With the creation of the GUIDE model, Guiding an Improved Dementia Experience, the Centers for Medicare and Medicaid (CMS) is, for the first time, formally recognizing the pivotal role of family caregivers and their impact on improving health and medical outcomes for people with dementia. GUIDE is an innovative pilot program designed to transform dementia care by focusing on care coordination and support for caregivers, with the aim of easing the caregiving burden and improving patient care. If successful, GUIDE will help improve the lives of millions of people living with dementia while providing meaningful support for the millions more who care for them.
Caregivers often find themselves ill-prepared for the evolving role of caring for someone with dementia. In addition to managing the day-to-day care, they must learn to navigate the changes in the behavior and physical and mental health of their loved one, while experiencing their own emotional and physical responses. A lack of support for caregivers can lead to both their own decline in health, as well as that of the person for whom they are caring. This can result in more frequent emergency room visits, increased readmissions and premature placement into long-term care facilities.
The Staggering Numbers
Dementia is a pressing public health issue. According to the Alzheimer's Association, over 6 million Americans currently live with Alzheimer's or another form of dementia, with associated costs of $345 billion in 2023. By 2050, this number is expected to rise to 13 million, costing nearly $1 trillion. Unpaid caregivers, numbering 11 million, play a critical role in the care of these individuals, yet their lack of support can lead to adverse health outcomes for both themselves and the person with dementia.
Research indicates a direct correlation between easing caregiver burden and reducing healthcare costs. Up to 70% of caregivers experience depression or fatigue while caring for a loved one, which results in a 73% increase in emergency department utilization for people with dementia. Supporting family caregivers with care planning and coordination can reduce readmission by 25%.
The GUIDE Model’s Three Focus Areas
Care Coordination: Patients and their caregivers will have an interdisciplinary team working with them to create and implement a personalized care plan and provide ongoing medical and social support.
Caregiver Support and Education: Caregivers will have access to training, education, support groups, a 24/7 support line and a dedicated Care Navigator.
Respite Services: Eligible caregivers may receive up to $2,500 per year in free respite services.
GUIDE Design and Eligibility
CMS is currently accepting applications for the GUIDE model, set to launch in July 2024 and run for eight years. Medicare Part B providers (doctors and health systems) are eligible to apply and are encouraged to form partnerships with organizations experienced in care coordination and dementia. GUIDE also creates a new opportunity for value-based providers to reduce costs.
Eligible patients must have a dementia diagnosis, Medicare as their payer, be enrolled in Medicare Parts A & B (not Medicare Advantage or PACE), not enrolled in hospice, and not reside in long-term nursing homes. Providers will collect and report data based on key metrics such as high-risk medications, quality of life outcomes, caregiver burden, utilization (per capita cost) and long-term nursing home stay rate.
GUIDE as a Game-Changer
The GUIDE model represents CMS’ recognition of the role that caregivers play in improving health outcomes - a role that has not been acknowledged in healthcare funding - as well as the burdens that they encounter. By formally including caregivers as members of the healthcare team and providing them with tangible support, CMS aims to drive improved health outcomes for patients while also improving quality of life.
Mellie's Commitment to Caregiver Support
With our mission to empower family caregivers, Mellie aligns seamlessly with CMS' new focus on caregivers and the GUIDE model. Mellie’s innovative platform and expert care coordination team support family caregivers by creating personalized care plans, providing access to resources, and offering ongoing support and monitoring, as well as coordination and communication tools.
With CMS leading the charge in recognizing and supporting family caregivers, the GUIDE model provides hope for millions affected by dementia. Mellie, inspired by this transformative approach, is poised to partner with GUIDE participants.
For more information on how Mellie can assist you in meeting the GUIDE requirements of care coordination and caregiver support and education, please contact us at partnerships@mellie.com or on our website. Together, we can usher in a new era of compassionate and effective dementia care.