GUIDE
Guiding an Improved Dementia Experience Model
The GUIDE Model is a voluntary, nationwide model testing the impact of providing comprehensive services and supports for people with dementia and their caregivers. It advances coordinated dementia care by providing evidence-based services including care navigation, 24/7 support, caregiver training, and respite services.
Innovation
Offers a new program track that includes training and technical assistance and a monthly population-based payment methodology (Dementia Care Management Payment) that enables innovative team-based care and respite services. It specifically targets Medicare beneficiaries with dementia and their unpaid caregivers at any stage of disease.
The Problem
People with dementia often experience fragmented care that leads to poor health outcomes, and they typically need comprehensive caregiver support; family caregivers, who are often people with Medicare themselves, bear significant mental, physical, emotional, and financial burdens.
The Solution
The GUIDE Model advances coordinated dementia care to support both people with dementia and their caregivers by providing evidence-based services including: care navigation, 24/7 access to a support line, caregiver training and education, respite services up to $2,500 annually, and connections to community resources.
Expected Outcomes
The GUIDE Model enables people with dementia to remain safely in their homes and communities longer by preventing or delaying nursing home placement, improving quality of life for both patients and caregivers, and reducing Medicare and Medicaid expenditures.
Strategy
The GUIDE Model empowers caregivers with evidence-based tools and support while providing coordinated care management that addresses both patient and caregiver needs, ultimately preventing costlier interventions and improving health outcomes for America’s aging population.
Model Goals
- Support innovation by offering a new program track and monthly population-based payment methodology
- Address affordability by offering a new payment for respite services and requiring screening for health-related social needs
- Delay long-term nursing home care
Patient Eligibility
Beneficiaries must have a confirmed dementia diagnosis, be enrolled in Medicare Parts A and B as their primary payer, not be in hospice, and not be a long-term nursing home resident.
- Has dementia, as confirmed by attestation from a clinician on the GUIDE Participant’s GUIDE Practitioner Roster
- Is enrolled in Medicare Parts A and B (not enrolled in Medicare Advantage, including Special Needs Plans, or PACE programs) and has Medicare as their primary payer
- Has not elected the Medicare hospice benefit
- Is not a long-term nursing home resident
Provider Eligibility
Eligible providers are Medicare Part B-enrolled providers and suppliers eligible to bill under the Medicare Physician Fee Schedule, excluding DME and laboratory suppliers.
- Medicare Part B-enrolled providers and suppliers
- Eligible to bill under the Medicare Physician Fee Schedule
- Excludes durable medical equipment (DME) and laboratory suppliers
- Established program track requires a practicing interdisciplinary team that provided at least 6 of 9 GUIDE Care Delivery Service domains to people with dementia for at least 12 months prior to Jan 30, 2024
Care Categories
Chronic Disease Management
CMS Benchmarks & Thresholds
eligibility
financial
operational
population
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