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The databases, called Prescription Drug Monitoring Programs (PDMPs), track prescribing of opioids and other tightly regulated medications. All U.S. states operate PDMPs, and most require clinicians to make accounts and check the system before prescribing opioids. Yet compliance remains uneven, an ongoing concern of policymakers.

“Our study shows that e-mails can encourage clinicians to make accounts and check their state’s prescription drug monitoring program,” said Adam Sacarny, PhD, associate professor of health policy and management at Columbia Mailman School of Public Health and principal investigator of the study. “We think these results are exciting because these databases can help clinicians prescribe safely, but many clinicians still don’t use them.”

In the new study, researchers collaborated with the Minnesota state government to build evidence on low-cost interventions to make prescribing safer. They focused on 7,872 physicians and physician assistants who were not meeting state requirements to hold a PDMP account or search the system before prescribing. Clinicians were randomly assigned to one of three groups: e-mails emphasizing the state’s legal requirements to use the PDMP, e-mails focusing on clinical guidelines and PDMP use, and a control group that was not sent e-mails. The researchers then tracked use of the PDMP and prescribing.

Both types of emails significantly increased PDMP engagement, including account creation, searching, and searching for patients with a history of risky prescribing. Emails emphasizing legal requirements more than tripled engagement. Emails highlighting clinical benefits were also effective, but less so: they more than doubled engagement. However, neither email had detected effects on prescribing.

“The legal requirement emails were particularly encouraging because they led one in four clinicians to use the PDMP who otherwise would not have,” said Mireille Jacobson, PhD, the study’s last author and professor of gerontology and public policy at the USC Leonard Davis School. “Although the emails did not change opioid prescribing, just getting clinicians to make PDMP accounts and check the PDMP could still translate to safer and better-informed care for patients.”

Data came from the Minnesota PDMP and included all controlled-substance prescriptions dispensed statewide. Prescribing behavior and PDMP use were tracked for seven months following the first email. The effects on PDMP use were durable, persisting for at least the seven-month period after the initial email.

The findings build on earlier work by Sacarny, Jacobson and colleagues that described the rate of PDMP usage and showed how simple messages can effectively promote PDMP use. In the prior study, which sent clinicians mailed letters rather than emails, messages emphasizing legal obligations also outperformed clinically framed messages—and neither approach altered prescribing.

“Email is a low-cost, scalable intervention that meaningfully increases PDMP engagement, especially when legal requirements are emphasized,” Sacarny said. “These interventions could serve as templates for efforts to promote other best practices in health care, too.”

“Our approach is backed by randomized trial evidence and can be easily translated to other contexts,” Sacarny added. “The results should be useful and encouraging for policymakers, health systems, and organizations focused on safer prescribing and patient safety.”

In addition to Sacarny and Jacobson, co-authors were Tatyana Avilova of Secretariat and Ian Williamson and Weston Merrick of the Minnesota Management and Budget Agency. The study was supported by the Abdul Latif Jameel Poverty Action Lab.

Release courtesy of the Columbia University Mailman School of Public Health

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This is the first of what will be annual national estimates from the multidisciplinary research team. To draw on a wide range of perspectives, the research team includes prominent experts across disciplines at USC — including the USC Schaeffer Center for Health Policy & Economics, the Price School of Public Policy, the Leonard Davis School of Gerontology, the Mann School of Pharmacy and Pharmaceutical Sciences, and the Viterbi School of Engineering — as well as the Alzheimer’s Association and the University of Pennsylvania. Researchers from other institutions provide additional guidance, and patients and care partners are regularly consulted to ensure the cost model reflects real-world experience.

“Having a better understanding of who bears these costs and how they change over time can inform evidence-based policies that may ultimately reduce the financial impact of dementia,” said Julie Zissimopoulos, co-director of the Aging and Cognition program at the Schaeffer Center, professor at the Price School with a joint appointment at the Leonard Davis School, and principal investigator of the U.S. Cost of Dementia project.

The team aims to provide the most comprehensive accounting yet of dementia’s growing economic toll. Beyond the cost of care, the model also accounts for lost earnings from patients and care partners who cut back work hours or leave jobs, as well as the diminished quality of life experienced by millions of patients and their families, among other factors.

“We have been working on the dementia model for more than a decade; it is now the most sophisticated model for understanding implications of current trends for the future. The fact that it includes all types of casts makes it a realistic picture — one that is not provided by other models,” said University Professor and USC Leonard Davis AARP Chair in Gerontology Eileen Crimmins, a senior scholar at the USC Schaeffer Institute. Crimmins and USC Leonard Davis Professor of Gerontology Mireille Jacobson, also a Schaeffer Institute senior scholar and co-director of the Aging and Cognition program at the Schaeffer Center, are members of the U.S. Cost of Dementia project research team.

Funded by a multi-year cooperative agreement from the National Institute on Aging, part of the National Institutes of Health, the project leverages data from several large, nationally representative surveys, including from the Health and Retirement Study and administrative health data from the Centers for Medicare and Medicaid Services. The researchers estimate costs to patients, care partners and the healthcare system using dynamic microsimulation — a powerful tool for understanding how changes in treatment, care and policy will impact costs of dementia over time.

An estimated 5.6 million Americans are living with dementia this year, including 5 million who are 65 and older, according to the researchers. Medical and long-term care for patients with dementia will cost the United States $232 billion this year, including $52 billion paid out of pocket by patients and their families. More than two-thirds of the total cost of care is paid for by Medicare ($106 billion) and Medicaid ($58 billion).

Dementia’s societal costs are even more staggering, the model reveals. The largest share stems from a factor often not measured in other cost estimates: The significant decline in quality of life for patients ($302 billion) and care partners ($6 billion). Lost earnings among friends and family who forego work to provide care — another measure often not captured by other estimates — total $8.2 billion. Care partners provide 6.8 billion hours of unpaid care, valued at $233 billion.

“This research demonstrates the enormous toll dementia places on patients, their families and care partners. But it also points to the potential value of developing ways to prevent and treat Alzheimer’s and related diseases that cause dementia,” said Dana Goldman, founding director of the USC Schaeffer Institute for Public Policy & Government Service,  and co-principal investigator on the project.

An ongoing look at dementia’s changing costs

The clinical resources available to tackle dementia are rapidly changing. New treatments slow cognitive decline in some patients with early-stage Alzheimer’s, and new blood tests are enabling early detection of Alzheimer’s.

The research team is building tools to help researchers and policymakers understand how these and future evolutions in dementia care, prevention and policies can affect costs for patients, the healthcare system and society. This information will support stakeholders in making decisions about priorities and the allocation of resources for reducing the costs of dementia. Going forward, the project will seek to uncover all types of costs to provide the most comprehensive estimates of the national cost of dementia to date.

The U.S. Cost of Dementia Project is funded by a cooperative agreement with the National Institute on Aging (#U01AG086827).

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Mireille Jacobson, professor of gerontology at the USC Leonard Davis School of Gerontology and a senior fellow at the USC Schaeffer Center for Health Policy & Economics, said the study was conducted to address the lack of comprehensive data on access to the lifesaving medication and eventually to support work on how it affects the number of deaths attributed to opioid overdoses in the U.S.

“There have been many analyses of how new policies, including naloxone becoming available through pharmacy dispensation, correlate with reductions in opioid deaths, but we don’t know exactly how much of the improvement is directly due to naloxone use versus any of the various other things being done to address this crisis at the same time,” Jacobson said. “We don’t really have any data on who knows what naloxone is for, carries it, and administers in the case of an overdose. We’re trying to fill in a missing link.”

Addressing an epidemic

In the study, Jacobson and coauthor David Powell, a senior economist at RAND, note the critical need to tackle the ongoing opioid crisis, which has had profound effects in the U.S, and understand the impacts of measures intended to address the devastating rate of overdose deaths.

Of the more than 100,000 drug overdose deaths that occurred nationwide in 2023, more than 75% of them involved opioids, according to data from the Centers for Disease Control and Prevention. Previous USC Leonard Davis School research has also shown how opioid overdose deaths have contributed to the widening gap in life expectancy between the United States and other high-income countries.

Since 2023, naloxone has been available over the counter, in hopes that wider availability would encourage more people to have the drug at the ready to save the life of someone overdosing. However, the lack of reliable, nationwide data on who was buying, carrying, and using naloxone has hindered research on how to best prevent overdose deaths, Jacobson said.

“With the problem being so widespread, one question is how to most effectively manage this crisis,” she said. “To know where to put our resources, we need to know about the actual ways this medication gets to the people who will use it. Our goal was to fill in the data and allow people to understand the mechanisms.”

Online surveys shed light

In June 2024, Jacobson and Powell conducted an online survey of two groups of participants. The first group was a nationally representative sample of 1515 people over the age of 18 not living in an institutional setting, while the second group contained 512 individuals who reported currently or ever having opioid dependence. Additionally, 50 respondents, or 3.3%, from the national sample also reported opioid dependence, bringing the total number of people reporting their own dependence on opioids to 562.

From the nationally representative sample:

• 700 (46.2%) reported having heard of naloxone and correctly identified it as a drug to reduce opioid overdoses.
• 160 people, or 10.6%, said they carried naloxone with them.
• 128 people (8.4%) said they had administered naloxone to someone else, while 93 respondents (6.1%) said they had been administered naloxone themselves.

Among the 562 individuals reporting current or prior opioid dependence:

• 500 people (89%) had heard of naloxone and knew its purpose.
• 340 respondents (60.5%) reported carrying naloxone.
• 267 (47.5%) reported administering the drug to someone else, and 221 (39.3%) said naloxone had been administered to them.

The survey also showed that a person’s perception of the risk of overdose, either for themselves or for someone they know, correlated with the choice to carry naloxone. Of the survey respondents in the national sample who reported themselves as “very likely to overdose,” 31% carried naloxone, and in the sample of people reporting opioid dependence, nearly 74% of those who said they had a high likelihood of overdosing carried the drug. The likelihood of carrying naloxone followed a similar pattern among those who stated that they knew someone else who was very likely to overdose.

Another notable finding concerned how people obtained the naloxone they carried. Among those who have ever carried naloxone, only 42% of those in the national sample, and just 22.6% of those who reported opioid dependence, said they purchased the medicine themselves. These results highlight the problem with estimating naloxone availability based on pharmacy sales, as it excludes the hospitals, clinics, and other community organizations who give the drug away for free, Jacobson explained.

Next steps

While the data provides some of the first nationwide insights on who has and uses naloxone, this is just a starting point for future research, Jacobson said.

She explained that she’s eager for the results to be examined and validated in other larger, more robust surveys, including in the USC Understanding America Survey. Ideally, future study will uncover the best ways to teach people about naloxone and the most efficient avenues to get the drug to the people who will use it to save lives.

“The hope is that we can look at this more longitudinally and in more detail,” Jacobson said.

The study, “Naloxone Knowledge, Carrying, Purchase, and Use,” was published in JAMA Network Open on March 3, 2025. Funding for the study was provided by Arnold Ventures (GR-72384) and the National Institute on Drug Abuse (R21DA060711).

Top image: Darwin Brandis/Adobe Stock

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Benzodiazepines, benzos for short, are often used to treat these common conditions. These sedating drugs are among the most prescribed medications in the U.S. and include familiar names like Xanax, Valium and Ativan.

The medications put patients at higher risk for falls, fractures, car accidents and even death, especially when they are used in combination with opioids, which is commonly the case. And despite being intended for short-term use, many patients, particularly older adults, are staying on them for months if not years or even decades.

USC Leonard Davis School of Gerontology Assistant Professor Michelle Keller is working to change that. She sent brochures about why these drugs are dangerous and how to taper off them directly to patients at home.

The snail mail delivered results.

“We found that for every 10 brochures we sent — a very low-cost intervention — one person completely stopped these medications [while] working closely with their doctor,” says Keller. “This is a neat intervention because it is so simple. All it requires is sending patient-education materials to a patient via mail. Sometimes health care is so complicated that it is nice to see such a simple intervention work.”

In an age of instant messaging, Keller’s work is one in a trio of studies from USC researchers showing that low-tech letters can lead to better practices around high-risk medications. Patients who received brochures about risks, alternatives and tapering recommendations were more likely to successfully quit taking benzodiazepines, while letters sent to clinicians successfully encouraged them to check patients’ records before prescribing opioids or to write fewer prescriptions for them.

Known as deprescribing, the process of tapering or stopping the use of prescription medications that are no longer needed or are potentially causing harm is particularly important in the case of highly addictive drugs like benzodiazepines and opioids. The National Institute on Drug Abuse (NIDA) reports that opioid overdoses kill more than 200 Americans a day, with benzos involved in close to 15% of these cases. Patients taking both drugs can face a fatal overdose risk 10 times higher than those using opioids alone, according to one study NIDA cites. Use and overuse of these medications can also cause dizziness, weakness, breathing problems and confusion, issues that can be exacerbated by older age.

Delivering Data to Doorsteps

Keller’s study adapted materials from an intervention originally used in Canada, called Eliminating Medications Through Patient Ownership of End Results (EMPOWER), for a population of older patients of 22 primary care providers in the Cedars-Sinai Medical Group in Los Angeles County. In the study, 308 patients received the EMPOWER materials in the mail, while 291 patients received standard care.

“Many physicians assume that patients are already aware of the risks of benzodiazepines, but our study found that patients may not know these risks. These medications may have been initially prescribed decades ago — before we knew all of the risks of benzodiazepines or when the person was younger and had a lower risk of falls, fractures, etc.,” says Keller, who holds the Leonard and Sophie Davis Early Career Endowed Chair in Minority Aging at the USC Leonard Davis School. “We found that several patients reached out to their physicians using the patient portal and expressed surprise that these medications had serious risks. That was really illuminating and increases our motivation to make sure that people know that these medications aren’t without risks.”

The EMPOWER materials not only illustrate the risks of benzodiazepines but also offer alternative strategies for managing symptoms and provide an example tapering schedule for gradually reducing medication use, all within a short brochure. Another powerful part of the intervention was a letter from the patient’s primary care physician that encouraged the patient to come in and talk to them about these medications.

Overall, 26% of patients who received the EMPOWER brochure had stopped benzodiazepine use completely, versus 17% of the control group, when assessed after nine months. 

In the future, Keller and her colleagues hope to reach out to different populations with the brochures, which have been translated into multiple languages. They also plan to provide the EMPOWER materials to hospital patients who have experienced a fall, fracture or other serious event.

Addressing the Issue

Researchers from Columbia University and USC discovered that letters can make a big difference when it comes to promoting safer opioid prescribing. Their study found that sending letters to doctors made a significant and lasting impact in prompting them to check a state database before prescribing opioids.

The focus was on clinicians who prescribe opioids alongside benzodiazepines or gabapentinoids — medications that when combined with opioids both substantially raise the risk of overdose. The researchers wanted to know if they could reduce dangerous prescriptions by encouraging more doctors to use state prescription monitoring programs (PMPs), which track these risky drug combinations. Although almost all states have PMPs in place, many doctors still don’t use them regularly, explains senior author Mireille Jacobson, associate professor at the USC Leonard Davis School and co-director of the Aging and Cognition Program at the USC Schaeffer Center for Health Policy and Economics.

“Well-meaning clinicians are still prescribing way too many opioids,” she says. “Getting them to check these types of databases can help them make more informed — and safer — decisions about medication use.”

The research team partnered with the state of Minnesota’s PMP and enrolled 12,000 clinicians who were randomly divided into groups: Some received no letter, while others were sent one of three types of letters. The letters, sent in early 2021, either informed them about a new requirement to check the PMP before prescribing opioids, provided information on their potentially risky prescribing habits or included both messages.

Clinicians who received the letter about the mandate to check the PMP were more likely to engage with the system. In fact, PMP searches increased by 9%, and this bump in activity lasted for at least eight months after the letters were sent. Clinicians who received the combination letter (mandate and prescribing info) showed similar improvements. Additionally, many signed up for PMP accounts, an essential step for using the system.

The researchers are encouraged that more clinicians enrolled in the system and searched for patient medication data, even though these letters did not lead to detectable changes in what they prescribed.

“Prescription monitoring programs can help make opioid prescribing safer, but they’re only effective if doctors actually use them,” says Adam Sacarny of Columbia University Mailman School of Public Health, the study’s first author. “Our research shows that a simple letter can make that happen.” 

Missives with a Mission

Delivering a stark message succeeded in reducing opioid prescriptions in a third USC study. A letter notifying providers their patient died from an overdose reduced the number of opioid prescriptions they wrote for up to a year. 

That study, led by author Jason Doctor, professor and Norman Topping National Medical Enterprise Chair in Medicine at the USC Sol Price School of Public Policy, follows a 2018 report by the same team that found the same impact, but only had three months of data. 

“Clinicians don’t necessarily know a patient they prescribed opioids to has suffered a fatal overdose,” says Doctor, who is also the co-director of the Behavioral Sciences Program at the USC Schaeffer Center. “We knew closing this information loop immediately reduced opioid prescriptions. Our latest study shows that change in prescribing behavior seems to stick.”

Doctor and his team sent letters from their county’s medical examiner to 809 clinicians — predominantly medical doctors — who had prescribed opioids to 166 people who had suffered fatal overdoses in San Diego County. The letter was intended to be informative and respectful in tone while providing information about safer prescribing. The researchers compared prescribing patterns among these clinicians with those who had not received the letter.

While there was a gradual reduction in opioid prescribing across the board, study authors found the rate of the reduction was faster and more robust among those who received the letter. The earlier study found that in the three months after receiving the letter, prescribing decreased by nearly 10% compared with the control group, which didn’t receive a letter. The new study found that after one year, those who received the letter wrote 7% fewer prescriptions than clinicians who hadn’t received the notification.

The big takeaway, says Doctor, is that the letters from the medical examiner provide a unique opportunity to communicate with physicians in the wake of overdose deaths to save lives from both legal and illegal opioids.

“The letter is a nudge to providers that the opioid epidemic is in their community and affecting their patients. It is easy to read the headlines and assume you are not part of the problem,” he says. “Doctors have an opportunity to talk to their patients and consider alternatives to opioids.”

Doctor and other study authors are working with Los Angeles County to examine lessons from the research and are looking at potential public policy interventions, including mandating such notifications from county medical examiners to clinicians.

Several of the researchers say they’d like to experiment with email in future studies. But a common lesson in all these letters: Don’t write off mail just yet.

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More than 40 caregivers, advocates, and policymakers came together to discuss and plan for the future of caregiving in California. Anticipating the significant demographic shift expected by 2030, the title of the conference emphasized how about 20 percent of the U.S. population would be 65 or older. Launched in 2022 by Donna Benton, research associate professor of gerontology and director of the USC Family Caregiver Support Center (FCSC), CaCFC aims to advocate for California policies and services that support diverse unpaid family caregivers and their care recipients.

“Our hope is that the coalition will eventually have the capacity to sponsor or co-sponsor our own caregiving bill and to be a vehicle for greater visibility of the work and needs of family caregivers, as well as a space of connection,” said Jenna Shankman, coalition coordinator and policy specialist.

The morning session started with opening remarks from Benton, who highlighted the urgent need to prepare for a future where a quarter of California’s population will be over 60.

“We have been talking about aging and how we need to plan for aging, but we have only 6 years to continue on this road, and of course, after 2030, we’ll still be working,” Benton said. “But we would like to see some of the things laid out, so that by 2030, you’ll be ready to care for your parents.”

Juan Carlos Guerrero, manager of regional organizing of Caring Across Generations, followed with a recap of the coalition’s first-year achievements, including the passage of SB-616, which expanded paid sick days in California. Guerrero also introduced the coalition’s 2024 priority bills, emphasizing the importance of these legislative efforts in supporting caregivers statewide.

“As we approach 2030 and beyond, it is key that we continue to advocate for the restoration and expansion of these services, so that aging families have the resources available to comprehensively provide and receive care in their own backyard,” Guerrero said.

The conference portion of the day’s events included discussions on potential legislation regarding caregiving.

Among the attendees was Deidra Gossett, a caregiver advocate whose personal journey highlighted the importance of such events. “I’m the primary caregiver for my 79-year-old mother diagnosed with dementia. I received an email through USC Caregiving Support Center looking for volunteers. So, I applied and was able to attend,” shared Gossett, who also connected her advocacy to her experiences at the USC Family Caregiver Support Center. “These meetings let me know that I’m not alone in this journey. Being both a caregiver and now an advocate has put a different perspective on my life.”

A highlight of the event was the special address by Chris Langston, CEO and President of Archstone Foundation. Langston discussed the foundation’s commitment to caregiving and showcased the significant progress made through their funding. Sarah Steenhausen, Deputy Director of Policy, Research, and Equity at the California Department of Aging, provided an update on the state’s Master Plan for Aging (MPA), focusing on key areas such as systems change, financing, and workforce initiatives.

As a caregiver for both his parents and his children, Langston said, “You need the real life experience that you can share with policymakers and the public that help them understand what the reality is and what people are going through.”

A panel discussion, moderated by Dr. Nina Weiler-Harwell of AARP California, featured insightful contributions from experts including Liz Fuller from the California Assembly Aging and Long-Term Care Committee, Katie Duberg from the California Work and Family Coalition, and Kate Hoepke from Village Movement California. The panel addressed critical issues such as advocacy strategies, policy advancements for paid family leave, and support for middle-income families, offering practical solutions. Weiler-Harwell, who received her doctorate in political science and government from USC, engaged the audience in a Q&A session with the panelists.

A significant part of the conference was dedicated to discussing the coalition’s priority bills and their impact on caregivers:

• AB 518 – Paid Family Leave for Chosen Family (Wicks): This bill aims to expand California’s Paid Family Leave program to allow workers to receive partial pay when caring for a “designated person,” who can be a member of their chosen or extended family. This expansion is crucial as the current law excludes many caregiving relationships, such as chosen family, unmarried partners, aunts, uncles, and cousins.
• AB 2428 – Community-Based Adult Day Services Medi-Cal Minimums (Calderon): This bill would require Medi-Cal Managed Care Plans to reimburse Community-Based Adult Day Services providers at a rate equal to or greater than the amount paid by the Medi-Cal fee-for-service delivery system. Immediate intervention is necessary to prevent further closures of these centers, which provide critical health and social support for older adults and respite for family caregivers.

Following lunch, the conference transitioned into an advocacy-focused afternoon. Participants, armed with legislative visit packets and clear talking points, headed to scheduled meetings with California legislators. These meetings were designed to build support for the coalition’s priority bills and to ensure that the voices of caregivers were heard at the highest levels of state government. Yasmin Peled, senior policy advocate with Justice in Aging, guided attendees to their appointments, emphasizing the importance of these engagements in shaping effective caregiving policies. The atmosphere was filled with optimism and a renewed sense of purpose, as participants left with a clearer roadmap for advocacy and action leading up to 2030.

Attendees met with the staff of over 20 California assembly members and senators, including Assemblymember Rick Chavez Zbur, Assemblymember Jim Patterson, and Senator Lola Smallwood-Cuevas.

Gossett found the day’s events particularly enlightening. “It was very eye-opening about how bills are supported by the public and how it’s very necessary for our experiences to help legislators vote,” she said. Looking ahead, she expressed her hopes for the coalition: “To continue to share information not only with each other but to all caregivers of California.”

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In 2020, the Centers for Medicare and Medicaid Services (CMS) reintroduced risk adjustment – a methodology used to estimate the cost to treat a patient – for dementia. The change gives MA plans, the private plan alternative to traditional Medicare, financial incentive to improve dementia detection, as plans are paid more for patients with more serious health problems than healthier patients. The more diagnoses a beneficiary has, the higher their risk score and the more Medicare pays the plan, raising concern that some MA plans might “upcode” or over-diagnosis as a result.

While the total number of Americans with dementia is increasing as the population grows older, age-adjusted rates of new dementia diagnoses (incidence) have been declining over the past decade.  At the same time, an increasing number of Medicare beneficiaries are enrolling in Medicare Advantage plans, changing the demographic composition of the program.  The study adjusted for compositional changes over time to isolate the effect of risk adjustment and compared the time trend in dementia diagnoses in MA relative to traditional Medicare (TM), where reimbursement levels were unchanged.

The study, published in JAMA Network Open, found that a higher fraction of MA beneficiaries were diagnosed with dementia in 2019 – the first year when new cases would affect risk adjustment.

More specifically, the percentage of MA beneficiaries who were diagnosed with dementia increased by 7.8% between 2018 and 2019, according to research from the USC Leonard D. Schaeffer Center for Health Policy & Economics. The uptick broke a trend of unchanged rates of new dementia diagnoses in MA over the prior three years and modest declines in TM.

One of the challenges to treating and supporting persons with Alzheimer’s and related dementias is that many people with the condition go undetected, said study lead author Julie M. Zissimopoulos, co-director of the Schaeffer Center’s Aging and Cognition research program, professor at the USC Price School of Public Policy and USC Leonard Davis School of Gerontology joint appointee.

Previous research from the Schaeffer Center found that about 20% of older Americans with dementia may be undiagnosed.  Their research has also found that there was a higher rate of diagnosed dementia among enrollees in traditional Medicare compared to otherwise similar enrollees in MA.

“We’re entering a new era for disease modifying treatments for Alzheimer’s, and many of these treatments are targeted towards early stage disease,” Zissimopoulos said. “That means people need to get detected and diagnosed early in disease stage to be eligible for the treatments that may benefit them.”

Another challenge is the racial disparities in dementia diagnoses. Studies have shown, for example, that Black people are at higher risk of Alzheimer’s disease and related dementias, yet are less likely to be diagnosed with the conditions than white people.

“Medicare Advantage plans enroll a disproportionate share of beneficiaries who are racial and ethnic minorities,” said study co-author Mireille Jacobson, co-director of the Schaeffer Center’s Aging and Cognition program and associate professor at the USC Leonard Davis School of Gerontology. To the extent the changes reflect new diagnoses, this policy has the potential to reduce racial and ethnic disparities in ADRD diagnosis.”

Researchers examined CMS-provided data from all Medicare beneficiaries through 2020.  More recent data is needed to see if the trend continues since the COVID-19 pandemic disrupted the healthcare system.

The big question that comes from the study’s findings is whether risk adjustment is leading to better dementia detection or inappropriate “upcoding” or over-diagnosis.

“Is this financial incentive encouraging better dementia detection? If so, then the financial incentive is probably working in a positive direction – diagnosing persons with dementia who may have been previously overlooked,” Zissimopoulos said. “The other side of that is the extent to which this reflects upcoding – the practice of over identifying disease and diagnoses because of the financial incentive.”

More about this study:

In addition to Zissimopoulos and Jacobson, the study was also co-authored by Geoffrey Joyce, Health Policy Director at the Schaeffer Center and associate professor at the Alfred D. Mann School of Pharmacy and Pharmaceutical Services. The Schaeffer Center is a partnership between the USC Sol Price School of Public Policy and the Alfred D. Mann School of Pharmacy and Pharmaceutical Services.

This study was funded by grant P30AG066589 from the National Institute on Aging.

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