Blue Zones, Dementia, and Staying Home

I binge watched the Netflix limited series on Friday night called “Live to 100. Secrets of the Blue Zones.” Dan Buettner takes viewers on a virtual trip to the five international geographic regions to get a sense of everyday life of the oldest residents, their families, and their communities.

By the end of the second episode, I was proclaiming to my boyfriend that value-based care isn’t necessary if we can just create Blue Zones.

Not so simple or even possible to even partially recreate something that developed accidentally. But it sure injected me with optimism!

Then Dan Buettner did just that in Albert Lea, MN. In 18 months of working with the city on modifying the environment in which its residents lived, life expectancy went up by 3.2 years, the community lost 7280 pounds, and health care costs dropped 40%. 

He writes about his research, travels, and work “recreating” these communities in the American Journal of Lifestyle Medicine:

TL;DR:

Here are the nine evidence-based common denominators (in the authors’ words) found in the centenarians living in these 5 areas of the world where centenarians are most concentrated:

• Move naturally

• Purpose

• Downshift

• 80% rule

• Plant slant

• Wine at 5

• Belong

• Loved ones first

• Right tribe

From the article’s abstract:

The series is a few hours of commitment, but I thought it was worth the screen time. If you want to nerd out more on Blue Zones, you can also check out Dan Buettner in this 20 minute interview here:

Okay, Blue Zones are remarkable, but what do Blue Zones and dementia have to do with each other?

The researchers have found that dementia is rare in the Blue Zones, while in America, 50% of people over age 50 have signs of Alzheimer’s Disease.

“But Dana, the GUIDE Model (which stands for “Guiding an Improved Dementia Experience”) is for individuals (and their caregivers, if they have them) living in home settings who already have dementia! What’s your point?”

First, but out of scope for this article, the Blue Zone researchers’ blog article linked above reports that dementia can be slowed with a shift to the Mediterranean diet and other lifestyle modifications. Maybe GUIDE program participants and partners will explore this and share it with the beneficiaries and their caregivers who volunteer to join their program! I digress..

Here’s the connection I intended to make:

With the GUIDE Model, The Innovation Center is using a policy lever to improve the environments and provide support, education, and respite for those living with dementia and who have Medicare fee-for-service as their primary insurance.

They are testing whether incentivizing participants and their partner organizations can use the program requirements in innovative ways, with a wide range of partner options, to reduce the frequency of community-dwelling (including assisted living) individuals with dementia presenting in the emergency room, admitted to acute care settings, and transitioning to skilled nursing facility and other post-acute inpatient settings.

They are also testing whether the model delays and/or reduces the incidence of patients moving into long-term care settings.

Ultimately, they hope that the GUIDE Model reduces total lifetime cost of care per beneficiary living with dementia.

CMS will be paying for Participant Providers (who will develop downstream contracts with Partner Organizations) to provide the following to their patients in the program:

• 24/7 access to a helpline

• Comprehensive Assessments

• Care Planning and Ongoing Monitoring and Support

• Referral and Support Coordination

• Caregiver Support

• Medication Management

• Care Coordination and Transition Management

• Up to $2500/year in respite services to give caregivers a rest from caregiving

It’s not a far leap to take to say the Centers for Medicare and Medicaid (CMS) are also acknowledging that treatment for those with dementia is limited compared to many long term chronic, life-limiting illnesses. Health care spend and quality of life cannot usually be meaningfully reduced through means commonly applied to other chronic illnesses like congestive heart failure, diabetes, and chronic obstructive pulmonary disease.

Those living with dementia commonly access acute care services secondary to behaviors they and/or their caregivers cannot easily control or the results of those behaviors.

It’s a disease where improved communication, connection, support, and environmental optimization between care teams, patients, and their caregivers can hopefully improve day-to-day lives of those suffering with dementia and reduce the reliance on acute and post-acute settings of care that can do little to change the trajectory of the disease.

In traditional fee-for-service care, there are no billing codes for these services.

So the Innovation Center is creating them for use in the GUIDE Model.

In Part II of this newsletter later this week, I will share a high-level summary of the GUIDE Model and what types of clinicians and organizations may make successful participants and partners.

Participating Provider applications will be available sometime in November, and potential contracting partnering organizations (adult day care facilities, assisted living facilities, Medicare B rehabilitation providers, home health agencies, home care agencies, and more) should start thinking about how and when they may consider possible options to participate.

Signing off for now, and hoping you tune in to Part II!

All the best,

Dana