Alzheimer's Disease and Dementia Advisory Council

meeting back in july and we want to continue that discussion we've been doing with a lot of research we have a lot of guests who are coming up here to share information but before we get too far I want to introduce senator clinton pinso who is now going to be joined in this committee it's the cochair sinerki hill love serving on this committee but he has a lot of other duties and so he is uhm letting clint pinso take over and i'm going to like clint kind of introduce himself and say why this committee is important by the way we key hill said he still wants to be involved and informed and wants to be helpful so he's not leaving he's just letting someone else come in and get involved to a black said my name is copinson from northwest arkansas live in spring new represent district thirty one which is tony town elmspring springdale and johnson all in washington and county my wife when when senator hill asked me if I wanted to be involved in the group at told him absolutely my deads got early dimension and so I kind of have a personal you know connection to this committee so I was thankful that I was asked to do it and I don't know if they knew my situation when they asked but I couldn't say no so looking forward to working with you all over in the future thanks and he has on purple and i've got on purple to so I don't even have did you did you play in that purple okay purple for all's hammers so okay first thing we need to do is approve our mish are our mission our motion approve our minutes i'm gonna get the right word down to prove our minutes do I have a motion for that. So move is there a second second all in favor say I anyone opposed okay motion okay we are going to pick up so just to remind ourselves uh doctor way gave an absolute fantastic presentation at our last meeting on all the timers medications I mean here we are so excited that now there's something out there that might be able to help and we know that things were only going to get better from this point forward with some other things in the future but you brought up a lot of interesting concerns and so we bought some folks to the table some of those concerns were that we had this new medication is it going to be available in arkansas like physically is it actually going to be in the state of our console for anybody to get so we're going to have the pharmacy association kind of address that in let us know we have also then began to question so do we have these medications require an early diagnosis of all cybers how do we get that early diagnosis of alzheimer's to even qualify for the medication then the next hurdle is will insurance companies pay for it so we've done a lot of investigating we have two letters that will address here in just a second from some insurance companies when we get to that but very first thing let's start off if you don't mind we brought in the pharmacy association because we first want to talk about if these medications are even going to be available to people in the state of arkansas so uhm first on our list john vincent chief executive our officer the arkansas pharmacist association i'm going to introduce some of the other people who were here in the room uh george johnson the professor of pharmacy practice that the university of arkansas medical sciences wave your hand there you go and on the. Bone on online here we have representing the eligible company and that's marine jaffa not lor cohen so ignore that it's marine chafer we also have elizabeth hitman from the director of meda- uh director of medical services here in arkansas who will be joining us as well so john i'm gonna let you have the first word can we get this medicine in arkansas also my name is john vincent i'm ceo the arkansas pharmacies association and just for the record because I have one of my colleagues in a student pharmacist one him just introduced himself. Hello everyone my name is haden wood MA second year student pharmacist at the u m s college forms team are from ramp floral near batesville in northeast arkansas i'm just here to help out with today's presentation and I am also a licensed pharmacist here in the stay and practice for many years prior to advocacy world and the association world and just like senator pinzo I have this disease and my family too in my immediate family so i'm this is important to me and i'm very pleased to be asked thank you for inviting us to be here today so just want to based on I did watch the last hearing and was able to see that see discussion great presentation and information shared based on what i've been able to research and understand and then we're happy to answer questions but just to make a real quick overview of of what's going on in this space so most prescriptions that are filled at local pharmacies the bass majority of prescriptions are assessable in the pharmacies but there's a growing number of new medicines that are coming to market that are more expensive they're more complicated they have uh special montreal in I know all of you heard about that at the last meeting about special in our machine has to be in fused over a few hours and under the supervision of health care professionals and then follow that because of some of the really severe cerefects and that is not unique to this drug there are lots of new medicines that are they are coming on the market that require greater level of of overside and and more complicated in terms of how they're ministered we've been used to that and the chemotherapy space for cancer but we're seeing that more and more with many other disease states beyond just the oncology or cancer state in this drug as fall under that category the the drug it's currently available and you heard a presentation about two and one that's not yet available in one that is. Or can be is the drug that is currently available or at least it's been approved when I say it's currently available it's been fda proved for use it the early approval in and this would probably be better to ask directly of easa from the pharmacy command factor industry but i'll give you my perspective from the pharmacy perspective so with the classive trades that are currently approved or allowed by the manufacturer so this is not a federal our status state law this is being determined by the manufacturer currently they're allowing certain dispensing physicians certain hospitals and infusion sights of care and I can't comment today on which of those would be allowed you'd be better asking hospital association or medical society on clinics or our hospitals are infusion centers that are in the medical side but from a pharmacies perspective there are some pharmacies that if they have an infusion sweet or chair that's allowed to do this and there are none of those in arkansas that I know of but i'm that mean there couldn't be but i'm not aware of that in the specially pharmacies or pharmacies that deal in harcost five thousand dollars a month prescriptions and above or and really the definitions probably a thousand dollars a month and about but the the most average procedure five thousand dollars. Uhm we we do have a handful of those in the state that special wires and that one here in whistle iraq uh of wall green specially infusion or nonfusion but especially pharmacy here and in moderate and hardly end and there's one insertion that in theory could do this but at least initially based on demand and what's been decided by the manufacturer there's only a single pharmacy in the entire country that is allowed access currently so it's limited distribution that doesn't mean that farmer or esa won't expand that if there is how utilization or better coverage by insurance companies but at least on their initial car scope of the market and look in it where this looks to be watching they have started with a single specially pharmacy that specially pharmacy so ayo s o l e o just for those of you may not have ever heard of it they're based out of frisco texas in the dow sport worth area first goes um not too far from us in terms of location but the actual physical location of the pharmacies that would dispense these if they were needed for according acre infusion center that couldn't get it directly would come from tempy arizona or cincinnati ohio so they they do have two senses in the state that are in good standing with state board of pharmacy. In the state board of pharmacy be better to get directly from john curt or your his team but my understanding from talking to the staff at the state board of pharmacy is they would allow soyo because this drug has to be administered under a physician or under qualified health care professional sectors practitioner physician with the right monitor and equipment they would allow if the soleo did fill the prescription for it to be mailed and delivered directly to the coin acre hospital so it doesn't have to be mean ordinarily prescriptions are sent to patients how many direct with patience but because of the way this one is is administered in this unique circumstances around it I just want to clarify that not our deal i'd like for it to be assistant arkansas based pharmacies especially if we're going to spend state dollars on these kind of drugs that love for there to be better access but the current situation based on the demand and what's expected from manufacturers there's a single pharmacy in the specially world part of either tip years on it or out of oh and i'll stop there and see what questions the committee has any questions from the committee. None okay thank you for hanging out because we got i'm i'm sure others will come up as we continue to to talk about this did you have anything i'm just sure like one counter closing community I know we're talking about alzheimer's and we're talking about a single drug right now but I do think for especially for legislators in the room for my policy perspective this is going to continue to come up over and over for other disease states with heart disease with asthma with long disease and others to tave a policy discussion about how to ensure access locally I just like to leave you with that very good information we didn't have any of those answers before we now know so uhm so there is a possibility that someone could get that medication a whole bunch of hoops to get through but then who's covering it so let's see if we can talk a little bit about that so you'll see in your packet you have two letters and hand out sea unfortunately uh jack hopkins with seventeen and also uhm max green blood with blue cross could not be here today they very very much want to uh testify before the committee and said that they would come to another meeting and you could ask more questions i'm going to briefly read a little bit of the letter from santanee says regarding liquimbi and like saying that correctly ok okay the drug mentioned in the democrat is that letter to the editor we do cover for an initial approval duration of three months six doses of confusion and the drug must be prescribed by or in consultation with the jerry attrition or neurologists there were a few requirements for authorization namely documented presence of beta emoloyed. Functional and cognitive test etc general standard documentation for approval regarding the prospect of new drugs entering the market because we will talk about we have eligible on the phone we will talk about some potential other medications said they're all evaluated by our pharmacy and therapeutics company or committee and the evidence reviewed as far as safety and efficiency than a decision is made whether to include that based on that short summary of of his letter blue cross you can breathe and detail it's actually several pages long I feel like doctor jewel johnson whose with us might be able to go into more detail because I think her comments will be similar to this so i'm just going to give a nutshell is that blue crosses saying that they will not cover it I have also heard from. Derek smith who represents united health and they are still determining so we do not know from united health so uhm jill johnson i'm gonna let you go ahead and and speak you are here representing employee benefits division do you mind sharing with uh some of the concerns there you have discovered with me can be certainly thank you for having me my name is jill johnson I am a political pharmacist at work at ua um for thirty years I still work on an acute care and patient team for about nineteen years of worked with the evidence based prescription drug program and ebd is one of our clients along with our own UA systems in several other plans who who provide insurance and pharmacy benefits for their employees I teach evidence based medicine at uams have for twenty years now and have a chair the EBRX pharmacy in the reputation's committee so much of what our saturday about how we voted has to do with the collective group of people but i'll tell you what we found when we've looked at it so it can be is a drug alternative patients have to be put on it early in their disease when they have malcognitive impairment or mild dimension and they have to go and get an infusion every two weeks when they got the fda approval and they measure the primary in point on the trial the way that they measured whether or not it was effective with something called the clinical dimension rating some of boxes and it detects it supposed to detect their functionality like how how well their functioning how other caregiver thinks they're functioning and it collects that so it's an eight to a range of zero to eighteen and what's good. About like can be is that it did slow the progress statistically it didn't start bet people still progress with their um also must disease on the drug but plus siebel progressed faster so then when you look at the difference between how fast placebo progress and how fast they progressed on the drug the difference was only point four five points and therein lies the problem there's something called the minimal clinically important difference in that has to do with how a patient feels cause that's really who who matters here right and so. All those statistically can be slowed the progression of all sharmers it wasn't to the degree that patience could feel the minimal clinically important difference with similar between one and two points in even on the far end of the range the best they got was a slowing off point set six seven so they didn't exceed they didn't reach the threshold of the point where a patient can tell they're taking it can feel it on average in addition there were several there are adverse reactions not only are you at risk for infusion reaction those can be managed it's probably why we don't see the drug being we know one reason that it's not been rolled out it's because pharmacies typically don't have offices where they're set up in case they have a reaction it's one thing to have an office to get the infusion but what if something goes wrong they've got to be staff to be able to handle what's going wrong in these patients if it happens in addition to the app one of the things that we know happens in not only the original drag you probably remember add you home it got all kinds of news uhm this second alzhemmer's drug also has this problem a coloria it's amalloid related what's it staying for imaging about your malities on pet scan some of them are demands a member hemorrhage uhm the rate differences for a demand where twelve point six percent versus one point seven percent in place ever so about eleven percent more people on average so that means every ninth person who got an infusion over eighteen months experienced one of these adamanties on pet scan for the hammerging it was seventeen percent versus seven percent so the number needed to harm meaning every tenth person over eighteen months would experience and a pet skin abnormality indicating a hammer during microhimerage. Are there any questions so far. Okay I don't think he so go ahead I mean i've got more information and I don't know if clinically that's about it for the can be we are hopeful that the bottom line is it it didn't reach that threshold for a patience could feel that it would that it was working I i'm gonna also pull up uhm elizabeth pittman if she is here as she hear you yes i'm here up there you are you here i'm sorry so do you mind sharing so medicaid will medicate be covering this yes member so medicaid policy regarding drugs is if it's fda approved and there's a federal rebate on it I mean medicare is covering it we cover it and this is a drug that falls into both of those categories so this is a drug that medicated is covering and we are getting a federal reading on billy can be not anything not fda approved yet we obviously don't cover so now we've kind of heard some are some art uhm so i'm going to open it up to the committee to ask questions kind of gearing this towards coverage why covering why not covering and I believe carried jordan had some questions now they want formulated yet okay jennifer then yeah m just clarification so on the hemorrhaging and all that i'm not medical so i'm just asking this if they had dimension or is it just all of like did you have something had to mention some that had alzheimer's some that had parkinsons in the scope in the main trial the main trial was clearly a de it had patience fifty denimer ninety who were all alzhemore's disease patients and who had evidence of uhm amaloid on pet scheme to to begin with uhm so I guess that would have been the population I have a question carry jordan. Uhm you mentioned that you were saying that the study was saying that the person wasn't aware that they were changing what it was only studies that are very weird the caregiver's perceptions of how the person was doing. To my knowledge that the primary and point was what they measured the change the cd the clinical dimension rating some of boxes that was the primary in point in whenever it trial is done it has like they look for the primary in point if they see a benefit which they did see statistically a benefit just not clinically a benefit then they can go to the next ones in several the other in points were safety. Okay senator hill and i'm sorry senator level did you have a question here and await okay david kirk from alzheimer's association thank you just had a question on when you do consider coverage for other drugs are there other drugs that have also presented similar factors and was a primary consideration just the the clinical evidence that you had available the research the trial club control the clinical trial evidence research air ebrx we first consider the clinical efficacy in this safety we move on to the cost and I can discuss that a little bit if you'd like or I can omit that everyone uhm would you like me to proceed so with the cause that the cost is twenty six thousand five hundred per year and the institute for clinical and economic review it's the short tour is isa I work with isa uhm they are based in boston at their cut all over in they are a nine they're an independent non profits where I think take trying to place a value car on on drugs uhm they deemed that this drug was not cost effective at the normal willingness to pay thresholds that it would need to cost instead of twenty six thousand five hundred a year for what it does is able to do clinically in this population it would need to cost somewhere between twenty nine hundred dollars and nineteen thousand six hundred dollars somewhere in there so it's it's overpriced for what it does uhm in so for the clinical for the horm for the the way it's infused that was not as big of a deal but with the cost altogether it exceeds its value it's can we considered it a very low value. Drug for money and so it it we pit the ability for it to help versus the ability for it to home and then the cost is factored in just by comparison how does that cost relate to other drugs that we have on the market such as like for cancer and and other disease types we try to incorporate a cost effectiveness data all the time because as you all know are health benefits in the united states are not on a sustainable trajectory and many not all the time but many times the drugs are priced outside of their value and so we incorporate that evidence the cost effectiveness evidence every time we can get the good data good peer reviewed published data we incorporate it and make similar decisions within ebrex factors are yes thank you so much for the presentation I this thing for I actually am filling out a farm do request like can be to be on the pharmacy and you must right now and i'll do the same for done anymore because the disease itself is so devastating it is like cancer it progresses relentlessly it gives the person in the end in a very sad way so I appreciate it they would cook's question about not only the cost but I will add on to with the quality of life the severe a harm the dead severe and then storm and the patient and the family suffers from it so many valuate cancer drugs and i'm on it be committees and. See those protocols with a trillion side effects between still take those drugs because you're fighting endless battle a terrible better life and dead better this is the same thing you lose the person totally so it is equivalent and the burden of their disease and health care it is the same so yes you are right there aside effects but I would say that the cancer drugs which I read about have worse side effects and yet it is a matter of survival and for someone to live a few months longer and to be with the loved ones if the patient and the caregiver are willing to take on the side effects with an informed consent which we are developing at ums we will develop an informed consent in which all the side effects the mind the infusion side effects the major side effects will very well be outlined for them to read and this still want to take the drug and by the way i've had one fish and in whom I did give a do help outside it and infusion pharmacy the patient was only sixty years old he did very well he so you know if it the monopoly antibodies not targeted only to the head for campus or to one particular area it goes on with the brain so that the consensus of the neural net just when I was sitting on the committee was that if it hits the sweet spot in the brain it will do good and in this particular patient it didn't do good so he was working faster he was able to drive he was able to do well so I think I think there are considerations for safety reingeriatrics are very very conservative and we take care of a patience very well but there's also hope and I don't want to take hope away and I don't want to take this opportunity away from my patience thank you. Dr way yes thank you and want to think that johnson and mr vincent everybody else for your comments I would just like to point out if I made up i'm wrong please correct me that most of the symptoms from the area are actually not in other words for the hem reducer the micro hammer just or the demand most of the patients do not have any some dumps I think that's not worthy I mean we could say you know what does that really mean well they are not experiencing the symptoms I think that's not order that yet specially for families of these patients and especially for their loved ones they're not the ones who are hurting the only thing honestly that we're talking about because safety is pretty clear is the cost and of course it's terrible to think about the cost but there is a cost. Okay hate wouldn't yes doctor way wasn't okay yeah I was going to I was going to give you some data on that that I was able to find when you were saying asking him to have the interest of rebel him really only it was four percent for my cases for thirty seven of eight hundred and ninety eight patient screens moderate was seven percent so sixty eight they're sixty six out of one hundred and eighty nine patients and there was only a severe severe interest rate for him ages and resulting in near fatal experiences at one percent rating so nine and eight hundred and ninety eight patients. Oh in resolution occurred eighty one percent resolution occurred by seventeen weeks and leotton I was just curious in the cost benefit did was calculated into the car givers lost wages as well as care give a respect and expenses of care if they were bit of fitting from the drug if they were improving were they able to stay at their job longer than caregiver yes uhm two things why thing is that neither the drug that's on the market like canby or the one that's aimed for market donate amount uhm have been shown or were looked at for prolonging life so making you live longer neither one is looked at that neither one has found that as far as the cost effectiveness they actually ran it on like from a societal perspective which would incorporate like the care gavers in the burden on character because it's it's major month my mother in law died of update of this in twenty twenty during the pandemic there was eight long ugly years and if you consider the the society perspective it could cars let's see it could cost it needs to cost anywhere from forty three hundred dollars it could cost up to twenty five thousand but uhm considering that in that's even if it's private at twenty five thousand the willingness to pay threshold is two hundred thousand meaning it's still that would be considered low value for many career as first pricing a drug I mean it's these drugs are alone and I mean anytime you run a markup model it's not you know. Uhm the health care perspective as far as the little bit because we make our decisions at ebrex first on evicating and pointing out that it didn't reach the level of uh minimal clinically important difference uhm the the health care perspective of the cost effect miss says that it needs to cost as little as twenty nine hundred dollars per year as much as nineteen six nineteen six so i'm still on the same range but we don't make all of our decisions on cost but we in this case the efficacy wasn't there which is why ebrx voted to not cover this doctor johnson bucket ask a question I understood you uh right uhm you mentioned to two drugs that are ineffective treating one of his fda approval in one dozen while would a drug that doesn't prolong life uh you know make better quality alive why would it get fda approval does it make a lot of sense to me that a drug would be approved by the fda the is in effective that's a very good question in it happens all the time the f d a's charge is to uhm compare a drug against perceived in sometimes they just use a single armed trial and they look at how they were doing before they get the drug and they decide how they're doing after in this case there was a plus ebay arm and in this case the fda accepted that a statistically significant change however insignificant the clinical change was they said that if it was a statistically significant change in that cd or some of boxes that that was sufficient evidence. It's just that many of the experts disagree on that point in recognize that uhm if you use the measuring stick which I believe that we should do is a drug or any therapy make you live longer or better than we should think about adopting it right in in this case it's they don't make you live longer but it's really in question on whether it makes you live better whether or not the patients can tell that they're slowing down any differently than they would from place though II think this might be a good time to bring in those who are on the phone with us uhm and that is a marine jaffa from the eliminally company and thank you for being with us I know you've been listening in and the drug that you have has not been approved by the fda yet but is similar and so you've been listening and just kind of wanted your general feedback on what you've heard in what you might want to share with everybody who's listening sure and thank you so much for the opportunity to connect with you guys today and I actually do have some is it okay share those here sure make sure. Okay yes we see that just fine thank you so this has been a really rich discussion that's been great to hear the conversation sort of a dress different things as relating practice the conversation as I go through these sciences as quickly as they can please feel free to to jump in and and start me with questions but just to clarify our drug is not yet approved it's it's application right now and so a little bit different the conversation folks were it is in the same class but it is is a different drug so just real briefly about you folks and think of us as diverse company but we have been in the alzheimer's space for over thirty years now and have a lot of failure is negative trials during that time we've learned a lot from all of these studies the disease about how to measure the disease about how to look at things that as folks were talking about you know what does it mean to be a clinical meeting difference in we make sure we're we're making an impact with treatments and so we've done a lot of different work that will mean that there be space but also on diagnostics and making sure we're giving researchers scientists doctors he pays tools and to be able to identify and diagnose patience as earliest possible because what we're learning is that earlier you treat patience the the better and stronger impact or likely able to have and so keep heard of that is is not only our clinical research partnerships but also working with state colors like all of you in the room policy makers legislators this spectrum to make sure that wor. Creating environment where we can achieve the best possible course outcome for people and family with all summers disease so this is a a busy side but really has meant to just be a snapshot of different things that lily is working on in science portfolio break here this the second line that is about our drug denatima that that is the anti analytical repeat that is before fda right now awaiting a decision on approval and we're very optimistic about that studying in pre clinical also disease so for four you even start to show symptoms because we as I mentioned we continue to believe that treating it as early as possible will be to the most strongest likely how the best outcome of success we also have several other different uh things focusing on different mechanisms action a treatment looking at towel which is another protein in the brain while it whereas these look at analogue and then we have some general therapies looking at other uh neural generative diseases such as temporary dimension or ftd in sense which is not a form of dementia but another generative disease and then symptomatic dimension and then a really early stage asset potentially for the treatment of alas but what is also wanted to make sure was reflected on the side as the work that we've done to demand diagnostics and so we have to after approved tracer diagnostic radio pharmaceuticals were essentially and I think someone alluded to it earlier you can get essentially a green stand to detect the presence of either beta amazon the brain or the presence of towel and those are too biological hallmarks of all servers disease so if it's a you do not have all similars if you don't have one of those those characteristics. Any questions and this before I keep going and I can't see so please just feel free to jump I think to keep going well briefly it's something that sounds like folks in the room are very familiar with this class of the antenna and there appears but i'm just so folks now gets the fully formed so that there's all these different stages at which these parks are made and demand about works too clear the fully formed from the brain put this sign up which again is a bit complex but really to try that to share a little bit about how we study to down a map in the clinical trial and I think the key thing here is that because this is a uh time therapy that works too clear from the brain what are researchers felt very strongly about was that there wasn't much sense and continuing to give the therapy once that analog was cleared out of the brain so beginning at about six months of treatment so right here so twenty four weeks participants who were on animal given another scan to measure an assessor the level of amalour in their brain and if patients if the level of amazon was below a certain threshold they were moved to positive obviously without them now until we wouldn't worry about unblinding but the idea being that once you clear the amalour there is no need to continue on a therapy and so there was six months checks were done at twenty four weeks fifty two weeks and seventy six weeks and what make what we found is that nearly half of the patients actually cleared analog by that right at one year mark and their benefits continue the analogue state away and so we think that this limited course of their therapy limited duration they were seen if occasioned in real world practice can bring. Real value for patients care partners positions wait forward so that's obviously we should have a we will get you don't have an appropriate something that I think has been really interesting to to lot that these are just zero k highways are face three study and this wise trail believes they're all stuff that was the name of the study was the first face three study to replicate the results of the face to study for these anti amboy therapy so in january twenty twenty one we now positive results but really small fees to study and that's when the work begin on this fees three study and i'll just say as someone who is nervously anticipating the results you know little he had been through many negative readings in the past the outcome was better than we could have you know sort of our best expectations and that not only did our face they're trying to primary employee but it meant all of it secondary and points that measure competitive and functional decline uhm so that show demand that it was underneath a man treatment delayed clinical production by thirty five percent as compared to those and could see both and this is measured by the hydro scale which we think is a more sensitive scale measures activities and cultural outcomes there are more meaningful to patience than the CD r summer boxes however there was also critical significance as measured by the cd our boxes as well believe one of the prior speakers mentioned another trial nearly half of participants had no clinical progression at one year so they were stable which we've got to be I think that was something that were very excited to see and meaningful person and forty percent decline. And their ability to perform activities of daily living in eighteen months and as I mentioned earlier over half of all participants completed their course of treatment by twelve months meaning that on a subsequent patts down they had cleared amazed below that shouldn't were able to come off drop so I mean there and just see if there are there are any questions from the group on anything here no questions a a I do one and warn either we have a very for schedule so if you don't mind summarising a little bit more cause we do have other topics to get to but so appreciate you're being online and sharing the information that maybe i'll just despite this and then I can I spend maybe cut to the last side but this is just a time really the big point here is this last one here that were expecting an activated decision by the end of this year and so then we would be another hopefully another approved folks will have to make some other decisions about about coverage and access to these therapies and just I want to just fight something on the point that folks have made about clinical meeting there have has been a lot of effort from scientists within our organization folks with the outside association and elsewhere to better explain what it means to delay disease progression what that means for parents what that means for families to have more time and and helping to translate for folks with that means we can probably I can work with jamie to make sure we get you guys some of those publications that help explain that I think in some ways that are more relatable to ten to not scientists to so maybe i'll just jump to this last side I think one thing we just wanted to focus on to is that we've had a lot of different conversations in different environments about potential state policy solutions I think it is clear that from the data that meets. And and others that earlier you treat patients the better their outcomes you've seen that in our base three results and so making sure that patience and families have access to a timely and accurate diagnosis is is just a satchel I think it's already doing tremendous things by having this policy council in place and conversations we've had across the country or the importance of insuring he cares are educated about how to identify patient that they have access to incentivists to do these these assessments and have access to the screening and diagnostics and we continue to think it's important that patients have access to those there put x level through c m and medicare and also at the state level and and access and different insurance plans as well but I know just through a lot of position and just let me know if you have questions I want to go back to anything yes we do senator love has. Oh okay his question of this group so it's kind of hard for me to see the the screen from the distance that i'm looking at I was able to look at brain and smith's computer here so I just want to kind of summarize you expect the FDA to approve by the end of this year and december twenty three so we will probably have to recircle back with all the insurance companies and and again find out are they going to cover it and kind of continue with this conversation in other words this is going to continue to come up so are there any questions from this committee david cook which is the question for the the panel thank you all for your presentation appreciate the information you share today one of the things I heard from the first presentation was of our health systems may not be uh not quite be adequately equipped to disseminate the these drugs uhm and so one of the questions we had the association as how do we best prepare our health systems when access becomes available to be able to to disseminate deliver these drugs when they are when they're here I know jody and it's great job presenting last month and i'd love to hear her thoughts not put on spot but if you have anything share but I wanted to say this can circle back around we did here today that some payers are going to pay for it's going to be available at least from a payment perspective there may be prior authorizations and things that have to be met into in order to ensure that it's being used correctly for the amount of money you're going to invest in this I mean monies is part of the routes significant investment because you spend it on there's the net maybe dollars can't spin on something else for some other horrific disease that there may be out there that that we need resources to to tree but even if more companies come online I do think this whole what is a fair market place what is accessible clock I mean. Soles a great company interdisciplinary out of texas talk about earlier but they also aren't just especially pharmacy they own their own infusion clinics so they are direct competitors if you will to arkansas hospitals or argentile based clinic so it is a concern is it is there's more usage and more coverage that the manufacturers recognize the need for access and fair competition and allowing arkansas based providers to be able to who have the relationships with the patience who know the care gavers to be you were talking about earlier requesting that UA ms get access to it you sought to be able to order it themselves and not have it delivered from a pharmacy out of arizona where there's all kinds of questions about that delivery chain command and all that stuff they all be able to get directly smart just want to make sure if I didn't make that clear earlier that that will be an ongoing issue with all of these had our medicines do I want to put around the spite you want to say anything generally enter it with the arkansas hospital association thank you sir I couldn't have said it better myself that's why we're pretty good partners and that that's absolutely accurate in the same thing I told you last month you can have a drug that is somewhere but if we can't get access if I can't get doctor way access in the hospital can't advocate on her behalf and on the patients behave to get it because the pharmaceutical manufacturers are playing the game called I win and they always do then we run into trouble so that's where i'm really glad to have participation from you I live in others to talk does about how to work together really well because limiting access is almost criminal especially when our patience have to have these drugs and you can limit access a bunch of different ways one you can have the internal dealings that john talked about to wear you make it in your only one who can supply it or you can limit it by cost alone and you play h. Versus have not which is also unacceptable so at the hospital association what we want is we want the diagnostic tool covered by insurance companies in addition to the medication what's a physician in a patient in a patient's caregivers and care team have made a decision that a particular patient needs a particular drug we need to do everything we can make that happen and that's what we advocate for every day when we advocate for our patience and per access to medications there are putics drugs diagnostic tools and and frankly even physical therapy that they need that we don't always get to give them one thing to sure we've talked about about access to that the therapy there has been a national cover determination with covered with evidence in place for a most of decade around these tracers and they recently just announced a proposal to actually some of those restrictions which is it's really exciting and really exciting for patients they will essentially list them that will retire that covers decision and leave it to the state so that regional contractors to make those coverage decisions so we've been encouraging the mass to be vocal about the value that they see in those diagnostic tools so that max make a decision that makes it easier for patience to get access to these appropriate these diagnostic tools but that's just another challenge another piece of the people that is coming down the pike. Any other questions from the committee. Yes doctors are so marine video manufacturer the tracer that moved on anything in arkansas we don't have the infrastructure that's not manufactured here so we get it from we have to either get it from dallas some members and there's transport costs then it it has to be done within two three days so resend our patience to memphis or dallas to get the pet scan so is there going to be any time lily setting up a factory in our conservative christmas so I will go back and sleep to the team I i'm not sure I know that they are confident that anywhere in the US folks can can eventually have access to that tracer but I am happy to go back and and confirm that because it's a good question i'm not i'm not sure. And we are discontinuing to open up dialogue and will continue this topic as there's you know the the early diagnosis is so critical and is very rare here in arkansas were not getting too much into that in this discussion maybe we can talk greater lengths and bring some other people in on that we've talked about that you know the pet scanned the available availability of that uhm david we've kind of had some conversations along this lines just just talk in and do you mind sharing a little bit of the hour we have in the future from all timers regarding early diagnosis sure I think doctor way touched on this last month during her presentation but we are hopeful that we'll have availability of being able to detect all timers using a simple blood test and we're still aways away from that we can't wait for that to build up infrastructure to make sure that positions across the state actually have access to diagnostic tools at the bare minimum like them a mocker or some so many contest to refer that one to a specialist I think as as has been mentioned this morning already that these drugs are only there they're only viable for people on the very early stages of of my kind of impairment which means the state needs to make more investments on awareness of the commission level but also with consumers about the importance of our detection diagnostics and also making sure we have reimbursement models in place to inside the buyers providers to have those conversations with their patience as well I know that's about it we do have hope and you know I know we talk a lot about fiscal responsibility but that that's a hard self or patient who at the bare minimum just wants more time with their family and so we can't afford to wait for for access we need to continue to push for those things. The doctors are actually we are doing only diagnosis we have been doing it for the past one year we have been doing spinal taps we are doing a lot for switah ratio so we are up with only diagnoses we are doing here to ms anyone wants it we get the result within two three weeks we send the floor to may or clean it the out of pocket cost for it is about five hundred dollars unless there another insurance picks it up so we don't need the pack and a lot scan we can do this final fluid it takes ten minutes to do it when do it under flora scoping guidance so we are doing any diagnosis we are set up for it I think other hospitals are probably also set up for it but we have done it for more than fifty patients right now and anyone who comes in i'm happy to get it set up and get it done within one month they will have the result they will be eligible for monopolies and the other thing that we will have to do on other tests that we will have to do is just get the apple e status confirmed because with apple e four the chances of hambridge and more so if their epi for home was a home was I guess they would not include them in the train in the terrible but we are set up to do it so please don't think that that diagnostic possibility is not there it is there and we have been doing it for at least more than a year now thank you for clarifying that II needed that that cleared out because I was kind of left with last time oh no we're not getting these diagnosis is early enough so II guess I do when it asks because I didn't specifically ask the insurance companies are they covering those early diagnose all the testing that's there So yes we do so they are based on my understanding and i'm not a clinician the base on my understanding there's two two tests that can be used and they're in either or situation when is the petskin that is out of state and what is called this three respinal fluid testing or cs that testing we cover both now my understanding is the petskin is not available in arkansas so it's typically to cover a service that is not available in arkansas it has to be a provider that is willing to take arkansas medicaid but if that providers willing to take arkansas medicaid then yes we would cover it upstate employee benefits II guess you just handle the medicine medicine so okay well we'll get more those answers next time I ask the insurance companies and maybe we will have blue cross and send in all of them here next time to answer those more directly okay we do have a following day and some other topics to get to uh synergy love did you want to make a general statement at the end would hear well I guess you were talking about it because i'm trying to piece this puzzle to get them regards to the done napsticks and you know whose cover and work in the end also just as a general question when using when you say medicaid does cover it how many patience are we are we talking that there is in the space of of dementia ozamers how many so I don't have that number today we can look for you and if you look at the ages of this population it's it is only on sat so we we do have more of a medicate population than typical but it's fifty to ninety for the struggle sixty five in ever is typically medicare they are payer first we pay after medicare so you know we're really talking about those before age sixty five here that would be premary medicaid so do you have a number I can get one but I don't have one off the top of my head so that I think I think that would be good but yeah how is this trying to piece this possible together me II hate to sound like that but when we begin in the top and legislatively about covering the drugs in different things like that and. What medicaid is going to look like move in forward I mean these are the kind of some of the questions that we're gonna we're going to run into so but thank you II have another question for you it's medicare going to cover also the mr cost and the screening with mrs for the drug so we cover anything that's considered one of our typical benefits within our limits and so you know they were we have limits and I didn't bring others lab limits I was trying to find him on my phone so if you want to talk to me afterwards we can go over that but within those limits yes we were covered those things okay great discussion will continue it next month with some other topics I know that we might even have some medicines that uh from what I understand if you use it in the home it's easily approved but when you use it in a nursing harmor assisted living facility it's often not approved but will will discuss that a in the next meeting and anything else i'm always opened ideas and and topics thank you for being with us online a marine thanks for taking the time out very informative and will look forward to hearing more in december from the fda thank you thank you and thank you all the guests who've come in for this topic we appreciate your input and just appreciate the opportunity for all of us to just have discussion on it the way that we learn is by talking to each other in hearing all different sides of uh other issues so appreciate that we're going to move on david cook i'm gonna do you just want to do it from right there where you are instead of moving down there and in the meantime I think we need this laptops up for carried jordan uhm oh it's is that already on there okay never mind I was going to tell you to go down and struck in that setup but um david has put together a package of information we have to give to the uh speaker behouse in the protem senate protem and also the governor. A report every year do by october first and he's going to go briefly through this report that you have in front of you so we can turn that in and make sure we're doing what we're supposed to do sure so what's in in in front of you is exhibit and basically what I did was put in the paper of the presentation that I share with you all last month talking about just the the status of legislation that advanced during the session and so II did try to direct back to some of the priority areas in the also state planned and then of course concluded are included disease information our statistics and some overview of the council's work and this is what we will submit uh unless there's any edits that need to be made and i'm happy to take any questions a lot of this was what was in your presentation last mind then and everything uh can I have emotion to go ahead and say that we're we're good with sending this one by october first rachel budget thank you a second cappy thank you very much and all those in favor say I anyone have disapproved say no very good thank you okay we will submit this by thank you for all your hard work david i'm putting that together really appreciate it okay we will move on to the assisted living rate discussion with kind of these discussions in the last uhm you know little bit the last meeting and jay hill i'm going to let you bring us up today we do have a can excel spreadsheet that shows where some money got distributed based on two million dollars that a lc approved to go to help some assisted living facilities do you mind just reminding some members you know what uh. What this wise what we were trying to do just for those who weren't here and don't know anything about it or someone watching online this is the first time they've heard can you explain what this is yes ma'am thank you so the spreadsheet that you have low will exhibit e is the result of an arper request that was made and granted for two million dollars for assistant living facilities to offset losses lost revenues incurred as a result of the public health emergency it required an attest station from the first from my facility as well as an agreement to be audited on the utilization of those fines and we put this out for all the all the assistant facilities assisted living facilities that have medicaid beds so this was opened to nat not private pay facilities only but facilities that uh that provided bed space for individuals who are on our living choices medicated waiver we had as you see the spreadsheet it listed the amount that were ran it to each of those facilities it was based on a five year look back on the number of utilization days bed days in a facility medicaid bad days in each of those facilities we had bought facilities that did not participate in the program for the night return and attest station denied did that submit the documentation needed for disbursement of funds one facility verbally opted out there is approximately two hundred and twenty thousand dollars that was remaining of that bucket that would have been allocated to those facilities what we we are in the process now working with a our division medical services to redistribute those moneys you lies in the same formula that was used in the initial payout so the number of bed days the dose was action days front. Twenty nineteen through twenty twenty three five fiscal years will be used to allocate those remaining dollars out to all the facilities that are already participating so some of these facilities will be getting more actually all I guess all of them will be getting a little bit more correct all the movie getting a little bit more are there any questions regarding this. Okay appreciate that update and then second is a rate increase or decrease or setting a new rate I guess they should say can you update us where are we just ma'am so act one ninety eight of the general session this year uh produce stay requirement now and statute for sister living facilities to produce cost reporting attitude part and human services again these are for the outside deliver facility where we have an acronym with the h s for everything for our for those alps that have medicaid bears that participate in our medicaid program they are they have all the say on almost all have turned in their data we began working through the process when the fiscal year began we put the survey out on august eleventh and then held a provider call and call with them all to discuss the survey to talk about what to determines mean give them opportunity to ask questions had a really good provider uh provider engagement in that call we still have seven outstanding facilities so up I think if memory serves I believe there are fifty four facilities that are reporting data we have seven outstanding uh some form for various reasons for instance that we have we are the facilities who see a fault had an unexpected emergency and was able to be present here toward the end of the reporting period we've been in communication with those we are also working with the healthcare association and with the arkansas system living association to just to help get that information from those outstanding facilities in the meantime the hs has we have a vendor engaged that is that does work in the space that will take this take all the data that comes in from the facilities and through an analytics process i'll be able to give us that that the just as represent maybe was speaking of what is the cost of doing business in the system living facilities over the previous. Twelve months period as we get close to the end of the temporary rate that we have in place so during the public off mercy we were enabled to submit an appendix k request through the live of choices waiver and increase the rate the daily rate that we pay for services in and out for a medicaid beneficiary the permanent rate is sixty seven twenty five a day presently and what we have been paying now for some time but we've been reimbursing for for but probably i'm close to a couple of years now is an eighty one or eighty five dollars rate depending upon urban or rural placement depending on where the facility is we are coming up very close to that nobody for eleventh deadline in which our rights would revert AC m s has granted the as grand states the opportunity to submit for those rights to continue past the end of the popular purpose of which we have done so in the event that we are not able to get a right to determine we have to work the republic comment and then obviously there is a submission to the federal our federal partners CMS and we don't control the tom line with which those which with those determinations are made so we've made application that would allow us to continue at the rate at the present rate at the eighty one or eighty five dollars a day and it is it is allowable through the for the duration of your wife or first so for us it will extend for a period of time until such time is we would make an adminite request to cms for a different rate and that would be based upon the results of a cost report study. Any questions from the committee on there very informative always appreciate your information and we'll be asking again follow up when we when we meet again so thank you thanks for the information well now we're going to get to a really exciting program saw presentation on this a few months ago and looking forward to allowing her to to share with this committee and anybody who might be watching our mind so carry jordan from uca i'm going to let you take over and share what your program is all about okay thank you representative maybe and I just need to let you all know I don't have control of the clicker slung and have to be having brand and change slides for me so just beer with me as we deal with the technological issues uhm i'm excited to talk about this program we've been talking a lot about pharmacological interventions today and i'm gonna talk about some nonformal clothes trickle interventions that we provide through the interprofessional activity program at uca otherwise known as I tap I need to represent make you aware of our sponsors we have been sponsored by a grant from blue a new foundation and and that has helped us to expand tremendously but also we had some start up costs for the uca foundation which were truly grateful for as you all are aware the state plan that we've all helped develop house four primary focuses of attention and the item program actually addresses three of these specifically it addresses access and quality of care support for the family caregiver and also dimensional training and work force development and I think this last point is probably the most exciting thing about itap programming and we'll talk about that here in just a little bit. The mission of italian is that to meet the needs of all our adults at risk for our diagnosed with alzhemist disease and related dimensions and their care givers and we do that by harnessing students to provide programs to help with physical activity cognitive engagement risk assessment and hopefully improve quality of life as well this is within the college of helping behavioral sciences at the university of central arkansas we have nine different disciplines six of those disappoints are involved with itap programming and so this is an interpretational program as well. And just briefly as you are more than aware that the leads to progress of decline in cognitive and functional status and studies who demonstrated time and again that that decline leads to bad outcomes for both the person with the mention and the caregiver so you have decreased quality of life you have increased ever burden and institutionalization of those with the mention eventually because of these declines so therefore the idea of maintaining cognition and functional status for as long as possible is something that is really needed in the community and you can do that through pharmacology but you can also do it through non pharmacological interventions so there is a growing body of research uhm a large and growing body of research that has really uh emphasised the importance of nonpharmacological interventions such as our displayed on this slide exercise cognitive stimulation and social engagement and if people what the minister are involved with these activities they have improved quality of life functional incognitive outcomes so there's several systematic reviews out there that demonstrate this time and again there's also a large body of research that supports care give her support programs and that's currently support groups but also coaching and various support programs on end specifically in decreasing care you were burden the problem is in branding you'll have to hit that button here require couple times. The problem is uhm that a large number of people with them in their caregivers don't access those services so their studies that indicate that thirty percent of people with the mention access no services at all in of those that do access services most of the services that are our access are things like custodial care home care where you might get help with bathing addressing and things that need sure they might go to the primary care provider gets some medications but the non pharmacological therapies that i'm talking about are just they don't access those and the reasons they don't access those uhm are multifaced but there's been studies that have demonstrated that two of the primary reasons are cost then you can hit the button now and availability those are two of the biggest reasons why people don't access services. Now in higher ed there's three trends that have been occurring in higher ad for some time that mailed well they dove still debt hills well with these needs of the community specifically experiencial earning uh which is an a part of experiencing learning is service learning and that's where students take what they're learning in the classroom and then they apply it to actual needs of the community i'm just gonna mention something about service learning cause i've recently looked up a bunch of literature on it for another green time applying for but it is service learning as good in that it doesn't just affect the head of the student it's more than knowledge service learning goes to the heart. In studies have shown time and again that service learning activities are the best way to change students attitudes toward people with dimension a service learning. Uhm the second thing that's a trend in higher ad is in our professional education so there will be one in a have students work more as a team versus being in our own individual silos. And then finally the small idea of stigma studies have shown time and again that students when they get out of school they choose not to work with older people and they also choose not to work with people with the mention and one of the big reasons why it's because when they're in school we have a tendency to give them opportunities that are like air for example at con in conway at the university of central arkansas the first thing we would introduce nursing students to was the nursing home so we would first first clinical they've ever been on we've taken to the nursing home and we'd have them spend a day giving beyond in a nursing home set and that's the type of clinical experience when a student leaves that setting they are thinking i'm never going to work in this place again this is awful okay so we give them a bad experience and that curious through into their professional careers so this idea of combating student stigma through providing experiences for students that are invigorating is extremely powerful and that's what we're trying to do in the item program. Uhm can you back up one slide please when an is it it is a combining of the community needs out there for people living with the mention there care givers with student needs and currently at the university of central arkansas we have three different programs that are all student run okay we have the interprofessional dominitric your coaching course this is a course that students taken an elective it's a twelve week course or actually it's fifteen week course the first half of the course we teach them about care giver burden and how to coach and in the last half of the course the students actually coach care givers in the community. And with supervision from faculty the second program that we have for caregavers was started by an occupational therapy student for his capital product project a year ago and it's the caregiver support grip so it's an actual support group that meets by weekly students lead it right now i'm you're going to meet jesse here in a minute she's a leading in this program for us right now but um in in this program we provide information for about thirty minutes and then we actually hold a support group for the next hour so for an hour and a half we have the security ever support group the program i'm going to talk to you about the most today is the step program which leads stands for student led their putin activity program and it's our biggest program and so and it's also the one i'm probably the most excited about although the other programs are good as well but this is the one i'm gonna spin the rest of the time talking about so what is also if you go to the next slide this light explains what it is what it is is uhm it's an inner professional program it lasts the twelve weeks of the semester we've been doing it for this is our fifth semester now where we've been running this program and it it's once a week for twelve weeks people in the community with the meantime come to uca the key givers drop them off and then we have students do activities with these individuals for three and a half hours once a day for the for the twelve weeks of the semester you can see here than the foresemester we have exercise science students who lead taylor group exercises we have communication science students who do individual co- individuals cargment of therapy and then nursing students who do individual and group in cognitive stimulation and socialization in the spring semester we break it up just to be a we have exercise science and we have physical therapy that does individual strength balance agility and mobility sessions and an occupational therapy works with the people on individual and group cognitive stimulation and socialisation. And the next few slides should show you some pictures of our program so if you want it just flip through those so this is if you got school and slow brand and i'll go through just kind of describe each other so this is a exercise student doing exercise group exercise therapy with some of our participants. This is some notion students doing some fall craft activities. This. This was kind of a fun program we had a man in the program who had been an archaeologist and he was interested so we allowed him to come up and actually do a presentation on his archaeology with help from his sister in and then we did an archaeological dig so he was teaching us in all the participants how to dig for bones in what night in a system outway. And that meant passed away i'd say a half a year later in his sister told me that this was a real highlight and she was so grateful that he had been able to do this. This is a poker game uh some of the men didn't really care for this craft activities so one of our students over here we can play poker and so this was a weekly poker game that they would engage in and they got to be quite friendly with one another as a well as well. This was a christmas um the final christmas event that was put on by the communication science students you can flip to the next slide and then this is just some physical therapy students working one on one with people so you can just flip through the rest of the slights are all pretty much the same physical therapy students. So I know we're kind of low on time so i'm gonna actually skip through a lot of these next slides i'm going to just summarise we have gathered data okay we've been looking at we've been gathering pre-imposed test data in fall of twenty twenty one and followed twenty two twenty two on the effects of our programming on participants and just to cut to the chase what we found is that that for most of our outcomes we've been measuring six different outcomes the people are maintaining their cognition and they're maintaining their function that's what we want they are not increasing those things but their maintaining them and so that's a real positive finding and it's one of the things we're wanting to achieve now bringing in if you'll just skip through multiple slides or tell you when to start I want to get to the student outcomes because I think those are some of the more important outcomes and I think the goal go through you go through one more and I think we'll be there okay so still no outcome so we had a hundred and four nursing students in twenty twenty one that we measured before the activity and immediately after the activity I do want to look at that some of the demographic information of these students which is on the next slide okay so you'll notice that these are very young students eighteen to twenty four years old most of them and most of them sixty eight percent had had no previous experience with people with the mention then whatsoever. Um it was a pretty diverse group of students as well okay so go to the next line so what we looked at as we looked at the general attitudes for people with the mention and then also their south efficacy or their confidence and working with someone with the mention and what we found you can see by the uh p values there is that we found statistically significant improvements in both of those scales and measures for those students uhm and not only that but the effect of the intervention if you go click one more time brian and you'll see that the effect in APN only thing about affects sizes which you may not but just the effect is very strong very strong effect on both student attitudes and their confidence levels so to me as a educator this has been one of the most exciting things of this program because I routinely get feedback from students of how much this experience has changed the way they see people with the mention on the next slide I have some quotations from students which we just read through one of them because we're gonna have other students talk here in a minute here's the last one I tend to be intimidated by the word to mention it contracts up that's like sad lonely frustrating gloomy and lots and lots of awkwardness one thing I learned through this experience is that the mention is a continual and people can be at any point along at any given time many of the individuals are interacted with seemed mostly normal okay so that there's just one comment of many many comments we've received from students about how this has impict pacted them. If you go to the next slide place so you can keep going through the slides I want to talk briefly about some of the costs. Okay go back back yeah back once I do you go okay so once a master we did look at costs of the program and this is the exciting thing about this as you know my hope for this program is that it doesn't just stay at UCA I would really like to duplicate this program at other universities around the united states I think it can make a huge difference and so we did a little bit of a cost analysis. And this was we had twenty participants in the astep program this particular semester spring of twenty twenty two in the total cost for the program for the semester was two thousand three hundred and twenty five dollars that did not include faculty salaries tackley salaries are kind of fallen into what we do is faculty members of the university which is scholarship and service so they kind of attack to that into our work loud if you go to the next slide you'll see that how much that was broken down in terms of participants so that's a hundred and sixteen dollars per participant now we did not charge the participants because we have these wonderful grounds but we did calculate that per hour that's two dollars and forty two since an hour of activities and if you compare that to the average cost of the average adult daycare center in arkansas nine dollars and twenty five cents that's quite a sense quite a bit and of course the reason it's not expensive because the students are doing the work and and we are not having to do with a lot of regulations either which is there some other safety issues but I won't get into all of that talk about that some other time. Okay so that's pretty much my presentation now what I would like to do is I would like to allow two of my students they have been working in the program to just give a brief summary of what they've gained from the program so you can see first hand that these are actual students that are being impacted this is james hisa who are let him introduce himself and jesse bennett and so i'll let you talk first james all right so i'm james clinton i'm a senior you said exercise science department I got this opportunity to be a part of their step program for my senior internship and as you guys get a bad to be in a senior I was ready to wrap things up and kind of thought this was going to be just a cake walk just going to get it done. When I learned it was a little more involved it was kind of burdened by um it's terrible that is as that is to say um but this program has been. Ah just incredible and I think that's part of the reason why doctor jordan asked me to speak here today is cause of a incredible effect of the sat on my wife and just a short about a time. And in fact i've even worked in that going into pt and other other things that I never thought I would do just because a four incredible this has been. But. Not exactly what there is what I want yeah yeah is there anything else you want me throwing there yeah it's is it incredible incredible program and think we've got seven seven more weeks of it and so i'm looking forward to it and the in the impact we make so yeah. The. My name is jesse bennett I am a graduate research assistant at the usa school of nursing am currently pursuing my masters and mental health counseling and I met doctor jordan in august of twenty twenty two so little over a year ago her ga at the time was about to graduate so I kind of filled her position and took her place so i've been involved with as tap for a little over a year now my roles today uh I hope and minister the pre imposed cognitive assessments for the state participants I hope colleague the caregiver support group as doctor door to mention earlier I help greet people help them out of the car is every thursday morning I do a lot of behind the scene stuff just help organizing really anything doctor jordan needs me to do so at the at the beginning I was kind of hesitant to get involved I haven't really worked with this population of people before I didn't really know what to expect but it has changed my live more than I thought imaginable I kind of had that stigma of elderly people or people were dimensional you know I don't know kind of what to say to them kind of like the awkwardness quote that you all read earlier but it this program has allowed me to get out of my comfort zone and really build genuine relationships with these people I mean we have. Fireman and doctors and teachers and military men and just all sorts of people to different genders and races at nighties cultures they all have their own stories and they're all have their own lives and you get to build a relationships and see like how these people lived in it it cannot take that stigma off of like this is a person with the mentioner not like that's not what defines them they just had that disease. Thank you so I think one of the things that is most rewarding to me is seeing their faces lied up every thursday morning when the students are waiting inside and we can greet them out of the cars and they're just eyes are shining their excited to see the students and hang out with them they're excited to see their friends and the other participants there that they've made they just have a great time with the program there's a sincere need for the type of help that this program provides and when that need is met its people are just genuinely grateful and I think by far this is the most rewarding thing that i've gotten to be a part of this foreign my life so just a kind of concluded amount things up I have a couple of quotes here from the caregivers who are part of this program uh if we could I think they're on the slight shell if we want to press that. So i'll just read this to your in canada I just reached out to our caregivers and asked what the programs meant to them and how it's impacted their lives great program the crafts are accomplishment the exercises are basically the only exercise he does the program allows for some much needed me time when I know he's doing something more than watching tv that he can't remember the support group is an outlet that helps me see differences and behaviors and how other space the challenges as they progress. The program have been a blessing from my husband and myself he gets excited and honored to help the students as he has done for years teaching anatomy and physiology as well as teaching students in the or during surgery procedures he was performing. It is of also a much needed break from me I find the care givers who be of tremendous help to find out what is out there to help our level junior flasher. The. My sweetheart of the past sixty years now has short term memory loss he enjoys his time it asked up the activities and the associations with the students act as a tonic. He always leaves the program on a bright and cheerful note door as night and our last one here as a caregiver of an all time or patient I was feeling overwhelmed and alone I needed help I found this help in the s tap program where I found others experiencing and feeling the same as I did this support group has provided me with the emotional help I needed being in the same situation the support group was able to lend me understanding words of compare comfort that I much needed and emotional support sally road in so as you can see it's helped not only or participants but their care givers as well. In a video you want to come down and ever see the program first hand you're more than welcome to come down just let me know in advance so we can kind of plan for it. That's a great presentation are there any questions for carry jordan or the students that were here. David I just I was curious from both of you spoke a little bit about your career change in the pt hours participating in the program be encouraged you to pursue work with over adults it's going to have a tough question I always thought that I would I have a passion for helping people and I really in an extra strange phase of life not knowing what I want to do in life and so this was just something that cannot brought in my horizon outside of exercise science to to see something that I can actually help people but also get a sense of gratification and then i'm actually doing something good in life rather than sin behind a computer screen which there's nothing wrong with that but it's not for me so. Doctors are I think had a question yeah we aren't we're doing a program on integrative medicine at your ms before covered and then we stopped but we we did activities like this exercise and other things and yes people enjoy it very much if you would like to come by some time and and and do it at a center a couple of sessions we would welcome it very much and you would make great generations by the way. There is a great need for that we hear that over and over again doctor way yes I want to congratulate your doctor jordan now one congratulate mister clinton is jesse you've done great I would like to just mention that I started a similar program when I was in boston but it was with high school students they were juniors and they either had math or history or biology for and the class they were in their teacher asked them to have a partner you know they would pay up with another student and class they would go by the pet there is a pet shelter their in town they would check out a pet then they would take the pet to the nursing home visit a resident and it was absolutely night and day we had patience who had been spoken for several years who would start to talk we had patience who never ever got dressed day that dressed every day I mean it was was really quite something but the most I think interesting and finding was that everybody had to fill out a questionnaire before and after you know what do you think of all people what you think of the nursing home and you know all the answers and then afterwards they had another question air of course those responses were marked were a temporary modified and improved but the real thing was what did you learn from this and most of the students said something that was similar to I learned that one person can make such a difference in someone else's life and it was phenomenal so don't want to school god out right for somewhere these kids still went to the pet shelter checked out any and a month they still went to visit their friend in the nursing home but you know you pns for more net so I want to congratulate uk and. One of the graduate you guys this is what we all I think need to share and understand and do better add cause how much better would it be if we could all share there thank you that's fantastic any other comments for anything regarding yep we just need to figure out how to get all those schools because every region of the state could benefit from the so thank you for the presentation okay so the next thing on our agenda is to figure out when our next meeting will be and we had said the last tuesday of the month which actually puts it on halloween and not that that's a two big of a deal but are our co chair over here cannot be here that day so i've asked about october thirtieth which is that monday at one o'clock is that agreeable to most people here to do it on october thirtieth that one o'clock yes okay okay then will set that as our next meeting date and ball kind of continue this conversation all see if I can get the other insurance companies to come and join us and continue along this pharmaceutical uhm route that we've been doing and any other presentations we we did talk about in home care and going into a little bit more in depth on that and our follow up and try to get some speakers along that lines if there's anything else you all want to add please just let me know open to ideas and appreciate the enthusiasm of this committee and everyone just being willing to listen and communicate so yes general something really quick last time the presentation that you gave really impacted and I thought that perhaps it would also some of the things that you said to do which I wrote down notes and i'm sure it was a whole lot smarter than this we're supposed to laugh or smooth to exercise fresh fruits and socially engaged and learn. So I actually implemented that at my work and am so uhm the departments are supposed to make sure that their staff laughs for a few minutes a day so they try to come up with something funny uhm we exercise now that is a little strange because I had to go out and we read behind our building but I allow my staff to go and take a ten minute break and just walk around in the sunshine and then we learn and we have a word that we learn every day today's word is avocation you may know what that means it means an interest that you have outside of what your couriers so anyway we use that instance try to learn those things I will tell you that I have seen my staff uhm get gerry and excited about the different things and the mood has been better so uhm I do think it helps with that but I honestly do think all of those things work together with alzheimer's and um loved your presentation is awesome. You just never know how you inspire someone so yes maybe maybe we will see some other businesses and organizations adopt that as well and actually tony bailians i'm seeing you in the back back back there I don't think you were at the last meeting do you have any update on the bold grant is there any update before we conclude on. That. Some of the same no I guess the only really update is you know so we apply for the the new round of funding which we did not receive so we did that receive that receiver correct and so we did they give reasons why well there if there was only there was a very small number of awards if I have it correctly. I have a bunch of numbers in my air cos we applied for several grants all at the same time we were one of david correctly if i'm wrong so it's thirty five but they were in different categories and so they broke those categories down even more and we just happened not to be there were fifteen. They have a correct it just organs all had core capacity funding under the bold act during the first round and this this time we assist the hell department to apply for enhanced level of funding and those awards were minimal but I knew what we saw during the first round as the cdc would revisit applications they initially denied and that was our case in arkansas when we apply for court capacity funding so he received it the second year so it's possible if congress can give the budget down that there will be another funding cycle on the the do some rewards but when they do award enhanceable funding to go back to review the applications they've already received there is a possibility we do can get it further down the road did we use all of the funding that was there before we do we make use of no so we we use a if I remember correctly david I was just talking about this yesterday roughly about sixty percent of it and a lot of the head to do with with vacancies and in some of the things that we tried to initiate that you didn't work out you know you make a plan in the plan just didn't work out that way but we we when it's all said and done as for his reporting pretty much exactly what we wanted to do what we plan to do um cd see them say they were impressed with the work that we did unfortunately just the application that we submitted didn't score high enough compared to the other states but as david said we do we still have the optimity to to get awarded at a later date you remember even in this cycle initially we were not awarded but we did get awarded in any year two of the great so so if if you're saying we use sixty percent of the grant so how much do we not use and that money is at money still there are we still able to use it moving forward or we had to return money to so that that money will be i'll see return so we never actually quote uncourt received the money as how we we reimbursed. So that that we would not receive those funds correct do you know how much that was what what would it would forty percent of that I don't remember i'm sorry a hundred and thirty four thousand able to utilize that said okay I appreciate the update sorry I didn't mean to put you on the spire just I hadn't seen the end I would completely forgot all about that topic so you're going to make one come so so you know in part of the challenge not to join you know if you others you know on the coalition with us and so you know that the work is is hard and and trying to build up you know and that's what we were doing is in in this cycle is building up and it just takes a little while to get going so hopefully if we can get you know into the second second award then we can do you know even more work so. Well thank you everybody uhm okay is there motion to adjust factor way thank you second thank you stephanie and i'll in favor say I okay thank you we'll see all october thirtieth.