Kenton Johnston, PhD, an associate professor in the Division of General Internal Medicine, has received a $3.7 million, 5-year R01 grant from the National Institutes of Health to study Medicare and Medicaid special needs plans for individuals with intellectual disabilities (IDs).
The award, from the National Institute on Aging, will support Johnston’s project, “Can Integrated Dual-eligible Special Needs Plans Improve Health Outcomes for Adults with Intellectual Disabilities and Dementia Who Are Dually-enrolled in Medicare and Medicaid?”
Adults with IDs such as Down syndrome are at elevated risk for early-onset dementia and have much higher lifetime prevalence of dementia. Further, persons with IDs experience substantially worse healthcare quality and outcomes—including shorter life expectancies—than the general population. Yet there is a lack of research on dementia care access, quality, and outcomes among adults with IDs.
“Dual enrollment in Medicare and Medicaid is crucial to meeting health needs and improving outcomes among adults with IDs. Yet accompanying services are often fragmented and delivered through bifurcated federal and state programs,” said Johnston, who is Associate Director of the Center for Health Services & Policy Research and Director of the Medicare Innovation Research Lab at WashU Medicine. “Navigating each program is hard for people with IDs, especially those with dementia who require specialized care from multiple service providers across care settings. Given these realities, the most important change to Medicare and Medicaid may be the increasing availability of Highly- and Fully-integrated Dual-eligible Special Needs Plans in which a single managed care organization is responsible for covering and coordinating all Medicare services and many or all Medicaid services (via itself or its affiliated legal entities).”
This new project will study the availability of and enrollment in integrated Dual-eligible Special Needs Plans (D-SNPs) and compare the effects of enrollment in integrated D-SNPs versus other dual coverage models on quality of care and health outcomes.
“Our work aims to provide evidence to health system leaders and clinicians on how to build on successful features of Medicare and Medicaid coverage models to improve dementia care and health outcomes for American adults with IDs,” Johnston said.