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

Abstract

Background and Objectives: This study describes the program requirements, workforce competencies, and barriers for dementia capable care coordination within health plans from seven states participating in the Center for Medicare and Medicaid Services demonstration programs for dually-eligible Medicare and Medicaid benefciaries. Research Design and Methods: Data came from contracts, policy documents, and 24 semistructured key informant interviews with national experts and leaders from community-based organizations, advocacy organizations, researchers, federal and state government, and health plans in the seven states. Results: Contracts included language mandating care coordination practices deemed dementia-capable, including workforce qualifcations, training, and experience; dementia screening; involvement of a caregiver in the care planning process; and education, support groups, and referral resources for people with dementia and their caregivers. There was little consistency across states in their dementia capable requirements and informants questioned the dementia capability of the care coordination workforce and practice. However, promising practices and areas for improvement were identifed. Discussion and Implications: The variability of the duals demonstrations made it diffcult to compare across states. The three-way contracts were often the starting point of a process to more clearly defne policies and practices in each state including workforce requirements. Efforts should be made to further adopt and translate evidence-based practices into health systems and evaluate promising practices.