How Home-Based Care Providers Can Harness The Power Of CMS’ New Dementia Care Model

The Centers for Medicare & Medicaid Services (CMS) unveiled the Guiding an Improved Dementia Experience (GUIDE) Model this week.

Stakeholders are already weighing in on how the model may affect home-based care agencies.

“We’re very pleased with that announcement, and it is certainly something that we’re going to explore,” Addus HomeCare Corporation (Nasdaq: ADUS) COO Brad Bickham said Tuesday on the company’s second-quarter earnings call.

More than anything, the model’s goal is to reimagine care for the millions of seniors across the U.S. that live with dementia. Through that, CMS hopes that these individuals can live in their homes and communities for as long as possible.

Theoretically, that will lead to higher satisfaction rates for seniors and their families, lower spend of the Medicare dollar and more opportunities for home-based care providers.

“We’re really excited by the opportunity that CMS is [presenting] with this,” Tina Hansen Pickett, a managing director at ATI Advisory, told me this week. “From the perspective of the growth in dementia diagnoses in the Medicare population, in addition to the opportunity that it presents for unpaid caregivers to really be supported through a Medicare payment model.”

The GUIDE model is set to go live on July 1, 2024, running for eight years after that. It is a voluntary model, meaning providers can choose to opt into it or not.

Providers that choose to opt in to the model – and make it a part of their operations moving forward – likely believe there are multiple tailwinds that could come from their participation. They include:

– A new pathway to expanding their patient censuses or client networks

– Strategies for building out core programs already in place

– Possible new reimbursement and revenue-diversification opportunities moving forward

I examine the new model in this week’s exclusive, members-only HHCN+ Update.

Home-based care and the GUIDE Model

Medicare Advantage (MA) plans have been able to offer benefits for caregiver support over the last few years. In traditional Medicare, those pathways haven’t existed.

A lot of home care providers have already committed significant resources to dementia-specific training. Many have also committed time and resources toward taking advantage of those MA benefits, one of which includes respite care, which is a part of the GUIDE Model.

“That caregiver support, the respite care, those in-home supports in MA,” Pickett said. “Where this is different is that this model is really testing that in the Medicare fee-for-service program. It would allow the ability for the Medicare program to gain insights and input into whether these types of caregiver interventions are actually beneficial in reducing burden and strain on caregivers.”

I presumed there were at least three ways that home-based care providers could get involved in the GUIDE Model when I first reported on it Monday.

CMS has since responded to my inquiry, offering specifics on how home-based care providers could involve themselves directly.

“[Here are] two examples of ways that home- and community-based providers, private-pay home care providers and Medicare-certified home health agencies could participate in the model,” a CMS spokesperson told me. “No. 1, they could establish a new, Part B physician practice service line that is eligible to bill for Medicare Physician Fee Schedule services. No. 2, they could partner with an eligible Part B participant, such as a physician practice, to offer some of the services required under the model, for example, respite services.”

For private-pay home care providers, the GUIDE Model could offer them their first entrance into Medicare, or their second entrance if they’ve already committed to MA.

HCBS providers, which typically bill Medicaid, could become more payer diversified, all while conducting business they’re already accustomed to.

As home health providers see their Medicare fee-for-service revenue shrink – due to MA penetration and CMS rate cuts – the model could enable them to hold onto more fee-for-service dollars.

Then there’s providers like Addus, which already deliver home health services under Medicare and HCBS under Medicaid. The company’s leaders see this development as “fitting perfectly” with their goal of delivering three levels of care – home care, home health care and hospice – in each of their biggest markets.

“It has a skill component with the home health, but also as a personal care-type component as well,” Bickham said.

The Frisco, Texas-based Addus provides personal care, home health and hospice services to approximately 47,500 consumers through 204 locations across 22 states. It’s in the process of bolstering its home health and hospice service lines in areas where it already provides personal care.

“Frankly, it’s good to see CMS recognize that that’s probably the population that honestly has the [biggest] lack of services or potential lack of services,” Bickham continued. “Those are the individuals that need home health, they can need personal care, they need hospice.”

Hospice News wrote its own story on Monday on the effects the GUIDE Model could have on hospice providers, many of which are also home-based care providers, like Addus.

Bickham pointed out that it could specifically be a tailwind in hospice due to increased length of stays.

Providers are often criticized for longer patient length of stays in hospice, but the patients that are at that stage longer tend to be dementia patients.

“You get a lot of criticism when someone’s stay is over a long period of time, and it’s primarily with those neurological disorders, such as dementia,” he said. “I think this is really trying to fill some of those gaps, to [mitigate] some of the pressure you have in trying to take care of those individuals in the right place. So, we’re very pleased with it, and certainly looking forward to exploring it.”