A truly innovative and potentially revolutionary payment model has just been introduced by CMS through the Center for Medicare and Medicaid Innovation (CMMI) – the Guiding an Improved Dementia Experience (GUIDE) Model. This 8-year pilot will include a standardized set of services for beneficiaries with dementia and their unpaid caregivers, including paying for respite care, and involve an interdisciplinary care team to deliver these services, including care navigators. Care intensity and payment is determined not only by the clinical state of the patient, but also by the level of strain the caregiver is experiencing.
The consideration that CMS is showing to the state of the caregiver shows that CMS recognizes the importance of that caregiver in keeping the dementia patient out of nursing homes. This caregiver support will include skills training, referrals to community-based social services, 24/7 access to a support line, and respite. Services for the patient will include addressing behavioral and functional needs, coordinating care between the dementia and other concurrent conditions, and improving transitions across care settings. Payments will come on a per beneficiary per month basis, plus payment for respite services. A one-time infrastructure payment may be available to support program development. There will be two tracks for providers to enter based on their experience in providing dementia-specific care. Much is still to be learned about the GUIDE Model. CMS will be releasing the RFA this fall. Participants will have to be able to bill Part B, and the patients cannot be currently enrolled in a hospice program. We still do not have full clarity on what patient data CMS will make available for GUIDE providers. GUIDE could be a great opportunity for post-acute care providers, including hospices, home health care providers, palliative care programs and others, to support their home-based serious illness care missions. Post-acute care providers may be able to apply directly with CMS to become GUIDE providers themselves, or partner with other providers, such as ACOs and other primary care providers, to provide the home-based aspects of GUIDE care. Acclivity is watching this closely and will continue to advocate for home-based care providers, as well as support such providers as we learn more about GUIDE. Please do not hesitate to reach out to Acclivity with any questions.
“Guiding an Improved Dementia Experience (GUIDE) Model Overview Factsheet” released by the Center for Medicare and Medicaid Services and accessible at https://innovation.cms.gov/media/document/guide-dementia-fs