A new, voluntary Medicare payment model focused on dementia care will add to the value-based care options for certain specialists, who often lack a path away from fee-for-service payment.
The Guiding an Improved Dementia Experience (GUIDE) Model will launch on July 1, 2024, and run for eight years.
By offering care coordination and other services, the GUIDE model “aims to improve quality of life for people living with dementia, reduce strain on their unpaid caregivers, and enable people living with dementia to remain in their homes and communities,” according to CMS.
The model also aligns with CMS’ goals to reduce health disparities.
“We know Black, Hispanic, and Asian-Americans, Native Hawaiian and Pacific Islander populations have been particularly disadvantaged in receiving dementia care,” CMS Administrator Chiquita Brooks-LaSure said in a July 31 statement. “The GUIDE Model will provide new resources and greater access to specialty dementia care in underserved populations and communities.”
The model will be open to care teams that include:
- A care navigator who has met certain training requirements, and
- A clinician who has cared for patients with cognitive impairment, for older adults, or who has a specialty designation in neurology, psychiatry, geriatrics, geriatric psychiatry, behavioral neurology, or geriatric neurology.
There are two participation tracks under the model:
- The established program, intended for participants who already provide comprehensive dementia care and can immediately meet the model’s requirements, and
- The new program, designed for participants who don’t yet operate a comprehensive outpatient dementia care program but who have developed a detailed plan to do so.
Model payment will include:
- One-time lump sums to certain safety-net participants, allowing them to invest in the necessary program infrastructure;
- Monthly, per-patient payments to cover care management and coordination, caregiver education, and support services; and
- Respite service payments, up to an annual cap, for eligible patients.
CMS will release the application for the model this fall. In the meantime, the federal agency encourages prospective participants to submit a letter of intent by Sept. 15.
For more information, check out the Texas Medical Association’s Clinical Quality and Payment webpage.
Last Updated On
August 14, 2023
Originally Published On
August 09, 2023