Enhancing Early Detection of Dementia in Primary Care with the GSA KAER Framework Preview

so there was this unmet need back in uh 2013 is CMS actually approached GSA and they said people aren't using the annual Wellness visit and surpris 10 years later guess what they're still really not right so so well um but anyway we know that a big part of that annual Wellness visit is to screen for impaired cognition and to detect um impaired cognition earlier and so GSA did what GSA does well and that's pulled together a work group and in that work group um they addressed what they called there's a quote here from that from the white paper that the work group put out where they said it's really a frequent but overlooked um over frequently overlooked Gap in in care for our aging population and that is where we're looking at we're really missing the boat on detecting early um impaired cognition and often the answer particularly back then was why do we want to find it early anyway what can we do anyway way and we know we certainly know a lot more now that we can there's disease modifying treatments for a small part of that population but there's also a lot we can do to wrap people in supports and services to keep them chugging along well in the community Carolyn's going to tell you about the risk-based approach to that when we get to that section of the kit but out of this um white paper this um framework was born and it's called care K AE R for Kickstart the brain health conversation a test for cognitive impairment evaluate for dementia and refer for Community Services again recognizing the importance of enveloping the individual and their family and supports and services and so from that that white paper came out in 2015 in 2017 the first care kit for brain health or what we call um care toolkit for Primary Care teams was launched in 2020 it was updated to become a much more online streamline version and then in 2022 it actually started in 2021 developing a care toolkit for obesity and older adults when you think about brain health or demena obesity there's a lot of similarities nobody wants to talk about either of these topics right providers are pretty ill-prepared in many cases to address either of them and frankly if you can assess and get to individualized care and refer for supports and services in both cases you can do a lot better for outcomes so we did launch a care toolkit for obesity the half of my time that I'm not spending on brain health I spend leading that work I love that work I'm very very proud of gsa's footprint and that work and so our care tool kit is an online format it's it's a compilation of the best of the best of tools most of the stuff in this is not our stuff we're linking out to all the research based stuff that is out there our work group came together and um you're going to see who our our Superstar work group is in a minute and they really focused on these are what we think are the best we often get the question of what should I do in my practice and the bottom line is you guys all know this if you've seen one practice you've seen one practice right you've got to figure out based on resources and availability and patient load and all of the different things going on in that practice figure out what's really best for you there are in each section and there's four main sections one to go with each letter I'm going to move this I'm looking through that it's going to be like above your head yeah all right um so there are key sections for each and every um key takeaways I mean for each one there's a section on ways to get paid for care-based care and we're going to talk more about that in a moment include information about how to effectively communicate for older adults you guys if you put in a um abstract at all from for this conference you would have seen a single page of information from reframing aging that's all about using person first information about older adults GSA is the national convenor for the national initiative to reframe aging all of that information you can link to our website but I was delighted when I opened up the call for proposals for Gap I'm like they're using this stuff this is awesome but it is all about reframing and getting rid of the silver tsunami and the Doom and Gloom and instead we're all aging and we're all getting older and we're making it a better place for all of us as we age um so there is some of that in the care kit and we certainly refer back and again we have tables and Exhibits it's all linking out to the best of the best and we do have some additional resources that Branch off basically everything in my world goes back to one care kit or the other and so the care framework I already told you about and really it is this idea of a supportive document of practical approaches clinical resources validated clinical tools and the primary audience for this is primary care teams with the the idea that no Primary Care team is going to take it and put it all into place today but the idea is that they're going to take it choose what approaches work well and then Implement them in their practice um I do some training in collaboration with the Alzheimer's Health System folks around care and I had one group who is in a a federally qualified Health Center and they were like we just need our docs to start asking a question we're not even talking about brain health where others are far more advanced in that and they're really ready to put in much more um robust practices and things but really the idea is that the the primary care is the principal audience but we know that many different audiences can use this case workers in the community are someone that really gets a hold of this and enjoys this um I will tell you that in the future development we have uh in the works right now it's actually with our review panel um we have in the works a care companion for the idd population we recognize that um there are individuals in the ID population that reach a certain certain age and they are diagnosed over the phone by someone who says oh they have Alzheimer's because they're a certain age so clearly there's a great opportunity to do better and we're really excited about that uh that will launch in the end of November and here's our awesome workg group um we have Amy bow and Allison Lee from the Alzheimer's Association Dr Clevenger and her colleague uh Laura Mets Laura is my social worker friend I have to say I love her she's the most amazing lady one of them that I've ever met I think she and I recently did a podcast with one of other patients um one of their patients wives to tell the story of someone's trajectory with Alzheimer's it was amazingly powerful I was the crying blubbering Idiot by the time I was done talking to them we have Diane Thai from The milen Institute Bonnie Burman from the Ohio Council for cognitive Health if you have not checked out their resources they are incredible they're doing amazing collaborative stuff in Ohio uh we have chash and Sue Boron who lead the um bold Center on um early detection and then we have Fred Ketchum uh who is out at the University of Wisconsin who's a neurologist a terrific guy and so we do have a section as I mentioned on getting paid for care now we did a pre-conference last year before the GSA annual scientific meeting Carolyn talked about how to get paid for care-based care and I will tell you there was a gasp in the room they are not getting it right like she is getting it right out there so Carolyn's going to take it away and tell you some of her practice pearls all right then yeah that sounds better okay so we uh we did talk about how to get paid uh we're going to start talking through um so one of the reasons we get really Scrappy about getting paid is because integrated memory care or IMC is a nurse-led practice it's a startup we're able to incubate in a large health system at Emory Healthcare which is wonderful but we got to make sure we're doing good care and that we're getting paid for the care we do um and I will give a shout out to the American nurses Foundation who funded us to do this focus on Direct reimbursement for nurses and we mean all the nurses in the practice not just the nurse practitioners so um because we' been doing that now we've been open eight years we figured out we were pretty Scrappy um about making sure we're paying attention to our billing codes and saying on top of things so um I'm going to start with this sort of first idea that uh just to remind all of us this was something I learned I used to share this one with a lot of our students this DX before TX this was a license plate somebody had the idea is that you know how do you how are you um prescribing or implementing a treatment plan if you haven't really done a good job understanding what we're treating so that's where we're going to start and then also end this process with the best diagnosis that you can so there's a big focus of course on timely and accurate diagnosis at this point I think this is Is gapna We I hope I'm preaching to the choir but you know other people have have these questions for us right um which is why are we pursuing this there's quote nothing we can do you know last time I checked there are not CES for a lot of things but we still tell people what's wrong with them