Two decades of collaborative innovation have reshaped policies, showcasing the transformative power of interdisciplinary collaboration.
In this episode, Malaz Boustani, an agile and innovative implementation neuroscientist, author, and entrepreneur, discusses the groundbreaking advancements and policy changes related to brain health, particularly dementia care. He shares the challenges and successes of creating a comprehensive care model for dementia patients and their caregivers. Malaz delves into the model's positive outcomes, the hurdles faced within the fee-for-service healthcare system, and the Center for Medicare and Medicaid Innovation's announcement to test an alternative payment model for evidence-based dementia care services. He explains how this new payment model includes per-member-per-month payments to healthcare organizations and additional funds for patient respite care, aiming to enhance accessibility and sustainability.
Get ready to be inspired and informed about the challenges and triumphs in crafting a transformative care model for dementia patients and their caregivers.
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[00:00:01] This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency. Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit OutcomesRocket.com or text us at 312-224-9945.
[00:00:30] Hey everybody, Saul Marquez with the Outcomes Rocket. I want to welcome you back again to our podcast. Today, I have the privilege of hosting the amazing Dr. Malaz Boustani. I've had him on the podcast before and I'm excited to welcome him back. For those of you that haven't had a chance to listen to his episode, let me tell you a little bit about him. He's a geriatrician, a neuroscientist and an agile scientist with extensive experience in designing, evaluating,
[00:00:58] implementing and disseminating healthcare innovations with a main focus on brain health. He used insights from Agile Science to develop the Indiana University Graduate Certificate in Innovation and Implementation Science and co-founded four health tech startup companies. He's just an incredible individual and he's been doing a lot of research. And as he likes to say, from discovery to delivery.
[00:01:25] And today, we're going to be able to talk about one of the most recent findings and the advancements he's made in particular with brain health. So, Malaz, thanks so much for joining me. Well, thank you so much for giving me the opportunity again and the platform to exchange information with the public. Thank you so much, Saul. Of course, of course, Malaz.
[00:01:48] And folks, I've had the opportunity to attend a couple of Dr. Bustani's innovation camps. I'm always impressed with the level of people that he has in his classroom, both digitally and in person. And so, really just a pleasure to have him back on the podcast. So, really talk to us about what is, you know, top of mind for you, Dr. Bustani. Oh, yeah.
[00:02:18] You know, I just wanted to share with you the journey and the public, the journey from really discovering a solution to take care of societal problem and all the way to where this solution becoming very, very close to be the norm, the social norm. And that journey is very rare to be witnessed by one person, usually.
[00:02:48] And I have the luxury to have lived that journey. And I think sharing this journey, the up and down of the journey, the loneliness, the community sense of it, it might give insight to a lot of people who might be on the beginning of the journey. And they are thinking about giving up and then maybe listening to my story.
[00:03:12] They get this extra kind of booster shot to say, you know, I can persevere for another month, another year, another two years. So, you know, because as you all know, crazy people think they can change the world. And everybody know those are the only people who actually change the world for the better. So we need our own supporter group.
[00:03:35] And hopefully this will be part of our supporter group conversation. Certainly, you're always a very inspiring person to talk to. And you've made some advancements, right? You've made some major advancements from a scientific front, the delivery front, and also with CMS. Do you want to cover some of that with us today? Yeah, let me start with the end.
[00:04:00] So on July 31st, 2023, just a couple of months ago, the Center for Medicare and Medicaid Innovation announced that they are going to be testing for at least eight years an alternative payment model to create demand
[00:04:16] so the healthcare system will be delivering the evidence-based dementia care services that us and other scientists across the country have been working on it for the past almost 20 years. So that's the great, exciting things. That's incredible. Oh, absolutely. So technically, beginning July 2024, so almost a year from now, doesn't matter if you live in Indianapolis
[00:04:44] or if you live in L.A. or if you live in Baltimore or if you live around San Francisco or around Emory, you don't need to be living in this kind of spot to receive this evidence-based dementia care model because the CMS is going to try to spread it out and make sure it's available to a lot of people across the country in the United States.
[00:05:13] So that's the great news. What I want to share with you, how has the journey happened and what it takes? So I want to go back from July 31st, 2023, I want to go back all the way to early 2000. So in early 2000, 2002, I came into Indiana University from University of North Carolina
[00:05:38] and finished my geriatric research fellowship and became a faculty. And when I came into Indiana University, my mentor, Chris Callahan, who was an amazing person, who recruited me there because I wanted to be like him, you know, modeling. He already was able to get funding to conduct a clinical trial, randomized controlled clinical trial,
[00:06:03] to test a model of care to see if we could reduce the burden of dementia, not just on the person who is suffering from dementia, but on their family caregiver. All right. So he designed really good model. Ironically, his model that he designed, I came up with the same concept just a couple of years beforehand, but he was ahead of it.
[00:06:32] He actually tested it and he took a sabbatical in England to really design that model and wrote a grant and got the grant funded from the Agency for Healthcare Research Quality. So I came over to execute that clinical trial. And it was very exciting. We called it the Cadillac model.
[00:06:56] What we did, we just simply said, you know, the current healthcare services for people with dementia and primary care is completely not good. We want to redesign it. All right. So we didn't come over and point finger at the primary care doctors or anybody else. We actually brought in resources to the primary care system in a package in the right way to see if that worked.
[00:07:23] And we want to evaluate it in a very, very, you know, high caliber, the same way you evaluate a drug through a randomized control trial. And our model was very simple. We did not, we just simply did two things. Number one, we expanded the definition of patients from the patient who suffers from the disease to their family member who are caring for them.
[00:07:50] So all of a sudden we start seeing dyads instead of one person. And what we did, we brought in resources, a care coach or a care coordinator who helped the patient and family to manage their ability to cope with the cognitive, functional, and psychological disability of their loved one in their own stress level. So that's in a nutshell. We gave them like feedback processes and tips and evidence-based way to do that. And we tested it.
[00:08:19] We had 180 people. Half of them got our model. Half of them did not get the model. We followed for 18 months. And guess what? It worked. So we were able to reduce the agitation that patient with dementia have, other behavioral symptoms, and we prevented the stress and the burnout of the caregiver. All right? So that was amazing results.
[00:08:45] It was the first actual randomized control trial that I ran. And I thought everything will be the same after that. You know, I can just move on to other things. So this one worked. And we were able to publish it in a big journal, JAMA. I got promoted to associate professor. I got invited to talk with other people all over Seoul. And then, you know, I was supposed to move on.
[00:09:12] And I actually move on to another problem that I want to fix, which is delirium. And then, like anything happened, luck hit the ground. And there's been a lot of series. So I can zoom in into this luck event. But I want to tell you a big luck happened around 2007 or so. And then another big luck happened around 2009 and mindset things happened.
[00:09:41] And then really around another two or three big events occurred that were really the energy that moved us from a JAMA article in 2006 to a policy change in 2023. You know, so there's a lot of luck in that concept. And you just simply has to be ready to harvest that luck in order for you to an actual make
[00:10:11] an impact instead of doing what the typical academician like me used to do, which is we discover solution and our end point is benchmark, you know, put it in a bookshelf. You know, like that's how we get judged. But I can zoom in into more and more into these little bit of an insight that might be helpful for other disruptive innovator who are trying to really make our society better.
[00:10:40] It points to your commitment, not just to publish. Obviously, that's a priority as an academician. But also beyond that, taking beyond the bookshelf into now what is a policy that can affect all of our lives, everybody that's listening, that's based in the U.S. that, you know, could be a recipient of or families which could be recipients of dementia care thanks to the to the work that you've done.
[00:11:08] And even beyond that, I would say, you know, there's there's adjacent tracks that that can oftentimes take a long time. Like, I think, med tech medical device entrepreneurs oftentimes go through a very long process from a minimally viable product to approved by the FDA. And so I think we could all draw from inspiration and lessons from what you've done.
[00:11:36] So so Malas, talk to us about what's changing and what the policy is. Would love to better understand that. Yeah. So the policy, it's starting from July is a big thing. So we currently this is the fee for service is the dominant payment process to take care of medical services and health services for our country.
[00:12:06] That concept of fee for service, it doesn't work for people living with dementia, you know, and especially it doesn't work for their their caregiver. So what will happen? And the model of care that I explained to you, we tried to disseminate it and within the fee for service and it just didn't work.
[00:12:31] We were able to have that model or that services in Indianapolis in a safety net health care system that we were able to make sure this model, these services are available since 2008, January 2008. So although we published it in JAMA in 2006, within less than two years, we made sure it's available and at least in Indianapolis in a safety net health care system that serve, you know,
[00:13:00] 50 percent African-American, almost 50, 60 percent dual eligible. So socially frail, underrepresented population. So we succeeded in implementation quickly there, but we never were able to kind of expand our services because our model was not compatible with fee for service. We raised funding. We did like foundation campaign.
[00:13:27] Askenazi's leadership and their commitment to the county, you know, kind of kept us on a life support. Could not have, does not have enough capacity to expand, you know? So we noticed right away that was a big problem. So this alternative payment model that will be tested by CMS is actually used different way to cover the expense of these health services.
[00:13:56] So what they do, they're doing two things that are really amazing and were highlighted by a group of us, a village of across the country, a group who really work with CMS to adopt this model. Number one, they're going to pay, they're going to do what we call PM-PM model. So they're going to pay the healthcare delivery, the organization that will deliver this model,
[00:14:22] they're going to pay them a flat fee somewhere between, you know, let's just to make it easy, somewhere between $200 to $300 per member per month on top of the fee for service you do it. So that gives a lot of flexibility, that gives a lot of scalability, sustainability piece. So that's, if you think about it, that's somewhere around $2,500 per member per year, something like that. All right?
[00:14:52] Then on top of it, what is amazing about CMS goal is they're going to give another up to $2,500 for the patients to use for respite care, you know, for the caregiver to use for respite care. So in a nutshell, if you think both of them, it's like $5,000 a month and almost $60,000 on average.
[00:15:20] $60,000 per member per year, right? People say, wow, that's a lot of money. Compared to the new disease-modifying agents that might be available, CMS is going to pay double that if you look at the wraparound services. So in a way, this is save money. So that's what they're going to be testing. They're going to be testing. Is this model, payment model, will facilitate the services, the dementia care services,
[00:15:49] and it does it actually even on the long run create better care, better health at lower cost? Because our model, even though improved the behavioral and psychological symptom of dementia, caregiver stress, kept people at the community at home longer, on average of two years. So, and if you take that money and translate it over 10 years, we did some, not us, the group of us,
[00:16:15] the Alzheimer Association, AARP, Us Against Alzheimer Disease, the Milken Institute, investigator and scientists from UCSF, from UCLA, from Emory, from Hopkins, from Wisconsin, a group from Brown. This is the village that were behind the scene that converted this, took this thing from the bookshelf and made it a reality.
[00:16:42] We projected over 10 years that can save billions of dollars to the federal government, you know? So this is a smart financial decision on CMS. This is one of the rare situations where everybody will win. Obviously, the patients and their family member, the healthcare providers who are passionate to support them, including community-based organizations and the federal government.
[00:17:12] That is, for me, what I think of it as a smart healthcare policy. And it's been 20 years. It took 20 years of amazing work. It took 20 years to go against my, you know, wrong intuition. You know, as a human being, you know, like all of us, I'm very selfish. I want myself.
[00:17:36] But you can't, for this kind of thing, you can't be, you can't do it on your own, number one. And you have to make sure you can work with, you can recruit and maybe work and let other people lead. So the beauty of all this stuff is my contribution to this whole journey was more of a catalyst a little bit. The last five years, this entire work was done with amazing people who put, for every one hour I put,
[00:18:05] they might have put 100 hours on top of it. And they are the one who finished the race, you know, like it was more of like a relay. And they were, they were really the hero. And all of us together, we became a village that led to this amazing, amazing story that will help a lot of vulnerable people who suffer from dementia. And ironic, we as a family, my, my family got touched by dementia on both sides.
[00:18:34] My in-law, my in-law, my mother and father-in-law lived with dementia for quite some time and suffered. We as a family suffered. And ironically, I wasn't able to help them as I like to because the model of care that we have was not available where they are. And then my father, who is still alive and who's currently live with dementia, he is in Syria.
[00:19:02] So my journey for the United States is just the beginning. I have to make sure this model is scalable and can be delivered to an underserved, you know, like a people in Syria where civil war is still going on and everything else. So the journey is not over globally, but at least in the United States, we have, we are, we are very excited about what's going to happen over the next eight years. I have a ton of questions left.
[00:19:29] Maybe we end up doing a part two to this because the, the, it's one thing to know about it. It's another thing. How do we take action on it as providers, as caregivers, as, as, as payers, right? How do we take action on this new policy that's available for us to better take care of ourselves, our loved ones that may be faced with dementia? So Malaz, if you're up for it, let's do a part two for today. Sounds perfect.
[00:19:59] Today was about the what and, and our next one will be about the how, but, but folks, we'll leave links to today's podcast in the show notes from Dr. Malaz Bustani and the work that he and his, his, his group of, what did you call him? Village. Village. Yeah. His village of, of, of very dedicated contributors to this project for you to, to understand it more, what it means.
[00:20:28] And then we'll, we'll touch base for a part two on this to figure out what you can do and how you can get engaged to take advantage of, of this hard work that's taken two decades to now be available to all of us. So Malaz, just want to congratulate you and thank you for jumping on the podcast to tell us about it. Oh, thank you so much, Saul. And keep up, keep up working on awareness and spread information that are factual, which is awesome. Thank you, Malaz.
[00:21:07] This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency. Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945. And, honestly, our founder is no, our founder is at fazer format. I've seen hundreds of my marketers andarc ning a broad role in this community.ٹpo Anaульт hasナ duct made Max zawsze as a担当 IronPilot News lokala. We'll