Dementia-Capable Care Coordination in Duals Demonstration Programs: Workforce Needs, Promising Practices, and Policy

Area of Science:

• Health Services Research
• Gerontology
• Public Health Policy

Background:

• Dementia-capable care coordination is crucial for dual-eligible Medicare and Medicaid beneficiaries.
• Seven states participated in Center for Medicare and Medicaid Services demonstration programs to improve care for this population.

Purpose of the Study:

• To identify program requirements, workforce competencies, and barriers to dementia-capable care coordination in health plans.
• To analyze policies and practices within state demonstration programs for dually-eligible beneficiaries.

Main Methods:

• Analysis of contracts and policy documents from seven states.
• Conducted 24 semistructured interviews with national experts and stakeholders.

Main Results:

• Contracts mandated dementia-capable practices, but consistency across states was low.
• Informants raised concerns about the dementia capability of the care coordination workforce and practices.
• Promising practices and areas for improvement were identified despite inconsistencies.

Conclusions:

• Variability in state demonstrations complicated cross-state comparisons.
• Three-way contracts initiated policy refinement, including workforce requirements.
• Further adoption of evidence-based practices and evaluation of promising approaches are recommended.