The Guiding an Improved Dementia Experience (GUIDE) payment demonstration is widening reimbursement channels for hospice providers as some seek to leverage technology to strengthen patient and family caregiver support.

Patients with dementia-related conditions have unmet needs that often fall outside of traditional fee-for-service Medicare coverage, according to Amy Etzel, manager of ancillary services at The Connecticut Hospice. Etzel oversees the hospice’s dementia program and palliative care services.

The GUIDE model has helped hospice providers to fill gaps of unaddressed physical, emotional, practical and psychosocial needs among dementia patients and family caregivers, Etzel said. The payment demonstration is expanding the potential for greater technology innovations that augment and support bedside hospice care, she said.

“GUIDE is a truly revolutionary program that puts real infrastructure behind caregivers and the care team,” Etzel told Hospice News. “We see technology as being more supportive of our rural patient populations. It should compliment and not replace that human connection that is so important to trust building.”

Technology trends in dementia care

The Connecticut Hospice was among more than 40 of the 400 health care organizations that participated in the first year of the GUIDE model, including the development of Dementia Care Programs (DCPs), reported the U.S. Centers for Medicare & Medicaid Services (CMS). The eight-year payment model demonstration is designed to improve care management and coordination, caregiver education and respite access for dementia patients and their families

Providers can leverage technology to help support patient assessment processes, Etzel indicated. Interdisciplinary teams can also use technology to assist in monthly check-ins, she said. The Connecticut Hospice has also increased virtual support for caregivers through increased video groups that connect them with others. The hospice has plans in the works to integrate a remote patient monitoring system, intended to improve reach among rural populations.

The Connecticut Hospice is joined by several other hospice and palliative care providers participating in the GUIDE model. These include Alivia Care Solutions, Avow Care Services, Delaware Hospice Inc., Hospice of the Chesapeake, Empath Health, Gilchrist Hospice Care and Andwell Health Partners, among others. CMS’ recently published a GUIDE map showed that participating organizations are predominantly located in Midwestern and Eastern regions.

The GUIDE model has created a pathway for greater engagement with patients upstream in their dementia illness progressions, which has led to more meaningful end-of-life experiences, Etzel said.

The Connecticut Hospice’s dementia care program has helped to build better referral relationships and improved care transitions. Roughly 85% of patients discharged from its dementia program transition to hospice services, she stated. The hospice has also seen improved access to palliative care as a result of referrals from its dementia program.

Other hospice providers participating in GUIDE have increasingly turned to technology in a number of ways.

A seven-member GUIDE coalition has convened to share and disseminate best practices in care delivery. The coalition is a mix of Medicare health care providers and tech-enabled entities including Ceresti Health, Craniomatrix, Harmonic Health, Isaac Health, Pocket RN, Tembo Health and Vesper Health.

In addition to sharing best practices, the coalition advocates for improvement of the GUIDE payment demonstration as it progresses and to ensure its sustainability under a new presidential administration, according to Edo Banach, strategic advisor at the law firm Manatt, Phelps & Phillips LLP. The firm’s services extend across several industries including health care, technology and financial services, among others.

Technology plays a key role in the ability to examine the impacts of the payment model in terms of quality, cost savings and access, Banach said.

“GUIDE requires a combination of hands-on care and top notch record keeping, reporting and analytics,” Banach told Hospice News in an email. “GUIDE Coalition members work with various providers — hospices, [Accountable Care Organizations (ACOs)] and health systems — to enhance their care delivery. These partnerships work both ways. It takes a village to carry out the variety of GUIDE elements, and oftentimes a partnership of two or more entities will assure that people get the best combination of care possible.”

Hospice providers have increasingly leveraged technology to provide more person-centered, goal-concordant care to dementia patients and their families, said Dr. Adam Flowers, CEO and medical director of Vesper Medical Care. Flowers is also medical director of Bluebonnet Health Services’ hospice program.

Texas-based Vesper is a GUIDE coalition member offers senior health care services including end-of-life support and personalized dementia care coordination. The health system also provides home health, supportive care and bereavement services. 

Patient data analytics, for instance, can help with earlier identification of declining conditions and elevated or intensifying care needs, Flowers stated.

“Technology can allow hospice companies to stay organized in making sure they have allocated the right resources into the right places,” Flowers told Hospice News in an email. “It allows customization of the hospice experience for each individual patient through electronic health records with capacities to flag certain conditions or situations that all providers and staff should be aware of.”

Growing hospice, tech collaborations

Among the strongest areas for technology utilization is the capacity to help improve family caregiver satisfaction with greater, faster access to resources and education, according to Jenna Morgenstern-Gaines, co-founder and CEO of the GUIDE coalition member PocketRN.

PocketRN launched in 2021 and last year piloted a dedicated dementia program designed to test the different components of the GUIDE demonstration. The pilot follows a patient’s “whole lifetime” across the health care continuum, Morgenstern-Gaines said. The program includes a team of licensed nurse practitioners and care coordinators who support clinicians serving dementia patient populations.

The program implements a “nurse for life” care model for dementia patients that has thus far reduced hospitalizations and emergency department visits by as much as 30% in some cases. Additional results have included a 95% cost satisfaction rating among Medicare beneficiaries.

Leveraging technology in the end-of-life space can also help hospice providers ease clinical burden amid widespread staffing shortages and rising demand, according to Morgenstern-Gaines

“Technology really underpins that ability to have immediate access to that workforce, which is huge in providing reassurance to someone in real time,” she told Hospice News. “It’s having reliable support to be able to pivot and help make changes as things evolve for a dementia patient. The end-of-life journey is not pretty for so many people with dementia, and nobody really explains to caregivers what could or might happen. This GUIDE model really helps close the gaps from the caregiver aspect in giving them relief, confidence and resources and also adds more resources to the mix when so much weight is on palliative and hospice care providers’ shoulders.”

Technology can help to reduce fragmented health care delivery that dementia patients often receive, said Paul Minton, chief technology officer at Naveon. Minton has a background in nursing and spent 15 years providing acute and emergency care, as well as home-based care.

Technology can increase collaboration with other health care providers and help to “unlock more meaningful time” for patients to spend with their loved ones, as well as reduce burdens on clinical staff, Minton said.

Louisiana-based Naveon has developed an AI-voice assisted program designed to assist family caregivers supporting hospice and palliative care patients. The Guided Response Agent for Compassion and Engagement (GRACE) program fields after-hours calls and uses data analytics to create efficient staff workflows and provide support.

“The role of GRACE is to listen with empathy, but also be precise about the information being collected to pass on key details to clinicians,” Minton told Hospice News. “Technology should be an extension for patients that is key for clinicians and caregivers without overwhelming staff. It’s all around communication and timely response. And in dementia hospice care, that extension of emotional nuance and trust deeply matters. It’s designing AI technology to improve calm continuity of care in what can be a fragmented system for dementia patients. It’s not about automation but amplification of care.”