The recently-introduced Guiding an Improved Dementia Experience (GUIDE) Model may have the potential to address key gaps in Medicare’s support of dementia patients and their caregivers. In a new white paper, healthcare research and advisory services firm ATI Advisory analyzed how GUIDE differs from other support models, and explored areas for further improvement.
The Center for Medicare & Medicaid Innovation (CMMI) Center announced GUIDE on July 31, offering an avenue for unpaid family caregivers of dementia patients to receive some reimbursement through traditional Medicare. These caregivers provide an invaluable service. CMS spends an estimated $157 billion on dementia care annually, whereas unpaid caregivers contributed almost $400 billion worth of care for loved ones with dementia in 2022, according to the ATI report.
Individuals with dementia are also more likely to have other chronic conditions, increasing the strain on their caregivers, the report noted. Still, caregivers are often untrained, uneducated and lack the social supports to ensure their own health and well-being.
That’s where GUIDE comes in. Core to the model is the creation of a care navigator, who will help caregivers access a network of support services, develop care plans, help with symptom management, communicate with clinical and non-clinical providers, among other tasks. Another unique perk under the GUIDE Model: caregivers will be able to bill Medicare for respite services — up to $2,500 — to relieve them of some of the stress that comes with unpaid caregiving. Respite services are one of the most-desired caregiver resources that are not currently billable under fee-for-service Medicare, according to the white paper.
“The GUIDE Model’s approach to care delivery and inclusion of caregiver supports has the potential to inform and transform how dementia care and caregiver supports are addressed within the Medicare program in the future,” the report said.
Still, there might be room for improvement. ATI presented several key considerations to better align the model with caregivers’ needs, more thoroughly assess its impact, and broaden its ability to inform people about dementia care. ATI recommended that GUIDE-participating caregivers transitioning their patient to long-term care be provided a small payment to help them maintain support activities. Monthly payments for at least six months can ease this shift to long-term care for patients and their caregivers, the report said.
To strengthen the model’s assessment of its impact, the white paper noted that caregivers should have their health and well-being evaluated, not just the individuals with dementia they serve. Focus groups or advisory councils were also ideated as a means of pinpointing other areas for future improvement.
These results should be disseminated to a broad group of stakeholders to “reduce fragmentation across healthcare systems and strengthen the quality and continuity of comprehensive dementia care,” the report said. ATI said it expects rates of dementia diagnosis to grow following the model’s implementation, which may increase Medicare enrollment and present opportunities to study a wider range of beneficiaries.
