The U.S. Centers for Medicare & Medicaid Services’ (CMS) has launched the Guiding an Improved Dementia Experience (GUIDE) payment model with close to 400 participating organizations, including many palliative care providers.
The CMS Innovation Center announced the GUIDE demonstration in July 2023. The payment model is designed to improve quality of life for dementia patients and their caregivers by addressing care coordination, behavioral health and functional needs.
Participation in the GUIDE model has expanded since its birth, CMS reported in a press release on Monday. Nearly 400 health care organizations are developing Dementia Care Programs (DCPs) to potentially serve hundreds of thousands of Medicare beneficiaries nationwide, the agency stated.
“DCPs represent a wide range of health care providers, including large academic medical centers, small group practices, community-based organizations, health systems, hospice agencies, telehealth organizations and other practices,” the agency indicated in a statement. “The GUIDE Model aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support and respite services.”
Mapping GUIDE’s progress
Many of the GUIDE participants CMS announced are physician groups, primary care providers and health systems, a good number of which provide palliative care.
More than 40 hospice- and palliative care-specific organizations are participating, including Androscoggin Home Health Services, Avow Care Services, Gilchrist Hospice Care, HopeWest and the Icahn School of Medicine at Mount Sinai. Additional palliative care provider participants include Chapters Health Palliative Care, Hospice of the Chesapeake and Sangre de Cristo Hospice & Palliative Care, among others.
A map of approved GUIDE organizations as of July 2024, based on CMS data. The above map does not include approximately 40 locations due to address-mapping issues. For a complete list of GUIDE organizations, click this link.
The payment demonstration is designed to test ways to improve quality by reducing strain on unpaid caregivers and help patients to remain in their homes and communities, according to CMS. The model features reimbursement for care coordination and management, respite services and caregiver education and support.
Kentucky-based Pallitus Health Partners, part of the Hosparus Health system, has also joined the ranks of GUIDE participants. Palliative care providers are seeing an increasingly diverse range of dementia patients with varying symptoms and psychosocial issues, according to Dr. Bethany Snider, chief medical officer at Pallitus.
“Pallitus Health Partners is incredibly excited to unveil the GUIDE Model, an initiative that embodies our dedication to providing exceptional care and support for those whose lives are impacted by dementia,” Snider said in a statement. “GUIDE offers a network of resources with services tailored to each person’s unique needs. This holistic program is aligned with our mission and is poised to help us improve the quality of life for even more patients and families.”
Roughly 14 million Americans are projected to have some form of dementia by 2060, triple the amount estimated in a 2020 report from the U.S. Centers for Disease Control and Prevention (CDC). Annual costs of treating the disease are projected to double by 2040 to nearly $500 billion, the CDC reported.
The GUIDE Model is a “key deliverable” from President Biden’s April 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers in that it addresses key goals of the National Plan (National Plan) to Address Alzheimer’s Disease, the agency stated.
A main aim of the model is to create comprehensive, person-centered assessments and care plans and establish 24/7 access to caregiver navigation and support lines for both medical and nonmedical needs such as meals and transportation, according to CMS.
Dementia patients’ disease trajectories can be difficult to project alongside their medical and nonmedical needs, with health care costs a cog in the wheel of quality as well, according to Dr. Gavin Baumgardner, vice president and national medical director of primary and palliative care at Contessa, a subsidiary of Amedisys (NASDAQ: AMED).
“The GUIDE model is very flexible,” Baumgardner said at the Hospice News Palliative Care Conference in Tampa, Florida in February. “[Payers] are not saying every dementia patient looks the same. Not every dementia patient has a caregiver and not everyone needs a caregiver necessarily. They tied that to the payment model, and that’s a good thing.”
Palliative impacts
More providers and payers alike are interested in GUIDE’s value proposition to improve quality outcomes and caregiver support, according to Baumgardner. For example, the GUIDE model could help pave the way for palliative providers to rethink their care delivery approaches and breadth of services that address social determinants of health through a more diverse scope of value-based and risk-based arrangements, he stated.
The GUIDE model may also lay the framework around ways that providers can seek stronger reimbursement avenues to help manage patients with more intensive palliative care needs, Baumgardner indicated.
“We’re looking at it from a contracting and partnership standpoint,” Baumgardner said. “How do we take that type of model when we’re talking with other partners that may not be ready from the full upside, downside risks? If you keep the patient at the center of all this, you’re going to get the right answer. GUIDE has been a nice step forward [of] rethinking how we might be able to partner with certain organizations in different ways … to do this intensive case management.”
