Plan: Barriers & Mitigation Strategies | DAC-SP Early Detection Blueprint

Obtaining novel cognitive assessment tools.

Healthcare systems may face challenges in introducing new cognitive assessment tools to their system. A lack of clinical consensus or precedent for the use of these novel tools may lead to resistance to their adoption, or a lack of reimbursement methods for specific tools, or challenges with procurement.

HOW THIS BARRIER MIGHT TAKE PLACE:

A lack of clinical consensus regarding these new tools due to the ongoing development of available cognitive assessments.
A need for novel tools to conform to local procurement practices and regulations.
A lack of clarity on how the costs of new tools will be covered (e.g., through reimbursement pathways in the U.S.).

Mitigation Strategy

Engage expert support across disciplines

Engage the support of scientific, academic, operations, legal, and procurement experts to address this challenge. The introduction of a novel tool will require validation and multi-level, change-management support from your core leadership team and across stakeholders.

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Tactics include

Consulting your scientific leadership and clinical operations leadership members to decide on the cognitive assessment tool(s) for your organization.
Engaging an experienced operations manager to maintain daily workflow operations and ensure continued progress.
Referring to scientific and academic publications to support your case for choosing the cognitive assessment tool(s) for your system.
Connecting with legal and procurement support, within your organization or externally, for any required vendor agreements and guidance on the use of a new tool in current workflows.

Building a novel care pathway.

Most healthcare systems are familiar with optimizing and improving existing care pathways. However, in many cases, an early detection program for cognitive impairment is a novel care pathway that requires significant capability-building.

HOW THIS BARRIER MIGHT TAKE PLACE:

Limited shared expertise in the latest disease information including available diagnostic tools and treatment options (both pharmacologic and nonpharmacologic).
Limited infrastructure to enable the use of diagnostics and treatment, leading to potential delays in building resources in the planning stage.
Resistance to change toward the new program, its workflows, and additional responsibilities.

Mitigation Strategy

Leverage champions to plan, manage change, and anticipate iterations

Build organizational capacity and buy-in for the program with sufficient time and targeted support by leveraging the champions’ expertise.

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Tactics Include

Developing a change management plan that addresses gaps in knowledge and potential resistance to the new program.
Providing clear communication about the rationale, goals, and expected outcomes of the program to ease the transition.
Establishing a communication feedback loop with stakeholders to create opportunities to identify and manage any issues as they arise.

Challenges in ensuring health equity and access for the program.

Ensuring the equity of access to and delivery of the early detection program for cognitive impairment is an important consideration that may directly impact the patient population. Patient access issues can be driven by many factors such as language, ethnicity, socioeconomic status, health status, and location.

HOW THIS BARRIER MIGHT TAKE PLACE:

Low health literacy and awareness among patients about early detection for cognitive impairment and Alzheimer’s disease.
Disparities in access to healthcare.
A lack of communication materials that are tailored to the relevant community (e.g., language, comprehension level, format or platform).

Mitigation Strategy

Conduct a thorough assessment of the local community's health needs and access disparities

Understand the target community's needs in terms of language, cultural sensitivities and health literacy around cognitive impairment and Alzheimer’s disease. Based on your findings, determine what needs to be modified in the current practice.

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Tactics Include

Partnering with local community organizations to better understand the health literacy of the target community and strategizing to expand access to care.
Developing education materials aimed at improving brain health knowledge within the community. This can empower people to make informed decisions about their brain health and increase awareness about the program. Ensure the materials are simple and easy to understand (e.g., Grade 5 reading level is recommended).
Involving the community advisory group (if already established) to seek input on how to meet different people’s needs.
Striving for a diverse workforce that represents the community’s demographic make-up, cultural, and language needs. Engage staff in training on providing culturally sensitive and linguistically appropriate care.
Establishing clear health equity goals and metrics. Monitor progress towards these goals to identify improvement areas and stay responsive to community needs.

Difficulty in obtaining and maintaining funding.

In healthcare systems where ongoing funding is not guaranteed, the program may require buy-in and commitment from funders. This is also closely related to raising awareness about the importance of building an early detection program.

HOW THIS BARRIER MIGHT TAKE PLACE:

Difficulty in creating a sustainable, long-term return on investment strategy for the program.
Difficulty in finding sustainable funding for new and integral roles such as Brain Health Navigators (e.g., a designated role to coordinate the care needs of referred patients and develop comprehensive plans to manage care delivery across the patient care journey), social workers, a project manager, and/or an implementation coach (e.g., a role that provides change-management guidance during planning and implementation and act as the liaison between the on-the-ground and managerial teams)
Challenges to securing funding for program sustainment and scale-up efforts.

Mitigation Strategy

Set long-term expectations and continue to communicate the program impact with key stakeholders

Securing funding for an early detection program for cognitive impairment requires various approaches across all phases of the work. It is essential to set an expectation with key stakeholders regarding the long-term benefits for the healthcare system and the target population.

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Tactics include:

Building a business case to demonstrate the value proposition, indicating specific metrics and program progress to highlight the downstream revenue-drivers.
Reporting your program successes to key decision-makers and funders to re-iterate the value of early detection.
Running a fundraising campaign or applying for grants from local advocacy or research organizations.
Working with regional, territorial, or local legislators or centers of excellence to share insights on best practices and potential workarounds to address funding-related issues.
If relevant, looking for reimbursement opportunities in your healthcare system. You may implement a study to monitor changes to cost, savings, and revenue of the program.

Misalignment on the value of early detection in primary care.

The value of early detection for cognitive impairment is often a subject of misalignment for healthcare systems. Many systems and providers have diverse perspectives on diagnostic tools, care pathways, and treatment options. Additionally, stigma surrounding cognitive impairment, Alzheimer’s disease, and related dementias can discourage patients from reporting symptoms and seeking testing.

Moreover, many healthcare systems have historically been organized around acute care and crisis management, so it is challenging to shift to a preventive approach for early detection of cognitive impairment. While there might not yet be global consensus on how to best approach early detection, there are steps that can be taken to help improve care across all healthcare systems.

HOW THIS BARRIER MIGHT TAKE PLACE:

A lack of public awareness and stigma on cognitive impairment, disease progression, the value of early detection, and possible treatment options.
A lack of standardized approaches or guidelines for primary care providers about early detection (e.g., unclear about what can be done to help patients with cognitive impairment).
A focus on pharmacological treatment as the only reason to prioritize early detection.
Challenges to securing funding to launch or scale the program.

Mitigation Strategy

Bridge the knowledge gaps to drive alignment and foster support

People will have different perspectives on the value of early detection depending on their role or experiences. It is crucial to understand the knowledge gaps so training programs can be structured in an effective way.

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Tactics include

Communicating the value of early detection clearly and consistently, with a focus on the benefits to patients and their families, using supportive evidence from publications or other data sources.
Identifying a core set of metrics, outputs, and economic evaluation for the healthcare system to support the economic case for an early detection program.
Partnering with trusted community organizations to disseminate accurate information about the disease and the importance of early detection.
Integrating education about early detection and Alzheimer’s disease and related dementias into the training for other health professionals (e.g., continuing education programs for their respective professional designation).
Using peer-to-peer programs to share success and challenges and building a network to problem-solve together as needed.

Barriers & Mitigation Strategies

Misalignment on the value of early detection in primary care.

Difficulty in obtaining and maintaining funding.

Challenges in ensuring health equity and access for the program.

Building a novel care pathway.

Obtaining novel cognitive assessment tools.

Obtaining novel cognitive assessment tools.

HOW THIS BARRIER MIGHT TAKE PLACE:

Mitigation Strategy

Engage expert support across disciplines

Tactics include

Building a novel care pathway.

HOW THIS BARRIER MIGHT TAKE PLACE:

Mitigation Strategy

Leverage champions to plan, manage change, and anticipate iterations

Tactics Include

Challenges in ensuring health equity and access for the program.

HOW THIS BARRIER MIGHT TAKE PLACE:

Mitigation Strategy

Conduct a thorough assessment of the local community's health needs and access disparities

Tactics Include

Difficulty in obtaining and maintaining funding.

HOW THIS BARRIER MIGHT TAKE PLACE:

Mitigation Strategy

Set long-term expectations and continue to communicate the program impact with key stakeholders

Tactics include:

Misalignment on the value of early detection in primary care.

HOW THIS BARRIER MIGHT TAKE PLACE:

Mitigation Strategy

Bridge the knowledge gaps to drive alignment and foster support

Tactics include

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DAC-SP Early Detection Blueprint