On July 31, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new voluntary nationwide model – the Guiding an Improved Dementia Experience (GUIDE) Model – a model test that aims to support people living with dementia and their unpaid caregivers. CMS is accepting letters of interest for the GUIDE Model through September 15, 2023, and will release a GUIDE Request for Applications (RFA) for the model in Fall 2023. The model will launch on July 1, 2024, and run for eight years.
The GUIDE Model will focus on dementia care management and aims to improve quality of life for people living with dementia, reduce strain on their unpaid caregivers, and enable people living with dementia to remain in their homes and communities. It will achieve these goals through a comprehensive package of care coordination and care management, caregiver education and support, and respite services.
GUIDE delivers on the Biden Administration’s April 2023 Executive Order 14095 on Increasing Access to High-Quality Care and Supporting Caregivers, which directed the Secretary of Health and Human Services to “consider whether to select for testing by the Center for Medicare and Medicaid Innovation an innovative new health care payment and service delivery model focused on dementia care that would include family caregiver supports such as respite care.”
It also advances key goals of the National Plan to Address Alzheimer’s Disease, which was established through the bipartisan National Alzheimer’s Project Act (NAPA) and has, for over a decade, accelerated federal actions to optimize the quality of care for people living with dementia and their caregivers while advancing research towards a cure. The GUIDE Model builds off of this extensive coordination within HHS and major input from various external stakeholders.
Despite its prevalence, many people living with dementia do not consistently receive high-quality, coordinated care. As a result, they experience poor outcomes, including high rates of hospitalization, emergency department visits, and post-acute care utilization. They also experience high rates of depression, behavioral and psychological symptoms of dementia, and poor management of other co-occurring conditions.
Dementia also significantly impacts the family and other unpaid caregivers, who often provide significant amounts of assistance with personal care, finance, household and medication management, clinical coordination, and other care. Many caregivers for people living with dementia, who are often Medicare beneficiaries themselves, report high levels of stress and depression, which negatively affect their overall health and increase their risk for serious illness, hospitalization, and mortality.
Through the GUIDE Model, CMS will test an alternative payment for participants that deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Under the model, participants will assign people with dementia and their caregivers to a care navigator who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations.
The GUIDE Model will also enhance access to the support and resources that caregivers need. Unpaid caregivers will be connected to evidence-based education and support, such as training programs on best practices for caring for a loved one living with dementia. Model participants will also help caregivers access respite services, which enable them to take temporary breaks from their caregiving responsibilities.
When used over time, respite services have been found to help unpaid caregivers continue to care for their loved one at home, preventing or delaying the need for facility care. The model is also designed to reduce Medicare and Medicaid expenditures primarily by helping people with dementia to remain at home, and reducing hospitalization, emergency department use, the need for post-acute care as well as long-term nursing home care.
Participants in the GUIDE Model will establish dementia care programs (DCPs) that provide ongoing, longitudinal care and support to people living with dementia through an interdisciplinary team. GUIDE participants will be Medicare Part B enrolled providers/suppliers, excluding durable medical equipment (DME) and laboratory suppliers, who are eligible to bill for Medicare Physician Fee Schedule services and agree to meet the care delivery requirements of the model.
If the participant can’t meet the GUIDE care delivery requirements alone, they have the ability to contract with other Medicare providers/suppliers to meet the care delivery requirements. These contracted providers/suppliers will be known as “Partner Organizations.”
In order to have sufficient model participation and improve the recruitment of diverse beneficiaries, CMS will also recruit organizations that do not currently offer comprehensive dementia care or have prior experience with alternative payment models. CMS will support model participation for these organizations by providing technical assistance and learning support as well as a pre-implementation year to prepare for model participation.
The eight-year model will offer two tracks: one for established programs and one for new programs. Established programs must have an interdisciplinary care team, including a care navigator, use an electronic health record platform that meets the standards for Certified Electronic Health Record Technology, and meet other care delivery requirements as outlined in the RFA. New programs must not be operating a comprehensive community-based DCP at the time of model announcement and will have a one-year pre-implementation period to establish their programs.
The GUIDE Model aims to address the key drivers of poor-quality dementia care in five ways:
- Defining a standardized approach to dementia care delivery for model participants – this includes staffing considerations, services for beneficiaries and their unpaid caregivers, and quality standards.
- Providing an alternative payment methodology to model participants – CMS will provide a monthly per-beneficiary payment to support a team-based collaborative care approach.
- Addressing unpaid caregiver needs – the model will aim to address the burden experienced by unpaid caregivers by requiring model participants to provide caregiver training and support services, including 24/7 access to a support line, as well as connections to community-based providers.
- Respite services – CMS will pay model participants for respite services, which are temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care for the purpose of giving the unpaid caregiver temporary breaks from their caregiving responsibilities.
- Screening for Health-Related Social Needs – model participants will be required to screen beneficiaries for psychosocial needs and health-related social needs (HRSNs) and help navigate them to local, community-based organizations to address these needs.
Health Equity Strategy
Delivering equitable care and addressing health disparities in dementia are crucial aspects of the GUIDE Model.
Dementia imposes significant financial, emotional, and logistical burdens on families, which are often exacerbated for certain racial and ethnic groups. Black and Hispanic populations have a higher prevalence of dementia, but they also are less likely to receive a timely diagnosis, have more unmet needs, are more likely to experience high caregiving demands, and spend a higher share of their family assets on dementia care.
CMS will actively seek out the participation of eligible organizations that provide care to underserved communities for participation in the GUIDE Model. CMS will offer a variety of financial and technical supports to ensure that participating safety-net providers can develop their infrastructure, improve their care delivery capabilities, and participate successfully in the model.
GUIDE will also include a focus on beneficiaries with dementia who are dually eligible for Medicare and Medicaid and, as with other patients supported by the model, help them to remain safely in their homes for longer.
Aspects of GUIDE designed to improve health equity include:
- Requiring participating providers to implement HRSN screenings and referrals.
- Offering financial and technical support for development of new dementia care programs targeted to underserved areas with less access to specialty dementia care.
- Annual reporting by participants on progress towards health equity objectives, strategies, and targets.
- Using data from the model to identify disparities and target improvement activities.
- A health equity adjustment to the model’s monthly care management payment to provide additional resources to care for underserved beneficiaries.
- GUIDE Model Press Release
- GUIDE Model Fact Sheet (PDF)
- GUIDE Model Frequently Asked Questions
- Webinar: GUIDE Model Overview Webinar (August 10, 2023)
If you are interested in receiving additional information, updates or have questions about the GUIDE Model, please see the resources below: