The Centers for Medicare & Medicaid Services (CMS) launched the Guiding an Improved Dementia Experience (GUIDE) Model on July 1, 2024, marking a significant step forward in supporting individuals living with dementia, including Alzheimer’s disease, and their families. Announced on July 8, 2024, with 390 participating organizations, this nationwide voluntary model is poised to transform how Alzheimer’s care programs are delivered across the country. This initiative, further detailed in a CMS blog post and a comprehensive participant list, aims to provide a much-needed framework for comprehensive, high-quality dementia care. The GUIDE Model began its eight-year journey on July 1, 2024, with the goal of revolutionizing support for those affected by Alzheimer’s and related dementias.
Understanding the GUIDE Model for Alzheimer’s and Dementia Care
The core mission of the GUIDE Model is to champion comprehensive and coordinated Alzheimer’s and dementia care. It seeks to elevate the quality of life for individuals facing these conditions, alleviate the burdens on their unpaid caregivers, and empower people with Alzheimer’s to remain in the comfort and familiarity of their homes and communities for longer. To achieve these ambitious objectives, the GUIDE Model introduces Medicare payments specifically designed for a holistic package encompassing care coordination, expert care management, essential caregiver education and support, and access to vital respite services. These components are crucial for effective Alzheimer’s care programs.
The GUIDE Model is a direct response to the Biden Administration’s Executive Order 14095 from April 2023, “Increasing Access to High-Quality Care and Supporting Caregivers.” This executive order specifically tasked the Department of Health and Human Services to explore innovative payment models for dementia care, including robust family caregiver support such as respite care. The GUIDE Model directly embodies this directive, focusing on enhancing Alzheimer’s care programs through systemic support for both patients and their families.
Furthermore, the GUIDE Model strongly aligns with the objectives of the National Plan to Address Alzheimer’s Disease. Established through the bipartisan National Alzheimer’s Project Act (NAPA), this plan has been instrumental for over a decade in accelerating federal efforts to improve the quality of care for individuals with Alzheimer’s and dementia, while simultaneously driving research towards effective treatments and a cure. The GUIDE Model is a testament to this ongoing coordination within HHS and the valuable input received from diverse stakeholders, all working towards optimized Alzheimer’s care programs.
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Key Benefits of the GUIDE Model for Alzheimer’s Care |
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| – Alzheimer’s and dementia are significant health challenges, currently affecting over 6.7 million Americans in 2023, with projections reaching a staggering 14 million cases by 2060. This highlights the urgent need for effective Alzheimer’s care programs. – Individuals with Alzheimer’s often grapple with multiple chronic conditions, leading to fragmented care, increased hospitalizations, and frequent emergency department visits. The complexities of managing health needs, providing constant support, and addressing behavioral and psychological symptoms create immense strain on caregivers. This burden disproportionately impacts minority populations, underscoring the need for equitable Alzheimer’s care programs. – The GUIDE Model establishes a standardized approach to Alzheimer’s care, incorporating 24/7 access to a crucial support line, comprehensive caregiver training, and a suite of education and support services. This standardized model aims to enable individuals with Alzheimer’s to live safely at home for longer, potentially delaying or preventing nursing home placement, and significantly improve the quality of life for both patients and their unpaid caregivers. – To address disparities in access to quality Alzheimer’s care, the GUIDE Model actively integrates policies to promote health equity. It ensures that underserved communities have fair and equal access to the model’s interventions and benefits, striving for inclusive Alzheimer’s care programs. |
Purpose and Impact on Alzheimer’s and Dementia Care
Despite the widespread prevalence of Alzheimer’s and dementia, many individuals do not consistently receive the high-quality, coordinated care they urgently need. This gap in care often results in adverse outcomes, including higher hospitalization rates, increased emergency department visits, and greater utilization of post-acute care services. Moreover, individuals with Alzheimer’s frequently experience depression, challenging behavioral and psychological symptoms, and suboptimal management of co-occurring health conditions. These factors underscore the necessity for improved and accessible Alzheimer’s care programs.
Alzheimer’s and dementia profoundly impact families and unpaid caregivers, who often dedicate countless hours to providing essential personal care, managing finances and medications, coordinating household tasks, and navigating complex clinical needs. Many of these caregivers, who are frequently Medicare beneficiaries themselves, report experiencing high levels of stress and depression, which negatively affect their own health and increase their risk of serious illness, hospitalization, and even mortality. The GUIDE Model recognizes the critical role of caregivers in Alzheimer’s care programs and seeks to provide them with substantial support.
Through the GUIDE Model, CMS is actively testing an innovative alternative payment methodology for participating organizations that deliver comprehensive, coordinated Alzheimer’s and dementia care. Participants in the model will assign individuals with Alzheimer’s and their caregivers to a dedicated Care Navigator. This navigator will serve as a central point of contact, helping them access GUIDE services and supports, as well as other essential services both within and outside the GUIDE program. This includes connecting them with clinical services and vital non-clinical services offered by community-based organizations, such as meal delivery and transportation assistance, enhancing the scope of Alzheimer’s care programs.
The GUIDE Model is specifically designed to strengthen access to crucial support and resources for caregivers involved in Alzheimer’s care. Unpaid caregivers will be connected with evidence-based education and support programs, including training on best practices for caring for a loved one with Alzheimer’s or dementia. Model participants will also facilitate access to respite services, enabling caregivers to take much-needed temporary breaks from their demanding caregiving responsibilities. These respite services are a vital component of comprehensive Alzheimer’s care programs.
Research has demonstrated that consistent use of respite services empowers unpaid caregivers to continue providing care for their loved ones at home for longer durations. This can effectively prevent or delay the need for institutional facility care, a key goal of effective Alzheimer’s care programs. The GUIDE model is strategically designed to reduce overall Medicare and Medicaid expenditures by enabling individuals with Alzheimer’s to remain at home, thereby decreasing hospitalizations, emergency department utilization, and the need for costly post-acute care and long-term nursing home care. This approach offers significant economic benefits alongside improved patient outcomes in Alzheimer’s care programs.
Select anywhere on the map below to view the interactive version
Source: Centers for Medicare & Medicaid Services
Participants:Dark Blue: Guiding an Improved Dementia Experience (GUIDE) Model, ]
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Model Design and Components of Alzheimer’s Care Programs
Organizations participating in the GUIDE Model are Medicare Part B enrolled providers and suppliers who will establish dedicated Dementia Care Programs (DCPs). These DCPs will be responsible for providing ongoing, longitudinal care and comprehensive support to individuals with Alzheimer’s and dementia through an integrated interdisciplinary team. This team-based approach is a cornerstone of effective Alzheimer’s care programs.
Recognizing that some participants may require additional support, the GUIDE Model allows participants to contract with other Medicare providers and suppliers, known as “Partner Organizations,” to fully meet the model’s care delivery requirements. This collaborative structure ensures that all participants can offer comprehensive Alzheimer’s care programs, even if they lack specific in-house capabilities.
The GUIDE Model operates on an eight-year timeline and includes two distinct tracks: one for established Alzheimer’s care programs and one for newly developing programs. Established programs, which already possess experience in serving the dementia population and delivering most of the GUIDE care requirements, commenced delivering GUIDE services on July 1, 2024. New programs, on the other hand, benefit from a one-year pre-implementation period, starting July 1, 2024, and concluding on June 30, 2025, to build their infrastructure and prepare for model participation. These new programs will begin delivering GUIDE services on July 1, 2025. CMS is committed to supporting all participating organizations by providing technical assistance, learning resources, and the crucial pre-implementation year for new programs to effectively launch their Alzheimer’s care programs.
The GUIDE Model is strategically designed to address the primary factors contributing to suboptimal Alzheimer’s and dementia care in five key ways:
- Standardizing Alzheimer’s Care Delivery: The model defines a standardized approach to dementia care delivery for all participants. This includes clear guidelines on staffing requirements, essential services for individuals with Alzheimer’s and their unpaid caregivers, and robust quality standards. This standardization is crucial for ensuring consistent, high-quality Alzheimer’s care programs nationwide.
- Alternative Payment Methodology: CMS provides an alternative payment methodology to participating organizations, offering a monthly per-beneficiary payment. This payment structure supports the implementation of a team-based, collaborative care approach, facilitating comprehensive Alzheimer’s care programs.
- Addressing Unpaid Caregiver Needs: The model prioritizes the needs of unpaid caregivers by mandating that participants provide comprehensive caregiver training and support services. This includes 24/7 access to a support line for immediate assistance and connections to community-based providers for ongoing support. These caregiver-focused services are integral to effective Alzheimer’s care programs.
- Respite Services for Caregivers: CMS directly funds respite services through model payments. These temporary services, provided in the beneficiary’s home, at adult day centers, or in facilities offering 24-hour care, are designed to give unpaid caregivers essential temporary breaks from their caregiving responsibilities. Respite care is a critical component of supporting caregivers within Alzheimer’s care programs.
- Screening for Health-Related Social Needs: A core requirement of the GUIDE Model is that participants must screen beneficiaries for psychosocial needs and health-related social needs (HRSNs). They are also responsible for connecting individuals with Alzheimer’s and their families to local community-based organizations that can address these identified needs. Addressing social determinants of health is increasingly recognized as vital for holistic Alzheimer’s care programs.
Advancing Health Equity in Alzheimer’s Care Programs
Promoting equitable care and actively addressing health disparities in Alzheimer’s and dementia care are fundamental principles of the GUIDE Model. CMS recognizes that disparities in access to and quality of care disproportionately affect underserved communities.
Alzheimer’s and dementia place significant financial, emotional, and logistical burdens on families. These burdens are often amplified for racial and ethnic minority groups. For instance, Black and Hispanic populations experience a higher prevalence of Alzheimer’s, yet they are less likely to receive timely diagnoses, often face more unmet needs, experience greater caregiving demands, and allocate a larger proportion of their family assets to Alzheimer’s care. The GUIDE Model aims to mitigate these inequities and ensure fairer Alzheimer’s care programs for all.
CMS proactively sought participation from eligible organizations that provide care to underserved communities. The GUIDE Model offers a range of financial and technical supports to ensure that participating safety-net providers can strengthen their infrastructure, enhance their care delivery capabilities, and successfully participate in the model. This targeted support is crucial for expanding access to quality Alzheimer’s care programs in underserved areas.
The GUIDE Model also specifically focuses on individuals with Alzheimer’s and dementia who are dually eligible for Medicare and Medicaid. The model aims to provide these individuals, and all those supported by the program, with the resources and support needed to remain safely in their homes for as long as possible, promoting independence and well-being within Alzheimer’s care programs.
Key aspects of the GUIDE Model designed to improve health equity in Alzheimer’s care include:
- Mandatory implementation of HRSN screenings and referrals by participating providers to address social determinants of health impacting Alzheimer’s care.
- Provision of financial and technical support for the development of new dementia care programs specifically targeted to underserved areas that currently lack sufficient access to specialized Alzheimer’s care.
- Annual reporting by participants on their progress towards achieving health equity objectives, implementing targeted strategies, and meeting measurable targets in Alzheimer’s care.
- Strategic use of data collected through the model to identify persistent disparities and to direct targeted improvement activities to address inequities in Alzheimer’s care programs.
- Implementation of a health equity adjustment to the model’s monthly care management payment. This adjustment provides additional financial resources to support the care of underserved beneficiaries, enabling enhanced Alzheimer’s care programs for vulnerable populations.
Events & Resources
Past Events
[Link to Past Events – To be added when available]
Additional Information and Resources for Alzheimer’s Care Programs
Model Background Resources
[Link to Model Background Resources – To be added when available]
Technical Resources
[Link to Technical Resources – To be added when available]
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Outreach and Engagement |
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| For additional information, updates, or any questions regarding the GUIDE Model and Alzheimer’s care programs, please refer to the resources listed below: [Contact Information or Resource Links – To be added when available] |
