Coordinating Center on the Economics of Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias: Prevention, Treatment, and Care - Research Projects

The Coordinating Center fosters collaboration among a group of researchers with overlapping interests. This group includes the researchers on five teams that received R01 research grants from the National Institute of Aging (NIA) as part of the Consortium on the Economics of AD/ADRD. It also includes five research teams that are supported with Research on the Economics of Alzheimer's/Dementia (READ) grants, and five researchers who are supported with Early Career READ (EC-READ) grants, that were awarded in a competitive process that was managed by the NBER Center. The R01, READ, and EC-READ projects, along with the names of their principal investigators and summaries of their core research objectives, are listed below.

R01/R56 Awards 

Strengthening the Dementia Care Workforce: Analyzing Economic Policies’ influence on Workers and their Patients Living with Dementia
Norma Coe (PI), Katherine Miller, Atheendar Venkataramani, Adam Dean, Jamie McCallum, Alon Bergman, Lindsey White 

The long-term care industry is one of the fastest growing sectors of the economy, yet the jobs created often come with low pay and poor work conditions. This project estimates the impact of three economic policy levers in improving the lives of the dementia care workforce and their patients: wages, unionization, and staffing regulations.
Slide Presentation from March 6 2025 NBER Meeting

Care for Persons with Dementia in Medicare Advantage and Traditional Medicare: Family Spillovers and Disparities
Lauren Nicholas (PI), Alicia Arbaje, Cathy Bradley, Stacy Fischer, Kenny Lam, Dan Polsky 

Medicare Advantage, the managed care alternative to Traditional Medicare, covers nearly half of Medicare beneficiaries. While managed care could improve the care of patients with Alzheimer's Disease and Related Dementias (ADRD) through care coordination and supplemental benefits, regulators have also raised concerns about inappropriate denials of care in Medicare Advantage. This project analyzes how Medicare Advantage enrollment impacts the care of beneficiaries living with ADRD, and how the impact varies across a patient's economic and demographic characteristics.
Slide Presentation from March 6 2025 NBER Meeting

Impact of Medicare and Medicaid Financial Policies on Post-acute and Long-term Care for Persons Living with Dementia
Cyrus Kosar (Co-PI), Momotazur Rahman (Co-PI), Elizabeth White, Pedro Gozalo, Vincent Mor, David Grabowski, Lacey Loomer

This project examines how healthcare financing and policy affect utilization and outcomes for people living with dementia, using 15 years of Medicare claims and clinical assessment data. It focuses on the following policy variables: certificate of need regulations, the expansion of Home and Community-Based Services (HCBS) funding, provider supply constraints, Medicare Advantage enrollment, Institutional Special Needs Plans (I-SNPs), and post-acute care reimbursement structures.
Slide Presentation from March 6 2025 NBER Meeting

Role of Home-based Medical Care and Telemedicine in Care and Outcomes of Dementia and Coexisting Conditions in Public and Private Medicare  
Amresh Hanchate (PI), Mia Yang, Stephanie K. Nothelle, Bruce Kinosian

Many people living with dementia simultaneously manage other chronic conditions that necessitate complex care regimens. These co-occurring conditions may additionally inhibit people's ability to leave home to access care. Thus, the availability of home-based medical care and telemedicine may be particularly valuable in improving treatment and outcomes for people living with dementia, and in mitigating the burden on caregivers. This project uses Medicare administrative data to examine the effect of the 2020 expansion of telemedicine on patient care and outcomes.
Slide Presentation from March 6 2025 NBER Meeting

Disparities in Undiagnosed and Misdiagnosed Dementia and the Impact on Health Care Utilization and Costs – A Novel Approach using Probabilistic Dementia Classifications
Péter Hudomiet (PI), Cheryl Damberg, Maria DeYoreo, Gabriel Hassler, Michael Hurd, Hannah James, Jodi Liu, Susann Rohwedder, Debra Saliba

Delayed diagnosis of Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD) implicitly delays the treatment and care of people in earlier phases of these conditions. This project develops and applies to research a novel classification method to more accurately quantify AD/ADRD diagnostic errors and delays. It uses this new AD/ADRD classification tool to assess the timing or delay in AD/ADRD diagnosis, and how the timing may vary among people with different socioeconomic circumstances.
Slide Presentation from March 6 2025 NBER Meeting

READ Awards

Effect of Labor Market Policies on Care and Outcomes for People with Cognitive Impairment and Their Caregivers
David Cutler (PI), Hailey Brace 

This project examines how labor market policies affect the care of people with cognitive impairments and their caregivers. It focuses on the effects of minimum wages, work rules like the Fair Labor Standards Act, and immigration policy on the formal long-term care services used by people living with cognitive impairment, and on the resulting health outcomes for these individuals. A companion project under development will explore the effects of policy on formal and informal caregivers. 

Disparities in Medicaid Managed Long-Term Services and Supports for Older Adults with ADRD: Evidence from Wisconsin
Corina Mommaerts (PI), Lauren Bishop, Laura Dague, Ari Ne’eman, Yulya Truskinovsky 

This project investigates the effects of Medicaid managed care for long-term services and support (LTSS), comparing outcomes for both people living with dementia and those without dementia. The project focuses on Wisconsin, where a voluntary Medicaid managed LTSS program (Family Care) was gradually rolled out between 2000 and 2019. The project will explore differences in program adoption (relative to traditional Medicaid) across the population, differences in LTSS use before and after program implementation and, specifically, the causal effect of managed LTSS on the use of in-home and community-based services versus nursing home services. 

Access to High-Quality SNF Care For Medicare Advantage Enrollees With Dementia
Tamara Konetzka (PI), Betsy Cliff 

This project investigates the effects of Medicare Advantage on post-acute care for Medicare beneficiaries with AD/ADRD, focusing on the use of skilled nursing facilities. It considers the effect of Medicaid Advantage enrollment on skilled nursing facility utilization, relative to other post-acute care options, and on the quality of skilled nursing facility used.

The Financial Consequences of Spousal Loss in the Context of Alzheimer’s Disease and Related Dementias
Gopi Shah Goda (PI), Joanne Hsu, Lauren Nicholas

This project examines the effect of one spouse's AD/ADRD diagnosis on the health and financial circumstances of their surviving partner after death. It analyzes the trajectory of health and finances over the period beginning before a spouse’s death, comparing households where the spouse has an AD/ADRD diagnosis to those without an AD/ADRD diagnosis, and following the trajectory of finances through the spouse's death. The study will also explore how AD/ADRD may differentially affect the financial circumstances of surviving spouses with different pre-widowhood socioeconomic characteristics.

Waterborne Lead Exposure and Cognition
Brian Beach (PI), Joseph Ferrie, Aaron Reuben, and Martin Saavedra

Individuals with higher childhood lead exposures, many years later, are more likely to have AD/ADRD listed as a primary or contributing cause of death on their death certificates. This project drills down on the causal mechanisms underlying this prior finding. Specifically, the project explores the effects of lead exposure on cognitive impairment and AD/ADRD-related outcomes as they develop across the life course. It involves constructing a dataset of lead exposure in the United States (covering around 60 percent of the US population); and then linking the lead exposure variables to AD/ADRD-related measures in other publicly available databases, such as cognitive impairment, labor market underperformance, independent living difficulty, and receipt of disability benefits.
 

EC-READ Awards

The Impact of Increasing Payments to Insurers for Covering Individuals with AD/ADRD on Enrollment, Access, and Use in Medicare Advantage
Mark Meiselbach (PI)

In 2020, CMS re-introduced AD/ADRD to the risk-adjustment formula for Medicare Advantage plans to account for the previous systemic underpayment for AD/ADRD enrollees. This project explores whether the 2020 risk-adjustment payments expanded access to AD/ADRD services and specialists for those enrolled in Medicare Advantage. It analyzes the impact of the reform on (1) Medicare Advantage enrollment among people with AD/ADRD diagnoses, (2) the inclusion rate of AD/ADRD specialists in the plans, and (3) service utilization, including AD/ADRD-related office, outpatient, and home health visits.

The Effect of Hearing Aid Coverage Mandates on Cognitive Decline
Benjamin Ukert (PI)

Hearing loss, which affects two-thirds of Americans over the age of 70, is associated with an increased risk of cognitive decline and dementia. Traditional Medicare does not cover hearing aids, but some state Medicaid programs do. This project examines the impact of hearing aid access on cognitive decline and dementia, using data from the National Health and Aging Trends Study (NHATS) data. The project analyzes the effect of Medicaid hearing aid coverage requirements on various outcome variables related to dementia, including the self-reported results of cognitive tests, such as the clock drawing test, orientation memory, and executive function. 

Billing Hassles and ADRD
Riley League (PI)

This project uses the Massachusetts All Payer Claims Database to analyze denied health insurance claims and appeals, comparing the experience of people living with AD/ADRD to those without AD/ADRD. It will quantify the prevalence and variability of denied insurance claims from AD/ADRD patients compared to non-AD/ADRD patients; assess the impact of claim denials on subsequent healthcare utilization by AD/ADRD patients; and explore any variability in claims denials and impact across people with different socioeconomic characteristics. 

The Hidden Costs of Care: Parental Dementia and its Impact on Work and Retirement 
Zhixiu Yu (PI)

Adult children often serve as informal caregivers for parents with AD/ADRD, resulting in significant financial strain. This project explores how caregiving responsibilities affect decisions about work, retirement, and when to claim Social Security retirement benefits. The project will identify the characteristics of people who tend to assume caregiving responsibilities, such as variations in caregiving prevalence between adult sons and adult daughters; and how parental caregiving in turn affects their work, retirement, and claiming decisions.

Timing of Dementia Diagnosis: Implications for Medicaid Enrollment and Financial Planning
Fangli Geng (PI)

The timing of an AD/ADRD diagnosis plays a pivotal role in shaping care pathways, determining resources utilization, and influencing patient and caregiver outcomes. An earlier diagnosis allows for more proactive planning, decreasing the risk of a crisis-driven care transition. This project quantifies the delays in dementia diagnosis and its variation across socioeconomic groups, and examines the effect of diagnosis timing on subsequent outcomes, including long-term care service use, Medicaid enrollment, and financial planning.