How this would play out

Widespread screening of individuals would lead to earlier detection of the biomarkers for memory loss diseases, even before symptoms arise.

Why we believe this

There are numerous benefits that result from timely detection. First, it allows for earlier intervention, which could delay the progression of memory loss by controlling conditions that can accelerate its progression such as heart disease, diabetes, stroke, high blood pressure, and high cholesterol. It also allows for better medical, financial, and legal planning for patients and caregivers. Lastly, earlier detection would increase the number of potential clinical trial and early post-market participants (i.e., the first post-FDA approval users), leading to increased innovation around treatments or cures. Post-market participants play a particularly important role in generating real world evidence since they are the first to use the drug after it has made it through clinical trials.

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How this would play out

Primary care practices would likely have to bear the burden of screening volumes, due to the relative lack of dedicated dementia care specialists like geriatricians, neurologists, and geriatric psychiatrists.

Why we believe this

Many experts argue that primary care practices should handle routine cognitive screenings as part of the annual wellness visit. However, for primary care practices to meet the demand for universal early screening they would need a combination of less laborious screening technologies and more creative deployments of their own care teams. Nurse practitioners and non-clinical staff, like front desk administrators, can be trained to administer behavioral questions, test for cognitive skills, and provide education and support following the patient’s appointment. This streamlines the screening process and helps everyone to work at top of license.

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How this would play out

Patients and caregivers will need access to educational resources and care management support following diagnosis.

Why we believe this

Community-based organizations, Medicare programs like PACE (Program of All-Inclusive Care for the Elderly), and MA supplemental benefit packages often provide this kind of support for individuals with dementia and their caregivers. These organizations will be pressured to assess their budgets to meet the increased need in resources for those with memory loss if better, widespread screenings were implemented.

How this would play out

The prevalence of dementia disproportionately impacts women as well as communities of color. Better, widespread screening would enable providers, drug manufacturers, and community-based organizations to improve their outreach to diverse populations to raise awareness on the benefits of early detection.

Why we believe this

Lower rates of early diagnosis in under-represented groups is not due of lack of interest, but rather results from a need to overcome a lack of access to information. A more diverse pool of individuals could also mitigate equity issues downstream in the clinical trial space. Historically, clinical trial populations for memory care therapies have been disproportionately wealthy and white; however, diagnosing more diverse populations could lead to more diverse research participants and the collection of better data on treatments.

How this would play out

Employers and commercial payers will have to consider the implications of more pre-Medicare beneficiaries being diagnosed with memory care diseases.

Why we believe this

Individuals who continue to work as their disease becomes symptomatic may need additional benefits, including paid sick leave, short-term disability benefits, and a flexible spending account. Medicare Advantage plans would have a better sense of how many of their beneficiaries are diagnosed, even before symptoms may be triggered. This would enable them to cover therapies and practices that would save them money as their members’ diseases progresses. Payers will have to think through how to create or structure strategic partnerships to maintain effective costs for memory care treatments—especially since providers may need help preparing for the influx of diagnosed individuals. Many plans are already working with home care providers to better manage patient populations, so this could be a good avenue to carve in at-home supports for memory loss.