The Centers for Medicare & Medicaid Services (CMS) recently introduced a groundbreaking initiative called the Guiding an Improved Dementia Experience (GUIDE) Model, aimed at enhancing care coordination for Medicare beneficiaries with dementia. The three primary goals of the model are:
- To improve the quality of life for individuals with dementia
- Reduce strain on unpaid caregivers
- Enable people to remain in their homes and communities, potentially delaying long-term nursing placements.
This initiative holds significant promise for improving the lives of those with dementia and their caregivers, encouraging interdisciplinary collaboration among healthcare providers and establishing a team-based approach to dementia care. It also emphasizes the importance of identifying and addressing social determinants of health (SDoH), promoting community-based support and offering respite services for caregivers.
Annual Wellness Visits
Annual wellness visits (AWV) play a pivotal role in this context, especially for Medicare beneficiaries as these exams are critical to ensuring improved outcomes for patients with dementia, mild cognitive impairment (MCI) and potentially a diagnosis of AD. These yearly assessments will also support appropriate prescribing for newly introduced, extremely expensive drugs for treating AD which are projected to cost Medicare up to 17.8 billion. For individuals, particularly those at risk of or already dealing with dementia, regular health check-ups provide an opportunity to monitor cognitive function, assess overall health and detect any early signs of cognitive decline. These check-ups enable healthcare professionals to intervene early, implement appropriate care strategies and provide valuable support to both the individual and their caregivers. By emphasizing the importance of AWV, physicians can improve early detection, coordination of care and quality of life for those living with dementia.
Unfortunately, a recent study showed that over 85% of Medicare AWV may fail to meet compliance requirements, underscoring the importance of maintaining rigorous adherence to these guidelines. Compliance with CMS requirements during AWV is vital not only as a matter of protocol but also for the overall quality of care provided to beneficiaries. It has far-reaching implications for healthcare providers and patients alike. By ensuring that AWV meet these standards, we can contribute to the success of coordinated care models like the GUIDE Model, further enhancing the lives of individuals with dementia and their caregivers.
Diagnosing AD After Dementia Diagnosis: Physicians are Supported by DISCERN™
With more compliance with AWV, physicians will be better prepared to detect cognitive changes in patients and begin a diagnostic pathway for detecting the cause of cognitive decline.
After receiving a dementia diagnosis, patients can complete a DISCERN test to identify if AD is the type of dementia impacting the patient’s symptoms. DISCERN is an easily accessible and accurate test for AD and is paid for by Medicare.
DISCERN is comprised of three different assays that assess several critical factors directly related to AD that regulate memory, the formation of synaptic connections among neurons, the levels of amyloid plaques and levels of neurofibrillary tangles in the brain. The DISCERN test is autopsy-validated versus the NIH Gold Standard definition of AD.
The established relationship between AD and the skin provides unique positioning for DISCERN which requires a minimally invasive, 3mm skin punch biopsy. The Morphometric Imaging (MI) assay is based on measuring an ensemble of multiple factors such as inflammation, synaptic growth and neuronal death that can be detected in skin fibroblasts. Complementary to the MI assay, the protein kinase C (PKCε) assay includes fibroblasts from the skin biopsy that are cultured and analyzed using enzyme-linked immunosorbent assays (ELISAs) to measure PKCε levels in relation to Aβ exposure in the brain. The AD-biomarker index also composes one of the three assays and tests skin fibroblasts from biopsies to culture to confluency.
* The DISCERN™ test was developed and its performance characteristics determined by NeuroDiagnostics Inc, dba Synaps Dx. It has not been cleared or approved by the U.S. Food and Drug Administration. NeuroDiagnostics, Inc. is regulated under the Clinical Laboratory Improvement Amendments (CLIA) as an accredited laboratory to perform high complexity clinical testing. The test is intended for patients with dementia. Test results should be interpreted in conjunction with other laboratory and clinical data available to the clinician. All rights reserved.