Systems Delivery Innovation for Alzheimer Disease

Am J Geriatr Psychiatry. 2019 Feb;27(2):149-161. doi: 10.1016/j.jagp.2018.09.015. Epub 2018 Sep 28.


Objective: The authors describe a comprehensive care model for Alzheimer disease (AD) that improves value within 1-3 years after implementation by leveraging targeted outpatient chronic care management, cognitively protective acute care, and timely caregiver support.

Methods: Using current best evidence, expert opinion, and macroeconomic modeling, the authors designed a comprehensive care model for AD that improves the quality of care while reducing total per capita healthcare spending by more than 15%. Cost savings were measured as reduced spending by payers. Cost estimates were derived from medical literature and national databases, including both public and private U.S. payers. All estimates reflect the value in 2015 dollars using a consumer price index inflation calculator. Outcome estimates were determined at year 2, accounting for implementation and steady-state intervention costs.

Results: After accounting for implementation and recurring operating costs of approximately $9.5 billion, estimated net cost savings of between $13 and $41 billion can be accomplished concurrently with improvements in quality and experience of coordinated chronic care ($0.01-$6.8 billion), cognitively protective acute care ($8.7-$26.6 billion), timely caregiver support ($4.3-$7.5 billion), and caregiver efficiency ($4.1-$7.2 billion).

Conclusion: A high-value care model for AD may improve the experience of patients with AD while significantly lowering costs.

Keywords: Alzheimer disease; Care design; care delivery; healthcare policy; high-value care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Alzheimer Disease / complications
  • Alzheimer Disease / economics
  • Alzheimer Disease / therapy*
  • Ambulatory Care / economics
  • Ambulatory Care / organization & administration*
  • Caregivers*
  • Delirium / economics
  • Delirium / etiology
  • Delirium / therapy*
  • Delivery of Health Care / economics
  • Delivery of Health Care / organization & administration*
  • Family*
  • Humans
  • Organizational Innovation
  • Primary Health Care / economics
  • Primary Health Care / organization & administration*