Lessons learned from the Medicare Alzheimer Disease Demonstration.

The Medicare Alzheimer Disease Demonstration tested a case management and community care benefit for persons with dementia. The demonstration produced statistically but not clinically significant reductions in caregiver burden and depression. It increased access to community-based long-term care services but did not affect the level of services used.

Effects of the Medicare Alzheimer's Disease Demonstration on caregiver burden and depression.

Study Question: Does improved access to community-based care reduce perceived burden and reported levels of depression among primary caregivers of people with dementia?

Data Sources: Baseline and periodic caregiver interviews with participants in the Medicare Alzheimer's Disease Demonstration. Client and caregiver attributes and caregiver outcomes such as depression and burden scores were among the measures.

Study Design: Applicants to the demonstration (all voluntary) were randomly assigned into treatment and control groups.

Effects of the Medicare Alzheimer's Disease Demonstration on the use of community-based services.

Study Question: Did the Medicare Alzheimer's Disease Demonstration with its case management and community service waivers affect the use of community-based long-term care services among people with dementia and their primary caregivers?

Data Sources: Baseline and periodic caregiver interviews. Measures include client and caregiver attributes and self-reported service use.

Study Design: The demonstration randomly assigned voluntary applicants into treatment and control groups.

Caregiver supports: outcomes from the Medicare Alzheimer's disease demonstration.

A randomized 3-year study assessed the effect of expanded community-based services and case management on 5,254 caregivers of dementia clients. A tested policy concern was whether the financing of formal care would result in a reduction of informal assistance. Unmet needs task assistance for the demonstration's treatment group caregivers decreased by 30 percent within 6 months and by about 20 percent over 36 months relative to controls.

Case mix controlled service use and expenditures in the social/health maintenance organization demonstration.

Background: The social health maintenance organization (S/HMO) demonstration was implemented, in part, to determine if the presumed integration of acute and chronic care in these plans could produce sufficient savings to allow plans to offer expanded and chronic care benefits without increased cost to the Medicare program.

Methods: S/HMO members and a sample of fee-for-service (FFS) recipients were tracked over three years to assess their utilization experience. Analyses controlled for case mix, using Grade of Membership procedures.