Key Points for Dementia Diagnosis and Management

Permanente physicians and staff are part of a new phenomenon: Kaiser Permanente (KP) has never had so many older members living so long and with so many medical conditions. The logarithmic growth in technology and the concomitant heightened public expectations have created a menu of seemingly endless diagnostic and intervention choices. The practice implications of these numerous advances are not yet defined but are already being felt. Physicians are summing up the impact on their practice in an exclamation that echoes throughout KP: “I cannot do it all in 15 minutes.” The metaphors “Age Wave” and the “Graying of America” describe the changing demographics of both KP and America. Our KP Program currently has 830,000 members older than age 65 with 55,000 of them older than age 85. This number is expected to double in the notvery-distant future. Medical care for this population has economic, ethical, and social implications that seem overwhelming. What can KP do to prepare before this change is upon us, especially in the context of finite resources? This article will describe what the Kaiser Foundation Health Plan (KFHP) and the Permanente Medical Groups are doing to address this challenge. Elder Care leaders at the regional and medical center levels, in collaboration with the cians have more than 6 million office-based contacts with older adult members. Older members represent a disproportionate number of hospital days as well as a significant portion of ambulatory surgery, pharmacy, diagnostic, durable medical equipment, skilled nursing facility (SNF), home health, and hospice services. KP’s over-65 membership currently comprises only 10% of total membership, but their care accounts for about 30% of costs. Membership, costs, and revenue vary across the KP Program and within its regions. In the KP Ohio Region, the percentage of membership comprised by over-65 members already is approaching 20% (Figure 1). In some service areas and medical offices in other parts of the KP Program, membership is already in the high teens. At some offices, older adults daily comprise more than 70% of visits. Ophthalmology, orthopedics, urology, neurology, dermatology, and many other specialty areas provide care for these members. As a program, KP must influence policy, maximize revenue, and manage care, costs, and quality for