On July 1, 2024, CMS launched the GUIDE Model. On July 8, 2024, CMS announced the 390 organizations participating in the model and published a blog post and the GUIDE Participant List (XLSX). Please visit the linked pages for additional information.
The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary nationwide model test that aims to support people with dementia and their unpaid caregivers. The model began on July 1, 2024, and will run for eight years.
The GUIDE Model focuses on comprehensive, coordinated dementia care and aims to improve quality of life for people with dementia, reduce strain on their unpaid caregivers, and enable people with dementia to remain in their homes and communities. It will achieve these goals through Medicare payments for a comprehensive package of care coordination and care management, caregiver education and support, and respite services.
GUIDE delivers on the Biden Administration’s April 2023 Executive Order 14095 on Increasing Access to High-Quality Care and Supporting Caregivers, which directed the Secretary of Health and Human Services to “consider whether to select for testing by the Center for Medicare and Medicaid Innovation an innovative new health care payment and service delivery model focused on dementia care that would include family caregiver supports such as respite care.”
It also advances key goals of the National Plan to Address Alzheimer’s Disease, which was established through the bipartisan National Alzheimer’s Project Act (NAPA) and has, for over a decade, accelerated federal actions to optimize the quality of care for people with dementia and their caregivers while advancing research towards a cure. The GUIDE Model builds off of this extensive coordination within HHS and major input from various external stakeholders.
Despite its prevalence, many people with dementia do not consistently receive high-quality, coordinated care. As a result, they experience poor outcomes, including high rates of hospitalization, emergency department visits, and post-acute care utilization. They also experience high rates of depression, behavioral and psychological symptoms of dementia, and poor management of other co-occurring conditions.
Dementia also significantly impacts the family and other unpaid caregivers, who often provide significant amounts of assistance with personal care, finance, household and medication management, clinical coordination, and other care. Many caregivers for people with dementia, who are often Medicare beneficiaries themselves, report high levels of stress and depression, which negatively affect their overall health and increase their risk for serious illness, hospitalization, and mortality.
Through the GUIDE Model, CMS is testing an alternative payment methodology for participants that deliver comprehensive, coordinated dementia care. Under the model, participants will assign people with dementia and their caregivers to a Care Navigator who will help them access GUIDE services and supports, and non-GUIDE services and supports including clinical services and non-clinical services such as meals and transportation through community-based organizations.
The GUIDE Model will also enhance access to the support and resources that caregivers need. Unpaid caregivers will be connected to evidence-based education and support, such as training programs on best practices for caring for a loved one with dementia. Model participants will also help caregivers access respite services, which enable them to take temporary breaks from their caregiving responsibilities.
When used over time, respite services have been found to help unpaid caregivers continue to care for their loved one at home, preventing or delaying the need for facility care. The model is also designed to reduce Medicare and Medicaid expenditures primarily by helping people with dementia to remain at home, and reducing hospitalization, emergency department use, the need for post-acute care as well as long-term nursing home care.
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