Practice Management

Tools for Supporting
Brain Health Services in Primary Care

Payment Opportunities
Aligned With KAER Framework Services

Tools for Supporting Brain Health Services in Primary Care

Health system capacity across the United States to detect, diagnose, and treat dementia is variable (Liu, 2024). In many areas, there is a need for primary care providers to expand their capacity to detect and diagnose dementia in order to meet the needs of the aging population (Liu, 2024). Many initiatives that are intended to provide supports for practice change to address these needs have been developed and are underway. However, primary care providers are often extremely busy and may find it difficult to implement new processes and protocols within their practices. In this section, we review selected programs and resources for primary care teams as they seek to expand their ability to deliver these services to help ensure adults receive brain health services that enhance quality of life and well-being.

Davos Alzheimer's Collaborative

The Davos Alzheimer’s Collaborative (DAC) fosters the implementation and evaluation of interventions in health systems that support healthy brain initiatives, including improved detection of dementia as well as diagnosis and coordination of comprehensive dementia care (Ball, 2022). DAC has developed a blueprint and resources to (1) plan, (2) implement, and (3) monitor and evaluate an early detection program for cognitive impairment. This blueprint is intended for health care providers and administrators, health care organizations, and health care systems. Each step of the blueprint identifies actions to take; many steps are accompanied by additional resources.

Cognition in Primary Care

Cognition in Primary Care is a program designed to facilitate detection of cognitive impairment and improve care for people with dementia. In addition to offering educational sessions and resources, Cognition in Primary Care provides several Clinical Tools, including workflow resources, tools for electronic health records (EHRs), and tools for caring for people with dementia. For example, adding relevant questions and protocols for screening and follow-up to EHRs is an important strategy to streamline and facilitate the delivery of brain health services. The clinical tools from Cognition in Primary Care include checklists for incorporating memory evaluations in EHRs.

AGREEDementia

The Advisory Group on Risk Evidence Education for Dementia (AGREEDementia) provides a wide range of educational materials and resources, including decision tools, links to guidelines, treatment resources, communication tools, consent forms, and other relevant materials.

Payment Opportunities Aligned With KAER Framework Services

Time is a valuable commodity for primary care providers as well as other health care team members. Compensation is integral in supporting staffing levels and infrastructure for appropriate care and for services to be viable and sustainable. Many potential strategies to obtain payment for services are aligned with the KAER framework, and payment opportunities are constantly evolving due to legal, regulatory, and administrative updates. Appropriate documentation in the EHR can help facilitate billing for processes associated with the KAER framework. 

Payment Resources

GSA has developed an informative podcast episode highlighting best practices for documentation and billing in the primary care setting titled Reimbursement as a Pathway for Quality Dementia Care.

USAgainstAlzheimers has published a comprehensive document detailing primary prevention recommendations to reduce the risk of cognitive decline that includes recommended billing codes for primary care providers.

CMS Payment Information

Many patients who receive cognitive services are Medicare and/or Medicaid beneficiaries with coverage for outpatient services. There are specific codes that should be used for providing care to adults with cognitive impairment, including the International Classification of Diseases (ICD-10) codes for different types of dementia and Current Procedural Terminology (CPT) codes for various services, ranging from assessments to care planning. The Centers for Medicare & Medicaid Services (CMS) provides information about payment for cognitive assessment and care plan services and chronic care management services. 

Compensation for a wide range of services aligned with the KAER framework may also be available through CMS’s alternative payment models, which provide incentive payments for the provision of high-quality and cost-efficient care and are run by the CMS Innovation Center. A variety of models are available, and new models continue to be developed. For example, the Guiding an Improved Dementia Experience (GUIDE) Model is a new CMS program launching in July 2024 that supports the delivery of care services for individuals with dementia. CMS provides an FAQ webpage that lists specific requirements and other details for participants in the GUIDE program.

Quality Measures

Health care teams should consider how KAER-related clinical processes align with the clinical quality measures in federal programs such as the Merit-based Incentive Payment System (MIPS) and payment models such as Primary Care First. To learn more, visit the CMS Quality Payment Program. 

References: Practice Management

Ball DE, Mattke S, Frank L, et al. A framework for addressing Alzheimer’s disease: without a frame, the work has no aim. Alzheimers Dement. 2023;19(4):1568–1578. doi: 10.1002/alz.12869 

Liu JL, Baker L, Chen A, et al. Modeling Early Detection and Geographic Variation in Health System Capacity for Alzheimer’s Disease–Modifying Therapies. Rand Corporation. January 30, 2024. https://www.rand.org/pubs/research_reports/RRA2643-1.html