2023 and 2024 have been exciting years in the treatment of Alzheimer’s disease with the approval of new disease modifying medications, and it also is exciting because the US government announced the launch of a new plan to improve care and support for people with Medicare living with dementia and their unpaid family caregivers - Guiding an Improved Dementia Experience (GUIDE) Model.

Many of us have family members beyond the stage of mild cognitive impairment, and so our loved ones with dementia are not eligible for Leqembi, Kisunla or other treatments, however this new care model enhancement has an opportunity to provide value for us, starting in 2024.

The Biden-Harris Administration announced this new Medicare Dementia Care Model with the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS). The goal is to to:

1) Improve the quality of life for people living with dementia

2) Reduce strain on unpaid caregivers

3) Help people remain in their homes and communities

They plan to do this through care coordination and management, caregiver education and support, and respite services - yes there is actually a $2500 / year in home respite service offering!

What do you need to know to about the program:

1) Only beneficiaries enrolled in traditional Medicare (Medicare Parts A and B) are eligible (you cannot be enrolled in a Medicare Advantage, Special Needs Plan or PACE program to qualify, however hopefully Medicare Advantage programs will start offering these services soon as well in order to stay competitive)

2) You need to receive care from a GUIDE enrolled participating facility - these can be large medical institutions / memory clinics or even PCP offices - however they have to enroll in the program by January 30, 2024 to participate in this 8 year program - ask your provider if they will be enrolling in GUIDE

3) You must live in an assisted living facility or independently (with or without an in home family caregiver); you may not reside in a long-term nursing home

4) Program Timing: For existing dementia care practices that enroll, these services are required to begin by June 2024 and for new dementia care practices that enroll, these services are required to begin by June 2025

What are the 8 benefits offered to families as part of GUIDE:

1) Comprehensive Assessment - patients and caregivers receive separate assessments to identify your needs and a home visit to assess the patient’s safety

2) Care Plan - families receive a care plan that address your goals, preferences and needs, which helps you feel certain about next steps

3) 24/7 Access - families can call a member of your care team (or their representative) using a 24/7 helpline

4) Ongoing Monitoring and Support - Care Navigators provide long-term help to families so you revisit your goals and needs at any time and are not left alone in the process

5) Referral and Support Coordination - the Care Navigator connects you with community based services and supports such as home-delivered meals and transportation

6) Caregiver Support - Caregivers take educational classes and receive respite services (up to $2500 / year for patients who have a family caregiver)

7) Medication Management - Clinician reviews and reconciles medication as needed; Care Navigators provide tips for patients and your family to maintain correct medication schedule

8) Care Coordination and Transition - Patients receive timely referrals to specialists to address other health issues such as diabetes, and the care navigators coordinate care with the specialist

Honestly, this new program has the potential to be amazing, and really affect change and improvement for families and patients with dementia. CMMI, the innovation arm of CMS who built this program, worked with both dementia experts as well as patients and caregivers when designing this program, and it shows in it’s thoughtfulness.

CMS will be reaching out to patients and their families to share more information on the program (so be on the lookout for a letter from Medicare), and we’re excited to see where this can lead in terms of providing real improvement and benefit to patients and their families!

To read more about the GUIDE model and to download the GUIDE Participant List (XLSX) to find a doctor or facility in your area, CLICK HERE

NOTE: Current information on the CMS site is geared to explaining the program to medical practices (not to patients), but more information for families will be coming soon

Source: CMS