National plan on Alzheimer’s disease takes shape

Members of an advisory council on Alzheimer’s disease met to set goals and identify recommendations for a national strategic plan to slow or even halt the expected rise in new cases.

The plan aims to prevent and effectively treat the disease by 2025 and is part of the National Alzheimer’s Project Act that was signed into a law on Jan. 2, 2011, by President Obama. The law established the Advisory Council on Alzheimer’s Research, Care, and Services and requires the secretary of the Department of Health and Human Services and the advisory council to create and maintain a national plan to overcome Alzheimer’s disease.

Clinical care of Alzheimer’s disease

A clinical care subgroup at the meeting noted the importance of ensuring that individuals with Alzheimer’s have their disease detected and diagnosed at an early stage, receive care planning, and have access to coordinated and high-quality health care throughout the course of the disease.

In particular, members recommended changes to Medicare coverage and physician reimbursement to encourage the diagnosis of Alzheimer’s disease and to provide care planning to diagnose individuals and their caregivers. In addition, quality indicators for the care and treatment of individuals with Alzheimer’s should be developed. The subgroup proposed medical home pilot projects targeted at improving medical management for individuals with Alzheimer’s using grants from the Center for Medicare and Medical Innovation (CMMI).

The subgroup also recommended addressing palliative care by forming a blue-ribbon panel of experts to recommend one or more models of care for people with advancing dementia, which would cover eligibility criteria and financing mechanisms. CMMI also could be tapped to supply grants to implementing these models.

Pilot projects to reduce potentially preventable emergency department visits and hospitalizations for individuals with Alzheimer’s were also advised and could be funded through CMMI. Furthermore, public-private partnerships could help develop and evaluate ways to improve hospital care for people with Alzheimer’s and other dementias.

Research goals

The research subgroup identified three key strategies for preventing, treating, and delaying the progression of Alzheimer’s disease:

• Aggressively committing resources, with  accountability, to Alzheimer’s disease research to match the current and growing impact of the disease on society.

• Accelerating public access to new therapeutic interventions by compressing the current average time of identifying and validating therapeutic targets and developing and testing the efficacy and safety of interventions.

• Exploring the possibility of providing incentives to private industry to invest in disease modifying interventions by convening a panel of experts from private industry to help determine the nature of possible incentives that would accelerate  discovery. These may include tax reform or incentives to drive greater investment, patent law reform to include pharmaceutical incentives, and enhanced market exclusivity.

Long-term services and supports

Members of the council’s subgroup on long-term services and support (LTSS) recommended that new guidelines for diagnosis be used whenever someone is admitted for LTSS or assessed for eligibility. The process of diagnosis also should include engaging the patient and family in advance care planning. End of life considerations should be incorporated into all surveillance and quality indicators.

Council members recommended that federal funds be made available to support a lead agency in every state to coordinate all available LTSS provided through various public and private mechanisms.