Provider, Interdisciplinary Staff, and Patient Perspectives on the Potential for Cognitive Assessment and Care Plan Services in Primary Care.

Abstract

In 2017, Medicare introduced the cognitive assessment and care plan (CACP) billing code to incentivize comprehensive care for people living with dementia (PLWD). CACP requires addressing 8 care domains. Adoption of CACP has been limited, particularly in primary care. We identified barriers and facilitators of implementing CACP in primary care. Primary care providers (PCP), interdisciplinary staff, and PLWD and/or caregivers from primary care practices participated in semi-structured interviews about dementia care. We applied content analysis methods to analyze qualitative data mapped to 3 CACP implementation outcomes: acceptability, appropriateness, and feasibility. Most participants found CACP acceptable due to its comprehensive nature and addressing unmet needs. PCPs and staff felt CACP was appropriate for primary care because they were already addressing many of the required care domains during Medicare Annual Wellness Visits (AWV). Concerns about the time, resources, and coordination needed made feasibility unclear. Potential strategies for implementation included using interdisciplinary team members, data and workflows from AWV implementation, and health information technology. CACP is acceptable and appropriate for primary care though comprehensiveness and requirements limit feasibility. Implementation strategies must address time, resource, coordination, and awareness/education needs to successfully deliver this Medicare benefit at a large scale.