ARTICLE | WEBINAR RECAP

Webinar Recap: Understanding the CMS GUIDE Model

Key Takeaways:

  • At a high level, GUIDE can be broken down into 3 key takeaways: assess cognitive impairment, caregiver support, $2,500/year for caregivers to access respite care
  • The 8-year GUIDE program introduces capital for earlier detection while aiming to reduce the overall cost of dementia care.
  • There are two paths to enter GUIDE: as an established entity, with most requirements in place, enabling a go-live in July 2024, or as a new entrant, facing a one-year delay.
    • 🤝 For this reason, it’s favorable for many providers to partner with an organization already offering robust caregiver support services.

As the CMS GUIDE program’s deadlines get closer, there is still a lot for providers to understand about the model and what they’ll need in order to apply and participate.

In partnership with Pearl Health, we brought together an expert panel to discuss the intricacies and value of the program. Bahamia Ulysse, ianacare’s Director of Caregiver Navigator Program moderated and facilitated an educational conversation with Dr. Cam Berg of Pearl Health and Dhruv Vasishtha, an ianacare advisor.

Below is an overview of key learnings and takeaways from the event, but our speakers shared even more deep knowledge and expertise, so be sure to check out the full webinar recording here.

WHAT OUR EXPERTS SHARED

1. What is GUIDE?

The Centers for Medicare & Medicaid Services (CMS) has initiated the GUIDE model for Guiding an Improved Dementia Experience.

It aims to improve dementia patients’ quality of life and their family caregivers by providing tailored support and interventions that impact health and medical outcomes.

 

"This is not a shared savings program…CMS is not looking to see how GUIDE itself is going to demonstrate shared savings with an attributed population.

Rather, its intent is to, first and foremost, incentivize the assessment of cognitive impairments and finance caregiver supports."

2. What Does GUIDE Look Like?

  • Interdisciplinary team creates person-centered care plan

  • Continuous monitoring and care

 

  • Training, education and support groups for caregivers

  • Expert Care Navigators facilitate access to clinical and non-clinical resources

  • Access to a 24/7 support hotline



  • Caregivers receive respite services up to $2,500/year

"Caregiver respite is the number one request we get from our caregivers time and time again."

3. Impact & Opportunities for Providers

Dementia patients navigate our health system differently. This disease presents particular challenges that lead to both wasteful and non-existent care, leaving patients and their families with few options for treatment and support. Proper care for these patients is a problem we all face, and it affects everyone.

Historically and currently, all efforts to address the dementia population have been fragmented and ineffective. With few clinical and therapeutic options, CMS is now turning focus to those that care for these patients and often bear the heaviest burden of care. Rolling these resources into supplemental models with GUIDE will be a huge step.

CMS, for the first time, is offering large capital to providers to address caregiver support for the duration of the program– 8 years. The model is accessible and achievable for providers to participate in.

 

"The caregiver is experiencing this illness at the same magnitude as the patient. And this model does actually address both sides of that equation...GUIDE will make the journey more aligned, and reduce the total cost of care."

4. Role of the Caregiver

Caregivers are crucial in managing dementia. They are deeply involved in care planning and patient monitoring.

Supporting caregivers not only aids in achieving better health outcomes for dementia patients but also helps in reducing costs related to dementia care.

5. GUIDE Caregiver Support Requirements

Comprehensive support for caregivers range from providing proper access to necessary resources like training, support groups, and navigation to medication management. Provision of 24/7 support help-line specifically for caregivers is one of the standout features of the GUIDE model.

6. Partnership and Building Infrastructure

In order to meet the support requirements needed to apply to GUIDE, providers will likely need to enter into partnerships with external vendors who have existing essential caregiver support infrastructures. These existing solutions, technology platforms and specialized services can significantly advance providers’ efforts in supporting dementia caregivers.

7. Future of GUIDE

The program will run for eight years, presenting an exciting opportunity for CMS to provide targeted support to dementia caregivers and patients, while also hoping to reduce costs. This new approach is likely to evolve into other high-risk populations, showing a promising future for value-based care in the US.

Q&A

Throughout the webinar, the audience sent in lots of great, thoughtful questions. Our panelists didn’t have a chance to answer each question live, so we wanted to feature some of those questions below, with answers from our experts:

What are opportunities you see emerging and the implications across healthcare?

Dr. Cameron Berg: “The concept of having prospective payments that are supplemental and oriented to more than just the patient with the idea of reducing total cost of care on a multi-year level is thrilling. That’s what we should be doing in value based care. We’re trying it in dementia and that’s very exciting. I think CMS will extrapolate this to other high risk populations based on the success of the program.”

 

Dhruv Vasishtha: I think is really exciting… the upskilling of family caregivers. At the end of the day, it’s just such a no brainer, but we really have only recently started to do this at scale. There’s this recognition that if you’re really able to train caregivers, not just on the ADLs, but in the tough advanced care planning conversations, or, you know, in palliative care, those types of elements allow people to age with dignity, honor their wishes, and actually have, as literature shows, better outcomes. So I think that that is really interesting and exciting to me… there’s just so much low hanging potential there.” 

Does ianacare offer wraparound GUIDE support to providers who want to participate but don’t have the resources to meet all requirements?

YES! Learn more about our solution and partnering with us here.

Can you all expand more on the funding levels and sustainability of the program?

Dhruv Vasishtha: So, when I think about this, obviously the best case scenario is that this is something like the first gen ACO model, which CMS keeps on reinvesting and reinforcing in different versions. The way that I view this is that CMS is going to be doing something with caregivers as Cam mentioned, this is a new category and they’ve put out this long, eight year program.

I’m really excited that our organizations are saying we’re putting our foot in the door and we’re really going to start doing this because I think that even if it’s not GUIDE, it’s going to have different reincarnations or incarnations either by CMS or as other benefits modeling the program at other value based providers. 

Interested in learning more about GUIDE and how we can help your organization apply? 

Book a free consultation today.

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