Intro to CMS’s GUIDE Model

Earlier this year, CMS announced the GUIDE model, or “Guiding an Improved Dementia Experience” model. This voluntary model aims to improve the quality of life for dementia patients and their informal/family caregivers with an approach to care delivery that prioritizes care coordination and caregiver support.

This program is the first of its kind and marks a shift toward recognizing the influence and impact informal/family caregivers can have on the health & medical outcomes of patients in their care.

Unlike past and existing CMS programs which have historically been aimed at reducing the cost of care, the intent of the GUIDE program is not to create a shared savings or evaluate reduction in total cost of care. It is purely focused on prioritizing and financing caregiver support.

The development of the GUIDE model underscores CMS’s realization that family caregivers play a concrete and crucial role in shaping health outcomes. By offering enhanced support to family caregivers, the program aims to alleviate some of the burdens of caring for patients with Alzheimer’s, resulting in better care for patients.

Lifting these burdens improves the physical and emotional health of caregivers, which has translated to improved health outcomes. Patients whose caregivers are depressed, burned out, or fatigued experience a 73% increase in ED utilization & $1,937 higher medical costs.

When family caregivers are involved and engaged in care plans, hospital readmissions decrease by 25%. These figures emphasize the pivotal role that caregiver support plays in enhancing overall health outcomes for patients.

Understanding the CMS’s GUIDE Program

Now that we’ve laid the groundwork for the “why”, let’s focus on the “what”. What exactly is GUIDE going to do to build caregiver support?

The program is focused on improving quality of life, reducing caregiver burden, and enabling people with dementia to stay in their homes longer using the pillars below:

  • Care Coordination & Management: Patients will have an interdisciplinary team to create a person-centered care plan to understand the status of their disease, and provide continuous monitoring and care.
  • Caregiver Support & Education: Participants must deliver caregiver support in the form of training, education, and support groups, as well as a dedicated, expert Care Navigator focused on facilitating access to the services and support they need– both clinical and non-clinical.
  • Respite Services: Some participating caregivers will be eligible for free respite services amounting to $2,500 per year.

The most novel pillar in this program’s structure is caregiver support. Each participant must ensure they have the content, expertise, and resources in place before enrolling in the program, something that has not been traditionally required in most clinical settings. These requirements are comprehensive:

  • Navigation: A dedicated expert is there to help facilitate communication, appointments, medication needs with the clinical care team, and referrals to community-based services including meal and transportation assistance.
  • 24/7 support line: Beneficiaries and caregivers must have access to a member of their care team or Care Navigator using a 24/7 helpline
  • Training: On-demand access to comprehensive educational classes, content, and support groups on a wide array of topics related to dementia caregiving.
  • Medication management: The clinical team regularly reviews prescribed medication as needed, while care navigators provide tips for patient and caregiver to successfully adhere to medication regimens.

The Mechanics of the GUIDE Model

The last piece of understanding the GUIDE model is the how. How it will run, how patients become eligible, and how CMS and participants can understand the impact and effectiveness.

The program will officially begin in July 2024 and will last eight years. Eligible patients must:

  • Have a dementia diagnosis
  • Have Medicare as their payer
  • Be enrolled in Medicare Parts A & B (not Medicare Advantage or PACE)
  • Not be enrolled in Medicare hospice benefit
  • Not be residing in a long-term nursing home (assisted living facilities are accepted)

There will be periodic evaluations throughout the program. For many existing value-based providers, this is a new opportunity to reduce the costs of care using the resources provided by the GUIDE model

Participants are required to collect and report data and will be evaluated based on:

  • Care Coordination and Management: High-risk medications (eCQM/CQM)
  • Patient quality of life: Quality of life outcome (Survey-based)
  • Caregiver Support/Burden: Zarit Burden Interview (Survey-based)
  • Utilization: Total Per Capita Cost (Claims-based)
  • Long-term nursing home stay rate (Claims-based)

In Conclusion

The GUIDE model marks a new chapter in the way our culture acknowledges and addresses all of the non-clinical care deeply impacting clinical outcomes. For too long, the pivotal work of family caregivers has been hidden and taken for granted by our healthcare and social systems. This model serves as a first step toward placing tangible value on that work.

By integrating them into the care team and supporting their participation, we can improve the holistic care experience for patients, improving their quality of life and keeping them at home longer.

Our work at ianacare is dedicated to recognizing and supporting this critical role. To date, we have served over 42k members with hands-on, proactive, and comprehensive support as they care for their loved ones. Our solution was built to bridge the gap in home-based care using innovative and scaleable technology alongside a team of expert, dedicated Caregiver Navigators.

Senior Doc provides medical care to seniors directly in their homes, assisted living, skilled nursing communities, hospice, or via secure Telehealth options.

If you are looking to become a provider at one of the fastest growing senior care providers in the U.S. please get in touch with our team today.