CMMI Announces New Dementia-Focused APM

The Centers for Medicare and Medicaid Services (CMS) announced the creation of a new payment model for people diagnosed with dementia.

The Guiding an Improved Dementia Experience (GUIDE) Model is an alternative payment model focused on preserving quality of life for diagnosed dementia patients while keeping them at home and providing support for their caregivers. According to the CMS Innovation Center, the model’s creation was directed by President Biden’s Executive Order 14095 on Increasing Access to High-Quality Care and Supporting Caregivers and the National Plan to Address Alzheimer’s Disease.

CMS will use the GUIDE model to test a payment model for individuals who provide “key supportive services” to people with dementia, and will offer caregivers access to a care navigator who can help them access specific services and community supports, according to the CMS press release. From CMS Administrator Chiquita Brooks-LaSure:

While we have made tremendous progress in improving care for people with dementia through the National Plan to Address Alzheimer’s Disease, people living with dementia and their caregivers too often struggle to manage their health care and connect with key supports that can allow them to remain in their homes and communities. Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden.

Inside Health Policy explains that the entities that participate will receive a monthly payment per-beneficiary but will also be able to bill for respite care up to an annual amount. The model will have one track for providers with existing dementia supportive care programs and one for those starting new programs.

In 2021, there were an estimated 38 million caregivers in the U.S. spending an average 18 hours per week on care, according to the Hill. One study from the Centers for Disease Control and Prevention (CDC) found that one in four baby boomers are caregivers.