# Improving the Quality of Care Provided Through Bundled Payments for Patients with Alzheimer's Disease or Other Forms of Dementia or Frailty

> **NIH NIH R01** · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2020 · $701,470

## Abstract

Improving the Quality of Care Provided Through Bundled Payments for Patients with Alzheimer's
Disease or Other Forms of Dementia or Frailty: Abstract
 Post-acute care (PAC) after a hospitalization helps patients with poor functional status – including the
growing number of vulnerable older adults with Alzheimer's and other forms of dementia and/or frailty – make a
successful transition to home through rehabilitation services provided after discharge. PAC has been fastest-
growing segment of Medicare spending prompting Medicare to increasingly transition to new payment models
that create strong incentives to reduce PAC care.
 Bundled Payments for Care Improvement (BPCI) is a large, voluntary Medicare payment reform
initiative that started in 2013. In BPCI's “Model 3,” PAC providers caring for patients discharged with one or
more of 48 targeted conditions assume responsibility for the entire cost of post-acute care over a 30, 60 or 90-
day period subsequent to hospital discharge and PAC admission, including any readmissions, emergency care
or outpatient visits. Episodes can be initiated by transfer of care from a hospital to a skilled nursing facility
(SNF), home health agency, rehabilitation hospital, or long-term care hospital. As of July 2017, 1143 episode
initiating organizations were participating in BPCI, of which 76% were SNFs. If Medicare payments are lower
than historical costs of care, enrollees are able to keep a portion of the savings; if Medicare payments exceed
the target enrollee will be responsible for part of the overage.
 Bundled payments provide strong incentives for PAC providers to better-coordinate services and
redesign care, which could be very helpful for vulnerable older adults On the other hand, such programs could
also induce providers to skimp on care or avoid these patients. Determining the true impact of payment
reforms like BPCI requires evaluating both (1) how PAC providers redesign care to achieve better outcomes
and lower costs, and (2) whether they skimp on care or reduce access for high need patients.
 We plan to: 1) use administrative to determine whether BPCI was associated with worsening access to
care and clinical outcomes for patients with dementia and/or frailty; 2) use a national survey of SNFs to
determine the strategies used by BPCI participants to redesign care for patients with dementia and/or frailty;
and 3) combine these two data sources to determine if any specific strategies for care redesign are associated
with improvements in outcomes for patients with dementia and/or frailty.
 This combined evidence will meaningfully advance our understanding of how to design policies to
incentivize the delivery of high-quality, cost-effective PAC to vulnerable older adults and avoid unintended
negative consequences.

## Key facts

- **NIH application ID:** 9891930
- **Project number:** 5R01AG060935-02
- **Recipient organization:** HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH
- **Principal Investigator:** Arnold Epstein
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $701,470
- **Award type:** 5
- **Project period:** 2019-03-15 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9891930

## Citation

> US National Institutes of Health, RePORTER application 9891930, Improving the Quality of Care Provided Through Bundled Payments for Patients with Alzheimer's Disease or Other Forms of Dementia or Frailty (5R01AG060935-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9891930. Licensed CC0.

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