Palliative care providers may be uniquely positioned to develop partnerships that support patients through the new Guiding an Improved Dementia Experience (GUIDE) Model recently unveiled by the Center for Medicare & Medicaid Innovation.
While the program is not a palliative care model, those providers are well-suited to deliver the kind of care that GUIDE outlines. For instance, the model involves a trained interdisciplinary care team that delivers a standardized set of services based on a person-centered care plan, according to CMMI.
“Palliative care providers would be very well-positioned to participate in the GUIDE model, but the GUIDE model is not synonymous with palliative care,” Edo Banach, partner at Manatt Health told Hospice news. “This very much builds upon some of the lessons that we learned from palliative care about the need for an interdisciplinary person-centered model, and then takes it to the next level by saying, ‘Look, we have to have some technological enhancements. We have to have partnerships, including with community-based organizations.’ I think it leverages palliative care, and then takes it to the next level.”
Banach has previously served as deputy director and senior leader at the U.S. Centers for Medicare & Medicaid Services (CMS) and as CEO of the National Hospice and Palliative Care Organization (NHPCO).
CMS will release the application for GUIDE in Fall 2023. The agency “encourages” providers to submit Letters of Intent to CMS by Sept. 15. The eight-year demonstration model will begin July 1, 2024.
GUIDE is designed to improve the quality of life for dementia patients and their caregivers by addressing behavioral health and functional needs, as well as better coordinating care and improving care transitions between community, hospital and post-acute settings.
Participating patients and families will also have access to a care navigator to help them access clinical and non-medical services.
The model is designed to attract a range of Medicare Part-B providers, which will likely new create partnership opportunities for palliative care operators, according to Cindy Campbell, senior director of advisory services at WellSky.
“Within the GUIDE model, palliative care providers fit in as an essential part of the network with whom this program seeks to partner,” Campbell told Hospice News in an email. “The GUIDE model incorporates principles that are foundational elements in palliative care including improving quality of life, reducing caregiver burden, and interdisciplinary, comprehensive care. These partnerships with providers create a network of expertise, which is needed to provide ongoing, longitudinal care and support to people living with dementia.”
These types of partnerships are baked into the program. If a GUIDE participant cannot fulfill all of the program’s care delivery requirements on their own, they have the option of contracting with other providers to fill in the gaps, according to Campbell.
“The expertise held in palliative care is a value-add whether participating in the GUIDE program or not,” Campbell said. “Given this opportunity to leverage skilled participation in such a program demonstrates a commitment to this fragile customer base — giving a leg up to strategic marketing efforts and adding fuel to growth potential.”
Among CMMI’s goals for the program is to define a standardized approach to dementia care delivery, including staffing levels, a suite of services for patients and their family caregivers, as well as development of quality standards.
Patients will be stratified into one of five tiers, based on a combination of their disease stage and caregiver status. Care intensity and payment increase by tier, according to CMS.
Health equity, support for caregivers and addressing social determinants are also key components of the model.
Participating providers will be required to offer caregiver education and training, access to a 24/7 support line and referrals to community-based organizations and resources. Respite care is also a component of GUIDE.
“Another very important feature of this model is the use of respite care,” Banach said. “[Palliative care providers] are entities that know a lot about giving people a break and providing care not only to the individual, beneficiary but also to their family and loved ones. That’s another advantage that a lot of these organizations are going to have right from the start.”
GUIDE includes two tracks, one for established programs and a second for new ones. New programs will have a one-year, pre-implementation period to get up and running, according to CMMI.
Reimbursement through the model includes a per-member, per-month payment, as well as an infrastructure payment for some safety net providers. Participating operators may also receive payment for respite care.
Among other outcomes, CMMI expects the GUIDE Model to allow more people living with dementia to remain safely in their homes for as long as possible, the agency indicated. This is another area in which palliative care providers are well-practiced.
“Palliative care providers are going to be in a great position to hit the ground running, because they’ve already done a lot of the legwork necessary to establish themselves, to establish partnerships, networks and referral relationships,” Banach said. “Those organizations are going to be in a great position to leverage the work that they’ve done. There are a few examples of integrated, person-centered interdisciplinary care right now. Palliative care happens to be one of them.”
