The New GUIDE Program: A Leap Forward in Dementia Care

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ATIWebinars
10/13/2023
AUTHOR – ATI Advisory

Summary

In the September 27, 2023 webinar, “Discovering Pathways of Support: What CMS’s new GUIDE Model means for dementia patients, caregivers, and providers,” ATI Advisory’s CEO, Anne Tumlinson, led an in-depth discussion into the Model and its expected influence on the entire care spectrum with a panel of industry experts, including Tyler Cromer, Kris Engskov, Kemi Reeves, and Will Saunders.

Bridging “Clinical and Psychosocial Needs” with GUIDE

Tyler Cromer, Principal and Head of Medicare Innovation at ATI Advisory, initiated the panel discussion by delineating the GUIDE Model’s primary goals for addressing one of the “costliest healthcare challenges in the United States.” These goals include enhancing the quality of life for dementia patients, providing support to caregivers, and helping dementia patients remain in their homes and communities. Cromer emphasized that this comprehensive approach encompasses caregiver training, education, and support services, marking a groundbreaking paradigm shift in dementia care and healthcare as a whole. 

Kemi Reeves, a Dementia Care Specialist at UCLA Health and a pivotal figure in the GUIDE Model’s development, explored this shift, stating, “Historically, clinical and psychosocial needs were treated separately. The GUIDE Model integrates these, recognizing that societal challenges can directly affect clinical outcomes.” Reeves emphasized the significance of personal care aides, lauding the Model’s innovative approach to offering respite support and recognizing the critical role of family caregivers. This perspective sparked a comprehensive discussion among the expert panel, exploring multiple facets of the Model, such as eligibility, implementation, and its potential financial and social impact on individuals, families, and organizations.

Navigating the GUIDE Model’s “Collaborative Nature”

For many organizations, especially PACE entities and those aligned with Medicare Advantage, a pivotal question arises: should they enter into fee-for-service Medicare in order to qualify for this new Model and thus be able to better serve dementia patients? While being a Part B provider is a prerequisite for the GUIDE Model, panelists highlighted that providers can contract with other entities to deliver the full model, allowing community-based organizations and respite care providers to extend their support. 

The panelists stressed the importance of effectively integrating these groups to maximize the Model’s potential. 

Kris Engsvok, Co-Founder & CEO of Rippl Care, a senior-focused mental health company, emphasized the collaborative essence of the GUIDE Model, stating, “This is not a winner takes all kind of thing. There’s a real collaborative nature to this, and that is what’s going to be required to get the right outcome for a patient.” Given the substantial number of undiagnosed dementia patients and underserved communities, the panelists underscored the importance of comprehensive education and a sustained discourse concerning the Modeland its potential beneficiaries. As Engskov aptly described, venturing into this “huge experiment” holds promise for creating a more inclusive, efficient, and patient-centered dementia care landscape, but numerous uncertainties remain. 

FAQs from the Webinar:

Q1: What types of organizations are well-positioned to participate in the GUIDE Model?

We see interest in GUIDE across the senior care industry, including primary care groups, health systems, PACE organizations, senior living facilities, hospice, home health, and home care organizations. Organizations are well-suited for the Model if they provide care to older adults, have familiarity providing care coordination services for individuals with complex care conditions, and also have clinical experience caring for individuals with dementia. The challenge we’re seeing, though, is that groups that are interested and able to provide GUIDE’s wraparound care management and caregiver supports, such as senior living or home care providers, are not currently enrolled to bill Medicare Part B under the Medicare Physician Fee Schedule, which is a requirement to apply and participate to the Model. Interested organizations are rapidly initiating discussions to establish partnerships to meet the application requirements in the GUIDE Model.

Q2: Does the GUIDE Model require delivery of primary care services?

Primary care services are not included in the standardized care delivery services that GUIDE Model participants must provide to beneficiaries and their caregivers. The Dementia Care Monthly Payment (DCMP) is intended to cover the Model’s required care delivery activities, which center around dementia care planning, coordination, and management. While participating dementia care teams are required to develop and implement comprehensive care plans, which includes coordinating care with beneficiaries’ primary care and specialist providers, they are not responsible for the delivery of primary care services.

Q3: How can community-based organizations and other non-Part B providers participate in the GUIDE Model?

We are hearing from groups every day that are interested in applying to GUIDE but they are not having traction getting the attention of a Part B-enrolled provider to partner. We also recognize that even for primary care or other Part B-enrolled organizations delivering care coordination models today may be new to establishing relationships with local organizations to deliver respite care, whether in the person’s home, a facility, or through adult day services. We anticipate many applicant organizations will need to establish networks of providers in their community to deliver the care requirements under GUIDE, especially the caregiver respite component of the Model.

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