Primary care could be the key to earlier dementia detection and better care coordination

Dementia care often begins in the primary care setting; however, many cases of early cognitive decline go undetected, according to experts at Jefferson Health and Independence Blue Cross. Improving screening and care coordination in primary care could help patients and families receive support sooner and avoid serious complications later.

In a conversation with Briana Contreras, an editor of Managed Healthcare Executive, James Ellison, M.D., M.P.H., a geriatric psychiatrist at Jefferson Health, shared that primary care is usually the first and sometimes only point of contact older adults have with the healthcare system. Due to this, earlier detection of cognitive decline can make a significant difference in how dementia is managed.

“For many older adults, primary care is the only healthcare contact that they have. So, it's the only place where a problem can be recognized and addressed and referred on to appropriate specialists if that is needed,” Ellison said. “Primary care often recognizes cognitive disorders late, and when we recognize it later, there's less time to intervene in a helpful way. Neurologists often say time is brain. The disease is progressing, and if we can recognize and intervene early, that's much better.”

Ellison noted that subtle warning signs may appear long before a formal diagnosis is made.

Changes in self-care, missed medications or difficulty managing finances can signal early cognitive impairment. However, many cases remain undiagnosed. He cited research suggesting that about 90% of people with mild cognitive impairment go undetected in primary care.

Efforts to address these gaps are driving new collaborations between health plans and provider organizations. One initiative is supported by Independence Blue Cross through its Clinical Care Innovation Grant program.

Rodrigo Cerdá, M.D., M.P.H., senior vice president of health services and chief medical officer at Independence Blue Cross, and editorial advisory board member of MHE said the grants are designed to test new care models that could improve outcomes and reduce costs.

“From our perspective, this is part of our clinical care innovation program. We really launched this in 2020 as the leading health plan in southeastern Pennsylvania, and our mission is really to improve the health of the communities that we serve,” Cerdá said. “The Clinical Care Innovation program is a way to invest in our network and test new approaches to care that improve quality, patient experience and the total cost of care.”

The grant supporting the dementia care initiative at Jefferson Health focuses on earlier detection and better coordination of care for patients with cognitive impairment. If successful, leaders say the model could eventually be expanded across other health systems and provider networks.

By strengthening the role of primary care in identifying cognitive decline, it’s hopeful health systems and payers can intervene earlier, support caregivers and improve the overall experience of dementia care.