 13:48
  in your entire population?
• 13:50
  So that would be the first thing. Come
• 13:51
  from a place of curiosity.
• 13:53
  Be very sort of thoughtful about how effective
• 13:56
  your care management is today,
• 13:58
  and recognize that it's probably not
• 14:00
  well suited and optimized for people who can't
• 14:02
  self manage.
• 14:03
  And you sort of say, I have these
• 14:05
  folks. I can self manage them.
• 14:08
  I have immense opportunity
• 14:10
  to improve RAF accuracy and be paid for
• 14:12
  the care I'm already providing.
• 14:15
  Right? I I should go talk to people
• 14:17
  who've been doing this for a decade or
• 14:19
  longer.
• 14:20
  Right? That would be my advice. Just
• 14:22
  look around,
• 14:23
  come from a place of curiosity, ask some
• 14:26
  questions.
• 14:27
  And there's significant opportunity
• 14:29
  for cost savings in a world today where
• 14:32
  that's what we hear at this conference. Everybody's
• 14:33
  saying, I get my MLO under control. I
• 14:36
  have to make sure my revenue is balancing
• 14:37
  against the cost I'm providing, the session on
• 14:40
  the silver tsunami.
• 14:42
  The average prevalence today, Chanel, is six to
• 14:45
  eight percent.
• 14:47
  As the baby boomers age, that proportion is
• 14:49
  gonna go up to ten to twelve percent.
• 14:51
  Wow.
• 14:52
  These people cost three times what the average
• 14:54
  Medicare person costs. So you can't ignore this
• 14:58
  problem. It's gonna get worse every year.
• 15:00
  So why not
• 15:01
  look at solutions now so that you can
• 15:04
  get the benefits
• 15:05
  of saving money on these folks for the
• 15:08
  next few decades?
• 15:09
  Absolutely. Excellent advice. Well, Dirk, I wanna thank
• 15:12
  you for your time today. But before I
• 15:13
  let you go, is there anything else that
• 15:15
  listeners should know?
• 15:17
  No. Other than
• 15:18
  maybe maybe I just share, like, when we
• 15:20
  do this with families,
• 15:22
  like, the mission behind what we do at
• 15:24
  Seresti,
• 15:25
  got nothing to do with money.
• 15:28
  Right? When we hear the testimonies from our
• 15:30
  coaches,
• 15:32
  you recognize that you can make a life
• 15:34
  changing impact on people.
• 15:36
  And, yeah, it's great when you can say
• 15:37
  you can save money, you can get more
• 15:39
  revenue. Right? But the the challenges that families
• 15:42
  face when they have this condition
• 15:44
  is worse than anything. Right? So caregivers
• 15:47
  of people with dementia are the most burdened
• 15:49
  caregivers that exist.
• 15:51
  The stress is super high. The mental health
• 15:54
  of people who are caregivers is incredibly high.
• 15:57
  So you can measure all these sort of
• 15:59
  softer things,
• 16:00
  and then, you know, it makes you believe
• 16:02
  that
• 16:03
  no matter how much money you can save,
• 16:06
  this is sort of just the right thing
• 16:07
  to do. And what we find is people
• 16:09
  who have had experience with dementia, they get
• 16:11
  it,
• 16:12
  and they become very quick advocates.
• 16:15
  Got it. Well, that's a great note to
• 16:17
  take with us. Derek, I wanna thank you
• 16:18
  once again for your time today and for
• 16:20
  sharing your insights on the Becker's Healthcare podcast.
• 16:23
  We also wanna thank our podcast sponsor, Seresti
• 16:26
  Health. You can tune in to more podcasts
• 16:28
  from Becker's Healthcare by visiting our podcast page
• 16:30
  at beccarshospitalreview.com.
• 16:33
  Awesome. Thank you.