A Turning Point for Cost in Dementia Care
By Jamie Sharp, MD
Chief Medical Officer
In medicine, progress is often incremental. That’s why moments like this are worth pausing to acknowledge.
As part of Rippl’s ongoing participation in the GUIDE model, we routinely review claims data to understand how our care model is impacting real-world outcomes for people living with dementia and their care partners. With updated claims through September 2025, we’re seeing something new and very encouraging.
For the first time, we’re not only seeing lower ED and inpatient utilization, but also a reduction in total medical spend following enrollment into Rippl’s GUIDE program.
A quick look at the data
This latest analysis looks at patients enrolled in GUIDE, comparing six months of claims data before enrollment to claims after enrollment, consistent with how we’ve previously reported outcomes.
A few important notes for context:
The average participant has been active in GUIDE for 7.5 months, which demonstrates strong retention, and our interventions are demonstrating reductions much earlier than most care programs.
Acute inpatient days exclude elective admissions and observation stays
Total cost reflects medical spend only
Even with those guardrails, the trends are clear:
Fewer emergency department visits
Fewer hospitalizations
And now, a corresponding decrease in overall medical cost
For clinicians, this is exactly the sequence we hope to see. Reducing avoidable acute care is meaningful on its own. When it’s paired with lower total cost of care, it suggests we’re changing not just where care happens (with outpatient services), but how effectively it’s delivered.
Understanding the bend in the cost curve and what it means beyond GUIDE
One of the most compelling views in this dataset comes from the per-member-per-month (PMPM) cost trend around GUIDE enrollment. What it shows is a pattern we see clinically: healthcare costs tend to rise in the months leading up to a dementia diagnosis, often driven by escalating symptom burden, unmanaged comorbidities, and episodic acute care. Studies of Medicare claims have shown that costs can climb significantly in the period right before a formal dementia diagnosis or treatment plan is established.
That real-world pattern echoes what we see in our own GUIDE population: as patients approach the point of enrollment, utilization and cost often trend upward. This is likely a reflection of the crisis-driven care that too often precedes connection to comprehensive support. Once patients are in a comprehensive dementia-focused program, however, that trajectory changes.
After enrollment, costs begin to flatten and then bend downward, illustrating a shift away from crisis care toward more coordinated, proactive support.
That bend in the curve matters for two reasons:
It reinforces what we’re seeing. Structured, specialized support after enrollment can lower unnecessary utilization with proactive support.
It points to a broader opportunity for healthcare: if we can identify people living with dementia earlier, before they hit the high-cost, high-utilization phase, we might be able to bend the overall cost curve even sooner and more dramatically.
Emerging research and tools make earlier detection increasingly feasible. Advances in blood biomarkers and other diagnostic modalities are giving clinicians the means to detect Alzheimer’s disease and related dementias earlier in the disease continuum than ever before. Early identification isn’t just a clinical aspiration, it’s a strategic imperative. Earlier recognition and engagement with supportive care pathways may help prevent the cascade of costly, avoidable events that characterize the period before diagnosis.
In other words, the cost curve we are bending after enrollment suggests what could be possible if we bend it before patients reach crisis: better outcomes for people living with dementia and lower costs for healthcare as a whole.
Still early and worth paying attention to
This is not the end of the story. We’re continuing to analyze cost categories and utilization drivers to better understand how and where these changes are happening. More data will come.
But as a physician, I believe it’s important to share promising signals when they appear, especially in a space like dementia care, where progress can feel frustratingly slow.
These early results suggest that comprehensive, team-based dementia care can change trajectories, not just for patients and families, but for the healthcare system as a whole.