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ARTICLE | GUIDE

GUIDE: The Catalyst for Transformative Caregiver Support in Healthcare

Picture of Dhruv Vasishtha

Dhruv Vasishtha

Dhruv Vasishtha sits on the ianacare clinical advisory board. He is a healthcare product leader and was most recently the founding SVP Product at firsthand, a GV backed tech-enabled value based care provider that supports individuals living with serious mental illness. Prior to that Dhruv led product at PatientPing, a national care coordination platform that was acquired by Appriss Health (now known as Bamboo Health)

Key Takeaways:

  • GUIDE as a paradigm shift:  The GUIDE model signifies a transformative shift in healthcare policy, positioning family caregivers as essential partners in the care continuum, deserving of support and investment.

  • First-of-its-kind data and evidence: The model is set to provide the first robust claims data and evidence that supporting family caregivers can significantly reduce healthcare costs, paving the way for broader adoption of caregiver support programs.

  • A lasting effect:  The GUIDE model’s comprehensive approach is expected to influence future CMS investments and inspire healthcare organizations to develop their own caregiver support programs, improving patient outcomes and reducing overall care costs.

For years, we’ve been advocating for a greater focus on the profound impact that family caregivers have on care delivery and patient outcomes. The Biden administration has been dedicated to pushing caregiver support forward over the past four years, but the announcement of the GUIDE model felt like a groundbreaking moment—a moment when caregiving shifted from being a peripheral concern to becoming a central focus in healthcare policy.

As details of the GUIDE model have come into focus, and we’ve learned about CMS’s goals with the program, it has become clear that this is not a one-off experiment. Instead, it represents a significant shift towards recognizing caregivers as vital partners in the care continuum, deserving of support and investment.

Let’s start by looking at the history of CMS care programs, where there are strong examples that show effort to refine care models by integrating resources for individuals providing critical but informal care. These programs show that CMS is willing to invest in and scale initiatives that demonstrate improved care coordination and cost savings, and a willingness to continue refining and building off of existing programs, as outline below:

MSSP ACO (Medicare Shared Savings Program Accountable Care Organizations)

  • Focused on coordinated, high-quality care for patients. Many ACOs recognize that addressing caregiver needs is essential for reducing costs and improving patient outcomes, especially when trying to reduce unnecessary healthcare utilization.

ACO REACH (Accountable Care Organization Realizing Equity, Access, and Community Health)

  • A program expanding on the success of MSSP ACO, this model promotes integrated, coordinated care which helps to relieve some of the burden placed on family caregivers

BPCI (Bundled Payments for Innovative and Simplified Your Care)

  • With a goal of cost containment and improved care efficiency, the BIPSY model also supports caregivers by providing more predictable and structured care plans

TEAM (Treatment, Engagement, and Management Model)

  • This model is built off of the BPCI program, with more explicit efforts to support caregivers, emphasizing the especially critical role of family caregivers for complex health needs. The model promotes the active participation of caregivers in treatment plans, ensuring they are well informed and supported through the long-term management of patient’s health

While some of these models provide caregiver support indirectly, in the past year, CMS has become more and more explicit about specific support for caregivers.

We’ve seen glimpses of this with the new changes to the Physician Fee Schedule (PFS), specifically, the reimbursement of caregiver services including specific programs for training and support. In addition to the new CPT codes for caregiver training, caregiver support has also been recognized as a benefit under Medicare Advantage (MA) plans.

The GUIDE Model goes even further, demonstrating a clear understanding that addressing caregiver needs is vital for achieving better health outcomes and more efficient healthcare delivery.

The structure of the GUIDE model takes a comprehensive approach. It is likely to set a precedent for future CMS investments, emphasizing caregiver support as not only a key component but the main component.

Our team has jumped head-first into the GUIDE program and sparked conversations with some of the nation’s largest care enterprises to gauge their understanding and interest in the CMS model and other caregiver support programs. We’ve come away with two main takeaways and predictions:

1. Broad Application Beyond Dementia

While GUIDE focuses on dementia, it’s not the only condition where caregivers are actively involved. Other high-cost and high-intensity conditions like ALS, Parkinson’s, cancer, and more require a high level of commitment and involvement from the patient’s informal caregivers (most often a family member). As healthcare costs continue to rise and more patients than ever are aging and being diagnosed with these conditions, CMS will continue to prioritize and invest in cost-containment measures similar to GUIDE.

    • Looking at a specific and timely example, many stop-loss carriers (1, 2)  have put out analyses showing that cancer produces the highest claims costs. Cancer in particular requires heavy caregiver involvement and is a high-burden condition for family members to manage. With cancer diagnoses on the rise, the burden placed on caregivers will only grow, alongside growing claims and costs. The GUIDE model will prove that interventions of comprehensive support will have a tangible impact on the outcomes and utilization of patients with caregivers.

 

We anticipate more payment models focused on these high-cost conditions emerging over the next few years.

2. Data-Driven Evidence and ROI

GUIDE will provide the first hard claims data and evidence that supporting family caregivers reduces the cost of care. This in itself is groundbreaking – historically, caregiver support has been offered as an employee benefit, where impact and ROI are measured by reduced turnover, absenteeism, and improvement in productivity. While these are still important and positive indications, there hasn’t been a concerted effort to measure the return on caregiver support as a lever for cost savings. And we believe this is where the greatest ROI lies. The learnings from CMS in the GUIDE model will pave the way for broader adoption of programs focused on caregiver support.

These results will also underscore the necessity for any care enterprise interested in cost containment and improved outcomes to build its own caregiver support programs

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Here at ianacare, we’ve been having more and more conversations with enterprises including health systems and payviders who express interest in GUIDE, but as a philosophy. 

While some entities and larger organizations may not want to enroll in the CMS program, we’ve heard from several organizations that if they see cost savings from the model, they would be motivated to build a bespoke version of a caregiver support program following the GUIDE model. This isn’t uncommon, as we saw with commercial insurers who created commercial bundles similar to the BPCI program.

However care entities choose to get involved, it’s clear that the GUIDE model marks the beginning of a new era in healthcare, where caregiver support is recognized as a critical component of effective care. This model is not just an isolated initiative but part of a broader trend toward prioritizing and investing in caregivers. As we move forward, stakeholders across the healthcare industry must recognize and support this shift, ensuring that caregivers receive the support they need to continue their vital work.

By embracing the principles of the GUIDE model, healthcare organizations can improve patient outcomes, reduce costs, and enhance the overall care experience. The GUIDE model is a testament to the evolving priorities of CMS and a call to action for the healthcare industry to embrace and invest in caregiver support. By doing so, we can drive meaningful change and create a more sustainable, effective healthcare system for all.

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