A new way to pay dementia providers could ease the burden on patients, caregivers

By Emily Woodruff/American Cities Health Journalism Fellowship

More than 6.7 million Americans were affected by dementia in 2023, with projected cases expected to rise to 14 million by 2060, according to the Centers for Medicare & Medicaid Services.

At Health Journalism 2024 in June, Jane Carmody, D.N.P., gave a lightning talk focused on Medicare's new dementia care model. Carmody is the senior program officer for the John A. Hartford Foundation.

The new care model, Guiding an Improved Dementia Experience (GUIDE), will pay providers specially trained in dementia to connect caregivers and patients to services. The program, which CMS launched officially on July 1, could lower the costs of dementia care and delay the need for around-the-clock nursing care.

While there are many programs dementia patients qualify for, such as adult daycares and meal delivery services, they are underutilized. GUIDE "offers hope, a lifeline, a how-to blueprint" for providing care to families dealing with a dementia diagnosis, said Jane Carmody, workshop moderator and senior program officer at The John A. Hartford Foundation.

GUIDE changes the way providers get paid. Instead of solely being compensated on a fee-for-service basis, which didn't always cover some aspects of care, providers in the GUIDE program will get a per-person monthly fee. For example, teaching the spouse of someone with dementia how to care for their loved one or how to find crisis assistance wasn't something a practice could bill for in the past. The new payment model takes into account the provider involvement families need for a dementia patient.

The program also requires providers to be specially trained in dementia care. In some existing programs the GUIDE model is based on, nurse practitioners have helped connect patients and families to social services. The GUIDE program also gives unpaid caregivers a yearly payment of up to $2,500.

"There are lots of programs out there, but they're not reaching the people who need them," said Carmody. The GUIDE model will hold a family's hand throughout the diagnosis.

The Centers for Medicare and Medicaid announced the first providers to participate in the GUIDE model on July 8. The program will run for eight years.

Emily Woodruff is a public health reporter in New Orleans. She was a 2024 AHCJ American Cities Health Journalism Fellow.