Tuesday, July 1, 2025 7/1/2025

Impact of Financial Incentives on Setting of Care for Older Adults with Alzheimer's Disease and Related Dementias

Award Number: R21AG069787
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/30/2020
PERIOD OF PERFORMANCE END DATE: 05/31/2024

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Impact of Financial Incentives on Setting of Care for Older Adults with Alzheimer's Disease and Related Dementias - Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) are irreversible neurocognitive disorders characterized by progressive decline in memory, cognition, and the ability to live independently. The public health burden of care for individuals with AD/ADRD is enormous, with national costs exceeding $277 billion in 2018, including $186 billion paid by Medicare and Medicaid. Despite such investments, coverage of home and community-based services (HCBS) is often inadequate to meet the needs of community-dwelling individuals with AD/ADRD. HCBS (e.g., home health care, personal care services) are likely to be costly than institutional care, more consistent with patient wishes, and may result in better outcomes. Greater access to HCBS may delay or replace the need for nursing home care, thus increasing the level of cognitive and functional impairment that necessitates admission to a nursing home. Many state Medicaid programs have begun to implement policies that incentivize a shift from institutional care to lower-cost HCBS. However, the impact of financial incentives on setting of care (home versus institution) for older adults with AD/ADRD is not well understood. The proposed study takes advantage of a natural experiment in New York state. Between 2012 and 2015, New York transitioned from fee-for-service delivery of HCBS to a managed long term care (MLTC) model that shifted the responsibility for costs to managed care plans. All Medicaid beneficiaries requiring more than 120 days of long term care were required to enroll in MLTC. The mandate was implemented in phases, starting in New York City and gradually expanding to other areas of the state. This natural experiment creates a unique opportunity to study the impact of financial incentives on setting of care (home versus institution) for older adults with AD/ADRD. Older adults (aged 65+) who are dually eligible for Medicare and Medicaid are affected by these incentives. Our team will leverage multiple longitudinal data sources to accomplish the following aims: 1) Describe trends in coverage and utilization of long term care services among older adults in New York state diagnosed with AD/ADRD between 2010 and 2019; 2) Evaluate changes in the intensity of home health care and nursing home care (days per year) among dual eligible older adults with AD/ADRD following implementation of MLTC mandates; 3) Evaluate changes in cognitive function and functional status (ability to perform activities of daily living) among dual eligible older adults with AD/ADRD admitted to home health care or nursing home following implementation of MLTC mandates. The goal of this new investigator-initiated R21 is to provide policymakers and other stakeholders with rigorous analyses to inform the design of financial incentives to improve delivery of long term care services for older adults with AD/ADRD. Findings will inform development of an R01 to study the impact of financial incentives on long term care utilization and outcomes among older adults with AD/ADRD across multiple states.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$33,169 )
2025	2021	THE RAND CORPORATION	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Aging Research	000	2	10/15/2024	NON-COMPETING CONTINUATION	-$33,169
														Subtotal = -$33,169

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2021	THE RAND CORPORATION	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Aging Research	000	2	6/22/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $354,145 )
2021	2021	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Aging Research	001	2	7/2/2021	NON-COMPETING CONTINUATION	$380,145
2021	2020	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Aging Research	000	1	1/14/2021	NEW	-$26,000
														Subtotal = $354,145

Issue Date FY: 2020 ( Subtotal = $401,087 )
2020	2020	RAND CORPORATION, THE	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Aging Research	000	1	9/18/2020	NEW	$401,087
														Subtotal = $401,087

Grand Total All Awards = $722,063

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Impact of Financial Incentives on Setting of Care for Older Adults with Alzheimer's Disease and Related Dementias

Award Number: R21AG069787

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/30/2020

PERIOD OF PERFORMANCE END DATE: 05/31/2024

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