What is the GUIDE Model?
In July 2023, the Center for Medicare and Medicaid Services (CMS) announced the Guiding an Improved Dementia Experience (GUIDE) Model – a voluntary nationwide model to support comprehensive, coordinated care for persons living with dementia and their unpaid caregivers. Archstone Foundation believes that identifying more effective and efficient models of care for persons living with dementia is especially urgent and we created a campaign to encourage eligible providers to apply. In our state alone, the number of Californians diagnosed with dementia is projected to reach 1.3 million by 2040, a doubling since 2020.
While dementia care today is expensive, complex, and uncoordinated, the GUIDE Model addresses gaps by enabling a comprehensive, integrated care approach that will improve quality of life for persons living with dementia, help them remain in their homes, and avoid unnecessary institutionalization, and reduce burden and strain on unpaid caregivers. (Persons with dementia rely heavily on support from family and friends; two years ago, more than 11 million unpaid caregivers provided about 17 billion hours of care worth $340 billion nationwide.)
Applications for the GUIDE Model are due January 30, 2024. This is a one-time application opportunity with enormous potential to transform and improve dementia care. The model’s key elements of comprehensive care are:
- A standardized set of services for beneficiaries and unpaid caregivers;
- An interdisciplinary care team, including clinicians with expertise caring for older adults with dementia;
- Care navigators on the care team who are trained in dementia assessment and care planning; and
- An alternative payment structure that compensates interdisciplinary teams to deliver person-centered care, including care coordination and caregiver respite and education.
What GUIDE Entails
The GUIDE Model will take place over eight years. Applicants with established dementia care programs may begin implementing the model in July 2024, while applicants establishing new dementia care programs will prepare for a year before they begin using the model in July 2025.
Some other aspects of GUIDE worthy of note:
- Selected Medicare Part B providers will be authorized to provide comprehensive care management and will be paid $150 to $390 per person monthly depending upon severity and social circumstances.
- There is no 20 percent copay for patients and no reduction in payments if patients participate in other Medicare programs such as Accountable Care Organizations.
- Part B providers are encouraged to contract with community-based organizations or other medical providers for parts of the services required.
- Respite services will be paid up to $2,500 annually for each beneficiary.
- Participants who are safety net providers may be eligible for a $75,000 infrastructure payment from CMS to set up and staff their programs if they are new to comprehensive dementia care.
What We Are Doing to Spread the Word
GUIDE is aligned with our 3Ts strategy – enhancing teams, providing training, and improving technology – as it facilitates collaborative, coordinated care that addresses the needs of all care team members, including unpaid caregivers. Wanting to make the most of this opportunity, we partnered with Dementia Care Aware and the Alzheimer’s Association to notify every provider we could find in California who might be eligible.
Using the 2021 CMS dataset detailing Medicare providers’ billing codes (Healthcare Common Procedure Coding System [HCPCS] codes), we identified 473 providers who billed for services – such as care planning, chronic care management, or psychiatric collaborative care management – that could be related to or replaced by comprehensive dementia care.
In October, before the GUIDE application was unveiled, we contacted all of these providers by mail to make them aware of the upcoming opportunity. Once the request for applications was published in December, we sent another letter directing providers to resources to explain the program’s benefits and then help them with their applications. A final mailing in coming days will remind them of the Jan. 30 deadline and encourage them to apply. All the mailings include a QR code linked to our website, where we have information and resources about GUIDE. It has been scanned by 8 percent of recipients so far.
We understand the GUIDE application may be overwhelming. So, to help translate the details and underscore the game-changing aspects of the model, we enlisted Dr. David B. Reuben, Archstone Foundation Chair and Professor at UCLA and Director of its Alzheimer’s and Dementia Care Program, to virtually guide providers through the program.
In a four-minute video, he explains how the GUIDE Model is financially sustainable for providers who already deliver or want to provide comprehensive dementia care – and will bring comprehensive services to new populations in health care systems nationwide. Dr. Reuben also highlights available tools and tips for providers considering the GUIDE Model, including the importance of engaging clinicians, administrators, product champions, and other stakeholders to collaborate in applying and then implementing the appropriate care program.
What You Can Do
Our website has information on GUIDE from various sources, a link to the application, and links to webinars with useful information on the GUIDE Model and the application process. You can direct questions to guidemodelteam@cms.hhs.gov and register for email updates about the program. We encourage you to register for an online session CMS is hosting on Jan. 11 at 11 a.m. PT, to review the GUIDE Model and answer questions about applying.
Our hope is that we’ll see a strong uptake of the GUIDE Model and corresponding improvements in the quality and coordination of care for persons living with dementia and their caregivers.
