New Developments in Cognitive Retraining Programming & Reimbursement
Transcript of New Developments in Cognitive Retraining Programming & Reimbursement
New Developments in
Cognitive Retraining
Programming
Richard Louis, III, Senior Associate, OPEN MINDS
The 2011 Planning & Innovation Institute
June 16, 2011
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Learning Objectives
Update on the developments in cognitive
retraining programs
Overview of the current applications of
cognitive retraining tools
Discuss the implications for behavioral health
care providers
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An Overview Of The
Latest Developments
For Cognitive
Retraining
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Cognitive Testing: “We‟ve Come Along Way
Baby”
Memory Check Cognitive Testing &
Assessment Program, operated by College
Health Enterprises
Launched in 2004
In partnership with Dr. Karen Miller, Ph.D,
UCLA Center for Aging
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Memory Check Cognitive Testing &
Assessment Program
Service: Provides cognitive testing and
assessment of adults 40 years and older who
are experiencing initial signs of memory loss
Assessment: 3 hour, battery of clinically
proven tests conducted in person by a licensed
Neuropsychologist
Where: Assessment conducted at the office of
the referring psychiatrist, primary care
physician, gerontologist, or neurologist
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Memory Check Cognitive Testing &
Assessment Program (cont.)
Report: Comprehensive 10-page written report
reviewed by the neuropsychologist with
referring physician
Physician meets with patient to present the
findings of report and prescribe treatment or
course of action
Reimbursement: Medicare
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Scientific Discoveries Fueling Commercial
Neuroscience Offerings
Ability to monitor brain functionality using scanning
technologies and new biologic tests
Changing theory of brain development and maturity –
longer and later
Discovery of brain cell regeneration – role of physical
exercise, cognitive exercise, etc.
Better understanding of brain chemistry
Identification of genetic and epigenetic factors in
behavioral and cognitive disability
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Recent Commercial Developments
Better diagnostics – brain scans, biomarkers, and
more – for mental, addictive, and cognitive
disorders
Innovative drug delivery systems – patches,
injectables, and genetically-designed drugs – for
mental illness, addictions, dementias, intellectual
disabilities
Virtual reality and alternative reality treatment
applications
Neurotech treatments
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Neurotherapy Market Has Two Sectors
Stimulation-based or neuromodulation therapies Invasive
• Vagus nerve stimulation
• Deep brain stimulation
Non-invasive • Transcranial magnetic stimulation
• Light therapy
• Frequency-based light & sound neurotherapy
Exercise-based therapies Neurofeedback (EEG, HEG, & rt-FMRI)
Cognitive retraining
Mindfulness meditation
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Definitions
Neurotechnology – Tools that analyze and influence the
human nervous system, especially the brain
Neuroplasticity - The brain's ability to reorganize itself by
forming new neural connections and allows the nerve cells in
the brain to compensate for injury and disease and to adjust
their activities in response to new situations or to changes in
their environment
Cognitive retraining – A therapeutic method of restoring or
improving cognitive skills
Brain fitness - Hypothesis that cognitive abilities can be
maintained or improved by exercising the brain, in analogy to
the way physical fitness is improved by exercising the body.
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Randomized, Double-Blind Study Shows Computer-
Based Cognitive Training Improves Memory &
Attention
Older adults in a randomized, double-blind study, who
received computer-based cognitive training, improved their
memory and attention scores and doubled their cognitive
processing speed, with an average increase of 131%.
The training used The Brain Fitness Program™ software from
Posit Science. Compared to their performance before starting
training, the people improved their memory and attention so
much that their average scores matched age-expected memory
and attention function of adults ten years younger.
Participants reported significant improvements in daily
activities such as remembering names or participating in
conversations.
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ADHD
Study assessed the impact of computerized attention
training and computerized instruction on measures of student
attention, academic achievement, academic productivity, and
student behavior.
Results showed that 6 out of 10 children with 6 or more
ADHD symptoms were asymptomatic after completing 6
months of Captain's Log training, when rated independently.
Only 2 out of 10 of these children who did not receive the
cognitive training became asymptomatic.
Ref: Rabiner D., Murray, D., Skinner, A., ―A Randomized
Trial of Two Promising Computer-Based Interventions for
Children with Attention Difficulties.‖ Journal of Abnormal
Child Psychology. 2010 38(1): 131-142.
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Schizophrenia
After 8 hours of training using the Captain's Log system with
individuals with Schizophrenia, cognitive functioning for
verbal memory and attention were significantly improved and
the negative symptoms of schizophrenia were also reduced.
The importance of this finding is that negative symptoms
(lack of verbal output, lack of emotional responsiveness, lack
of social connectedness, and apathy) are not usually improved
via medication.
Ref: Bellucci, D.M., Glaberman, K., Haslam, N. (2003)
"Computer-assisted cognitive rehabilitation reduces negative
symptoms in the severely mentally ill." Schizophrenia
Research, 59, 225-232.
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Traumatic Brain Injury
Study looked at TBI patients with working memory problems and used a
cognitive rehabilitation treatment program to specifically train them to
improve their working memory skills.
Treatment group was compared to other TBI patients who had processing
speed problems but did not have problems with their working memory
abilities.
The experimental group showed improvement in working memory and
executive function. The control group did not show any improvement in
memory skills after undergoing the cognitive remediation therapy.
Ref: Serino, A., Ciaramelli, E., Di Santantonio, A., Ladavas, E., ―A
Rehabilitative Program for Central Executive Deficits after Traumatic
Brain Injury.‖ Brain and Cognition. 2006 Mar; 60(2): 213-4.
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Parkinson‟s Disease
This study found that specific cognitive rehabilitation
training is needed to improve executive, higher level mental
functioning in Parkinson's patients.
Half of the patients were randomly assigned to the cognitive
rehabilitation treatment group and the other half received the
standard medical treatment for Parkinson's disease.
The cognitive training group significantly improved on two
measures of executive functioning and no improvement was
found in the standard treatment group.
Ref: Sammer, G., Reuter, I., Hullmann, K., Kaps, M., Vaitl, D.
―Training of Executive Functions in Parkinson's Disease.‖
Journal of Neurological Sciences. 2006 Jun 8.
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The State Of The Brain Fitness Market
In a report, titled ―Transforming Brain Health The
State of the Brain Fitness Market 2010,‖ by Sharp
Brains, an independent market research firm found:
The Internet is becoming a primary distribution
vehicle for brain fitness software
Few vendors have developed on-line mobile
platforms to deliver the software and services
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The State Of The Brain Fitness Market (cont.)
Adults over the age of 50 appear to be
adopting brain fitness technology as a
mainstream aspirational and lifestyle choice
The development of education-focused
cognitive training programs received a boost in
2009 from federal funding and research linking
cognitive and self-regulation capacities to
academic performance over time
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The State Of The Brain Fitness Market (cont.)
The largest customer segment deploying brain
fitness software includes provider
organizations such:
Insurers
Health plans
Senior living chains
Brain-based clinical decision support systems
are becoming available and integrated into
electronic health records
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Brain Fitness Software Market Continues to
Grow
Between 2007 and 2008, the fledgling market
for brain fitness software increased from $225
million in 2007 to $265 million in 2008
Currently more than 700 residential senior
living facilities and communities have installed
computerized cognitive training programs
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By 2015, Brain Fitness Software Market
Projected to Reach $2 Billion
The worldwide digital brain health and fitness
software market was valued at $295 million in 2009
By 2015, the market value has been projected to
increase nearly tenfold, reaching at least $2 billion,
with the possibility of reaching up to $8 billion
The 2009 market value was 35% higher than the 2008
value
Since 2005, the market has experienced an annualized
growth rate of 31%
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Brain Fitness Software Market Segments
Health care provider organizations
Schools
Consumers
Employers
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United States market leaders In 2009:
The Schools Market
The school market was valued at $90 million,
a 38% increase over the 2008 value of $65
million
The market leader was Scientific Learning
The market focus was on addressing
underlying learning problems
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United States market leaders In 2009:
The Consumer Market
The consumer market was valued at $70 million, a
40% in crease over the 2008 value of $50 million
The market leaders were:
Lumos Labs
Posit Science
Market focus was maintaining or enhancing targeted
cognitive functions
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United States market leaders In 2009:
Employer Market
The employer market was valued at $40
million, a 60% increase over the 2008 value of
$25 million
The market leader was Brain Resource
Market focus was on improving productivity
via enhanced brain health and wellness
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United States market leaders In 2009:
The Health Care And Insurer Market
The health care and insurer market was valued at $95 million,
a 18% increase over the 2008 value of $80 million
Market focus was the delivery of scalable, cost effective,
evidence-based solutions for cognitive and emotional health.
The market leaders were
Brain Resource
CogniFit
Posit Science
Ultrasis
United BioSource
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An Update On Current
And Potential
Applications In
Behavioral Health
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Companies In The Business
Product Company
Brain Fitness Program Posit Science
Brain Training Solutions Brain Resource
Cognitive Training CogniFit
My Brain Solutions Ultrasis
CDR System United BioSource Corp.
Adaptive Computerized Cognitive
Training New England Cognitive Center
Neurofeedback Training The Center for Cognitive Enhancement
Mobile Training Lumosity
BrainAge Games BrainAge
Brain Fitness Software Dakim
Brain Games Fitbrains
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PositScience: Cognitive Enhancement
Programs
Auditory System
Visual System
DriveSharp
Compatible with Mac and Windows
Cost: $690 (Auditory and visual)
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Technology-Based Cognitive
Enhancement Programs
Posit Science study shows
that brain fitness software
can improve memory and
attention in older adults
Increased processing speeds
averaging 131% in
participants
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Auditory System
The Brain Fitness Program is Posit Science's clinically proven,
award-winning software for a sharper brain.
The Brain Fitness Program speeds up and sharpens auditory
processing—the listening system of the brain. By improving
the quantity and quality of what your brain takes in through
sound, it drives an overall improvement in thinking, focus, and
memory. Use the Brain Fitness Program to: Improve memory
by 10 years
Speed up auditory processing by 131%
Find words on the tip of your tongue
Participate in and remember conversations more fully
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Visual System
The InSight brain fitness software targets visual processing—how
efficiently your brain takes in and reacts to what you see
The Benefits of InSight Brain Fitness Training
Clinical studies show that training with InSight: Speeds up visual
processing by up to 300%
Helps people take in more with each glance
Improves brain activation in areas related to attention and focus
These improvements lead to generalized gains, too. Studies also show that
InSight:
Enables people to drive more safely and confidently
Helps people to be more effective, efficient, and in control of everyday
tasks
Allows people to retain health-related quality of life and independence over
time
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DriveSharp Brain Fitness Program
DriveSharp brain fitness software is clinically proven
to make people safer drivers.
Decades of research show the technology in
DriveSharp: Speeds up visual processing and
increases "useful field of view" so drivers see more of
the road with each glance
Decreases reaction time, so drivers can stop 22 feet
sooner at 55 mph
Cuts at-fault crash risk by 50%
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Posit Science Launches Brain Odyssey—Free
On-Line Brain Games!
Posit Science has launched a free social networking web site
that offers team cognitive training exercises.
The site went live on October 4, 2010. Although the games are
free, the web site operates like a multiplayer platform by
offering virtual goods that can be purchased to further progress
through the game.
The game is targeted at older adults, and the move is geared at
expanding the availability of cognitive training, which has
been proposed as a way to delay onset of Alzheimer‘s disease.
The prevalence of dementia world wide has been projected to
triple by 2050.
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Brain Fitness Program Studies And Research
1. Evaluation of Approaches to Auditory
Rehabilitation For Mild TBI
2. Brain Fitness in Parkinson's Disease
3. Cognitive Training for Post-Traumatic Stress
Disorder (PTSD)
4. The ACTIVE cognitive training interventions and
the onset of and recovery from suspected clinical
depression
5. Combined Cognitive Remediation and Vocational
Therapies for Schizophrenia
6. Improving Task Engagement in Schizophrenia
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Evaluation Of Approaches To Auditory
Rehabilitation For Mild TBI
This in-progress study is testing the efficacy of
the Brain Fitness Program on improving
auditory performance in veterans with mild
traumatic brain injuries.
In: N/A - Study in progress
Program: Brain Fitness Program
At: Portland VA Medical Center
Indication: Traumatic Brain Injury (TBI)
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Brain Fitness In Parkinson's Disease
The goal of this in-progress study is to
determine whether the Brain Fitness Program
improves outcomes for people with
Parkinson's disease.
In: N/A - Study in progress
Program: Brain Fitness Program
At: University of South Florida
Indication: Parkinson's
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Cognitive Training For Post-Traumatic Stress
Disorder (PTSD)
The goal of this in-progress study is to determine
whether cognitive training improves outcomes for
veterans suffering from post-traumatic stress disorder
(PTSD.)
In: N/A - Study in progress
Program: Brain Fitness Program
At: SF Veterans Administration Medical Center /
University of California, San Francisco
Indication: Post Traumatic Stress Disorder (PTSD)
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The ACTIVE Cognitive Training Interventions And
Onset Of And Recovery From Suspected Clinical
Depression
This study examined the effects of cognitive training on 1606
people without suspected clinical depression at baseline. Only
the Posit Science program intervention group had a significant
effect on depression, with its participants being 38% less likely
to develop suspected clinical depression at a 1 year follow-up.
In: Journals of Gerontology
Program: DriveSharp
InSight
At: Iowa City Veterans Administration Medical Center,
University of Alabama Birmingham, Posit Science
Indication: Depression, Healthy Aging
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Combined Cognitive Remediation And
Vocational Therapies For Schizophrenia
Study of individuals with schizophrenia
combines Posit Science programs and
vocational therapies to measure improvements
in cognitive tasks, task engagement, and
everyday function.
In: N/A - study is in progress
Program: Brain Fitness Program
At: Yale New Haven Medical Center
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Improving Task Engagement In
Schizophrenia
People with schizophrenia frequently have
impairments in attention which have been shown to
be related to overall functioning. Study goal is to test
whether the Brain Fitness Program improves task
engagement in individuals with schizophrenia.
In: N/A - study is in progress
Program: Brain Fitness Program
At: Columbia University, Yale School of Medicine
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Posit Science Announces Success in Reversing „Chemobrain,‟
the Debilitating Side Effect of Chemotherapy Experienced by
75% of Breast Cancer Survivors
Using the computer-based Posit Science Brain Fitness
Program™ may improve mental function in cancer patients
with symptoms of ―chemobrain,‖ a condition that affects three
of four breast cancer survivors who undergo chemotherapy.
―Chemobrain‖ impairs concentration, memory, and decision-
making skills, and can cause anxiety and depression.
About 94% of participants in a recent study of women
suffering from ―chemobrain‖ reported statistically significant
improvements in cognitive function, stress levels, and health-
related quality of life after using the Posit Science Brain
Fitness Program.
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Brain Resource: Brain Training Solutions
www.MyBrainSolutions.com
Online brain Assessment to identify your brain
profile that is automatically matched to the
best brain training exercises to optimize your
wellness & brain function
Computer Games
Interactive Videos
Cost: $10-month, $24-quaterly, $72-annually
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Research Solutions
Brain Resource proprietary platforms are used
to predict who will best respond to what drug
( iSPOT ) , develop new drugs
( PharmaceuticalTrials ) , and discover new
brain insights ( Discovery Science)
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OptumHealth Behavioral Solutions Partners
With Brain Resource
OptumHealth Behavioral Solutions and Brain Resource have
entered into an agreement that provides for Brain Resource‘s
WebNeuro and MyBrainSolutions to be incorporated in
select OptumHealth offerings in the US Managed Care market.
Through the partnership we provide the standard for reliably
measuring brain health with goals to:
Engage Employees, Employers and Care Providers in
improving brain health, minimizing risk, maximizing
productivity Make best use of limited resources
Reduce overall health costs by early detection of
behavioral health issues and better management of brain
health to keep people well
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OptumHealth Behavioral Solutions Partners
With Brain Resource (cont.)
OptumHealth Beahvioral Solutions will work with
Brain Resource to provide clinicians with a Web-
based assessment that measures general cognition
(how people process information) and social
cognition (how people manage their emotions).
This 40-minute assessment is based on well-known
and validated tests of memory, attention, executive
function, and response speed, and mood, social skills
and emotional resilience.
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CogniFit: Personalized Brain Fitness
Online technology developed and patented by
CogniFit that provides an automated
assessment of one‘s cognitive profile
Builds a matching brain training program that
is optimized to fit that profile
Provides an assessment cognitive abilities
Memory
Attention
Perception
Focus
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CogniFit: Personalized Brain Fitness (cont.)
Cognitive abilities ranking
One hour a week
Cost: Free
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CogniFit Studies And Research
CogniFit Personal Coach for Patients with Multiple
Sclerosis
Cognitive training with CogniFit Personal Coach
boosts reading skills in dyslexic students
Improving Cognitive Performance in Elderly
Subjects Using Computerized Cognitive Training
CogniFit Personal Coach Program Improves
Cognitive Abilities Among Older Adults
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CogniFit Personal Coach For Patients With
Multiple Sclerosis
The findings are evidence that cognitive
training can significantly improve a wide range
of memory skills in MS patients.
Article published in NeuroRehabilitation 26
(2010) 143–153.
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Cognitive Training With CogniFit Personal
Coach Boosts Reading Skills In Dyslexic
Students
When dyslexic college students trained with
CogniFit Personal Coach®, their brain
activity, working memory and reading
performance were shown to increase
significantly, and results lasted up to six
months after training.
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Improving Cognitive Performance In Elderly
Subjects Using Computerized Cognitive
Training
The results show that systematic, individually
tailored training can improve several important
functions. Abstract published in Alzheimer's &
Dementia: The Journal of the Alzheimer's
Association, July 2008 (Vol. 4, Issue 4, Page
T492)
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CogniFit Personal Coach Program Improves
Cognitive Abilities Among Older Adults
People who played computer games showed an
improvement in performance, but for people
who used CogniFit Personal Coach, the
improvement was significantly greater.
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Ultrasis: My Brain Solutions
Ultrasis is the market leader of computer
delivered, interactive healthcare products;
providing user friendly and cost effective
solutions for:
Healthcare professionals
Corporate market
Individual consumers
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Ultrasis: My Brain Solutions
BrainSolutions delivers employers with
affordable, scalable and completely confidential well
being and performance solutions to their employees.
MyBrainSolutions is an interactive brain training site
which brings together a brief objective brain
assessment, games, videos and trackers designed to:
Reduce your stress
Boost your memory and attention
Maximize your positivity
Cost: $10-month, $24-quarter, $72-annually
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Beating The Blues:
Cognitive Behavioral Therapy
Beating the Blues has been proven to help people suffering
with mild and moderate depression to get better and stay better
and is based on Cognitive Behavioral Therapy (CBT)
It is a way of helping people to learn to cope with anxiety and
depression and has been recommended for use in the NHS by
the National Institute for Health and Clinical Excellence
(NICE).
Beating the Blues brings all the benefits of CBT directly to
your patients by the use of computer and multi-media
technology which means that you can access the treatment
when and where you want. This type of therapy is referred to
as Computerized CBT.
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United BioSource Corporation: CDR System
UBC offers the computerized CDR System to assess
the major aspects of cognitive function known to be
influenced by medicines and disease, including
attention/ concentration, short- term working memory
and long-term episodic secondary memory.
The CDR System can be utilized in any clinical
setting and with any population, throughout the drug
development process, from first-in-man trials to
global trials during phase III and IV.
Cost: Not available
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Scientific Learning: FastForWord Program
The Scientific Learning family of software
products strengthens brain processing and
literacy skills to increase reading proficiency
in students of all ages.
The Fast ForWord program is a reading
intervention program designed for K-12
education institutions and clinical specialists,
whose students are struggling and reading
below grade level.
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Scientific Learning: FastForWord Program
(cont.)
The Fast ForWord program develops and strengthens:
Memory
Attention
Processing rate
Sequencing
The strengthening of these skills results in improved
critical language and reading skills
User qualifications: Professional or State Board of
Education Certification, e.g., Audiologist, Speech-
Language Pathologist, Psychologist, Educator, etc.
Cost: Not available
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New England Cognitive Center: Adaptive
Computerized Cognitive Training
ACCT is designed to maintain or enhance cognitive
fitness utilizing computer-based activities and offers a
complete mental fitness workout on the computer.
ACCT offers a wide range of challenge levels,
making it a highly flexible program which may be
adapted to each client‘s functional and personal
needs.
Client and caregiver feedback indicate improvement
in areas such as concentration, decision making, self-
esteem, socialization, self-confidence and quality of
life.
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State of Connecticut Support For NECC
Since 2004, NECC has received ongoing financial
support from the Aging Services Division of the State
of Connecticut Department of Social Services.
An three-year research grant was followed by the
establishment of a dedicated line item in the State
budget.
The funds have been used to underwrite research
efforts, contribute to the development of programs,
and serve individuals with Alzheimer‘s disease and
dementia.
Cost: Not available
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Center For Cognitive Enhancement :
Neurofeedback
EEG biofeedback, or neurofeedback, has been
used successfully for over two decades at the
clinical level on the effects of stress, epilepsy,
ADHD, anxiety disorders, depression,
fibromyalgia, chronic fatigue syndrome,
addictions, post traumatic stress disorder,
obsessive compulsive disorder, TMJ, and pain
management
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Center For Cognitive Enhancement :
Neurofeedback (cont.)
Neurofeedback is best provided by experienced EEG
biofeedback specialist or neurotherapist
Treatments range from 10 to 50 sessions
Treatments usually involve one hour of training two
to three times per week
Cost: Affordable financing is available on their
website
Brain mapping and EMDR also available
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Lumosity: Personalized Brain Training
Lumosity.com provides users with constant
access to an ever-growing library of brain
games, training courses and assessments.
Training courses typically consist of 20 to 40
daily sessions. During these daily sessions,
users complete 3 to 5 different exercises over
the course of 10 to 15 minutes.
Lumosity selects these exercises based on your
specific training goals and priorities.
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Lumosity Automatically Tracks Your
Progress
Your Brain Profile Index, gives you an instant
snapshot of your improvement across five core
cognitive areas: speed, flexibility, memory, attention
and problem-solving.
Calculate BPI using not just your results, but also
those of other users within five years of your age.
BPI gives you a sense of how you compare to others
in your age bracket.
Cost: Registration free (fee for some services)
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The Nintendo DS
The Brain Age games feature activities
designed to help stimulate the brain and give
by solving simple math problems, counting
currency, drawing pictures on the Nintendo DS
touch screen
Cost: $19.00 (purchase at online retailers:
Amazon, Target, Best Buy, WalMart)
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The Benefits of Dakim BrainFitness
Dakim BrainFitness Software provides rigorous cognitive
exercise, cross-training the brain in six cognitive domains
Long-term memory
Short-term memory
Language
Computation
Visuospatial orientation
Dakim‘s exercises are presented at five levels of challenge to
meet the needs of patients with a broad spectrum of cognitive
functionality—at the highest level, appropriate for patients
with the highest brain function, and at the lowest level,
Appropriate for patients with cognitive impairment or
dementia.
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Dakim BrainFitness Program Raises Memory
Improvement Scores
Elderly adults who played Dakim BrainFitness program over a
six-month period of time increased their memory scores by
almost two points, from 10.4 to 12.1.
The results indicated that longer use of the BrainFitness
program was likely to produce ongoing improvement in visual
and verbal memory over time.
A pilot study was also done before launching the clinical trials.
In the pilot study, 22 elderly adults were assigned to the
Dakim BrainFitness computerized game or to an active control
group. Participants used the game five times a week for half an
hour each time for two months. After the two months, a
modest effect size was seen on one memory test.
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Dakim BrainFitness Software, Professional
1. Speech pathologists
2. Occupational therapists
3. Recreational therapists
4. Neurologists
5. Neuropsychologists
6. Gerontologists
7. Geriatric psychiatrists
8. Geriatric care managers
9. Nurse practitioners
10. Audiologists
11. Licensed clinical social workers
12. Rehab companies
13. All other healthcare professionals who provide therapy for cognitive impairment
Cost: $249.00 (software)
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Fit Brains Games
Fit Brains provides scientifically developed
brain games targeting the five major brain
areas:
Memory
Problem solving
Concentration
Visual spatial
Language
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Fit Brains Games (cont.)
Online service provides access to:
Brain circuit training
Tracks progress
Brain assessment
Earn awards
Cost: Free registration (fee for some services)
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Implications Of These Tools For Consumers
Easy access and convenience
Can be used at home or work
Consumers may experience immediate
progress
Can be used in adjunct to traditional treatment
and therapy
Improved treatment compliance
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Implications Of These Tools For The
Behavioral Health Market: Service Providers
Relatively low cost to incorporate
Does not require licensed staff
Tools can be provided in conjunction with
existing treatment programs and services in a
variety of settings:
Outpatient
Residential
Home based
School based
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Tools As Service Line Expanders
The addition of cognitive retraining programs
to existing service lines may:
Expand your current patient base
Lead to new referral sources
Add a new billable service
Expand current continuum of care
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Potential Market Advantages
Adding these tools to your service lines may
improve your competitive edge in the market
Creates an opportunity to repackage and
promote existing programs
Demonstrates organizational vision by
providing innovative programs to better meet
consumers, payer and the community needs
Enhanced focus on community-based services
Great PR
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Potential Market Advantages (cont.)
Opportunity to revisit current and / or contact new
payers
Out-of-site, out-of-mind
Review with payers current and / or establish new
rates of reimbursement for existing and new services
Promote outcomes with payers and referral sources
for new contracts or to obtain reimbursement
Reduced consumer length of stay
Improved medication compliance
Reduced no show rate
Improved grades for youth
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Reimbursement
Aetna considers cognitive rehabilitation as adjunctive
treatment of cognitive deficits (e.g., attention, language,
memory, reasoning, executive functions, problem solving, and
visual processing) medically necessary when all of the
following are met:
The cognitive deficits have been acquired as a result of neurological
impairment due to trauma, stroke, or encephalopathy, and
The member has been seen and evaluated by a neuropsychiatrist or
neuropsychologist, and
Neuropsychological testing has been performed and
neuropsychological results will be used in treatment-planning and
directing rehabilitation strategies, and
The member is expected to make significant cognitive improvement,
e.g.,is not in a vegetative or custodial state.
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HealthNow New York Medicare Advantage:
Cognitive Rehabilitation
Cognitive rehabilitation is a therapeutic approach designed to
improve cognitive functioning after central nervous system
insult.
Therapy methods that retrain or alleviate problems caused by
deficits in attention, visual processing, language, memory,
reasoning, problem solving, and executive functions.
Cognitive rehabilitation consists of tasks designed to reinforce
or re-establish previously learned patterns of behavior or to
establish new compensatory mechanisms for impaired
neurological systems.
Cognitive rehabilitation may be performed by a physician,
psychologist, or a physical, occupational, or speech therapist.
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HealthNow New York Medicare Advantage:
Cognitive Rehabilitation (cont.)
Cognitive Rehabilitation may be medically necessary
for persons with acquired cognitive defects resulting
from head trauma, or acute neurologic events
including cerebrovascular accidents.
It is not medically necessary for patients with chronic
progressive brain conditions with no potential
restoration.
Be provided by a qualified licensed professional and
must be prescribed by the attending physician as part
of the written care plan.
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HealthNow New York Medicare Advantage:
Cognitive Rehabilitation (cont.)
Must be a potential for improvement (based on
pre-injury function) and patients must be able
to actively participate in the program
Duration and intensity of cognitive
rehabilitation therapy programs vary
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HealthNow New York Medicare Advantage:
Cognitive Rehabilitation (cont.)
One approach for comprehensive cognitive
rehabilitation is:
16-week outpatient program
Five hours of therapy a day
Four days a week
Cognitive group treatment occurs for three two-
hour sessions each week
Three one-hour individual sessions (total of nine
hours per week)
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The Association for Applied Psychophysiology &
Biofeedback: Guidelines for Third Party
Reimbursement for Biofeedback
To determine if you will be paid for biofeedback
services, you should call the insurance company and
verify coverage
Note the basic details of coverage may be available
on-line
Payment may be restricted to participating providers
or there may be higher deductibles and increased co-
pays if you are not a network provider
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The Association for Applied Psychophysiology &
Biofeedback: Guidelines for Third Party
Reimbursement for Biofeedback (cont.)
Some services may require preauthorization
Many insurance companies have (long) lists of
excluded services, and the biofeedback codes are
often on these lists
In other cases, the procedure codes will only be paid
if the diagnosis code is from a list of covered
conditions.
Example: The basic mental health procedural codes, like
90806, used by psychologists and counselors are only
covered when the diagnosis is for a psychiatric or
developmental disorder.
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The Association for Applied Psychophysiology &
Biofeedback: Guidelines for Third Party
Reimbursement for Biofeedback (cont.)
There is a relatively small set of procedural codes for
biofeedback.
There are two pure biofeedback codes
90901 any modality of biofeedback
90911 pelvic floor training for treatment of incontinence
There are also two codes for mental health providers
90875 and 90876.
These refer to sessions that combine biofeedback with
some kind of talk therapy or counseling—90875 for a
25 minute session and 90876 for a 50 minute session
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The Association for Applied Psychophysiology &
Biofeedback: Guidelines for Third Party
Reimbursement for Biofeedback (cont.)
The 90806 code is for psychotherapy, not
biofeedback, and providers combining
biofeedback and psychotherapy are advised to
use 90876 or 90875
The 97532 code refers to cognitive retraining
typically been used by speech and language
pathologists working to improve cognitive
function of patients with cognitive deficits
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The Association for Applied Psychophysiology &
Biofeedback: Guidelines for Third Party
Reimbursement for Biofeedback (cont.)
All Medicare carriers are now paying for the health
and behavior intervention codes.
In Florida, the allowance is $97 for the evaluation
(96150—1 hour or 4 units) and $89 for individual
treatment (96152—1 hour or 4 units)
The federal workers‘ compensation program
(http://owcp.dol.acs-inc.com/portal/main.do) will pay
for biofeedback training
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The Association for Applied Psychophysiology &
Biofeedback: Guidelines for Third Party
Reimbursement for Biofeedback (cont.)
The best advice is to:
Be persistent and prepared
Verify coverage for all possible biofeedback codes
for all of your patients
Coverage often varies widely based upon the
specifics of a given contract and may include
restrictions based upon type of licensure
If you get a rejection initially, contact a
supervisor, case manager or provider relations
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The Association for Applied Psychophysiology &
Biofeedback: Guidelines for Third Party
Reimbursement for Biofeedback (cont.)
Many providers have reported success in
getting reimbursement for biofeedback
services, but it often requires getting
authorization on a case-by-case basis.
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Are These Diagnostic Tools?
In an interview with a Brain Resource
representative they answered:
Brain Resource applications look at the person,
not the disease. Applications are evidenced-
based decision support tools that can assist
providers in clinical assessment, evaluation,
and decision making process.
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Do Some Of These Applications Constitute
Treatment?
In a July 2008 press release Greg Bayer, CEO
of OptumHealth Behavioral Solutions,
positioned the applications as ―aiding
treatment‖.
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Are These Technologies Cost Effective?
In a Market Watch interview in 2009, Dr. Eugene
Baker, Vice President of EAPs for OptumHealth
Behavioral Solutions responded:
―Improving brain health can result in less
‗presenteeism‘, the tendency to be at work but
distracted and not able to focus. If you look at the
disability costs, absenteeism and presenteeism
account for most of the medical costs, and that‘s a
good reason for employers to be focused on brain
health.‖
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What Are The Outcomes?
In a March 2009 issue of Biomedicine, Mary
Furlong, Ed.D, a leading authority of aging
and consumer technology, stated, ―Consumers
should look for products with published
studies showing the product worked.‖
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Computer Assisted Cognitive Retraining
Program: Clinical Considerations
1. Does the accompanying literature clearly define the objectives
of the program?
2. Does the program address what it claims to address?
3. Is the reinforcement and feedback immediate, friendly and
appropriate?
4. Is the program interesting?
5. Are the instructions easy to follow?
6. Are appropriate and useful data collected and analyzed?
7. Where would the program fit within your treatment model?
8. How much supervision is needed?
OPEN MINDS © 2011. All Rights Reserved.
“The purpose of business is to create and keep
a customer.” Peter F. Drucker
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Upcoming Educational Events Human Services Leadership Academy Seminar: Financial Risk Management
Best Practices for Executive Teams & Boards, July 18, 2011, Ewing, New Jersey www.openminds.com/njacp
Human Services Leadership Academy Seminar: Strategic Planning & Marketing Planning: Developing Your Organization Tactics for Success, September 27, 2011, Ewing, New Jersey www.openminds.com/njacp
The 2011 OPEN MINDS Executive Leadership Institute: Discover the Lessons of Great Leaders in Times of Crisis, October 5-7, 2011, Gettysburg, Pennsylvania www.openminds.com/eli
The 2011 OPEN MINDS Institute for Behavioral Health Informatics: The 7th Annual Conference on the Future of Technology in Behavioral Health, October 19-21, 2011, Baltimore, Maryland www.openminds.com/ibhi
The 2012 OPEN MINDS Best Management Practices Institute: Finance and Technology to Maximize Performance, February 16-17, 2012, Clearwater Beach, Florida www.openminds.com/bmpi
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