How Home-Based Care Providers Are Planning To Get Involved With The GUIDE Model

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The Centers for Medicare & Medicaid Services (CMS) first announced the Guiding an Improved Dementia Experience (GUIDE) Model in late July. Home-based care providers have now had time to think about the opportunity the model may bring with it.

The goal of the model is to “support people living with dementia and their unpaid caregivers.”

But there’s more than one avenue for home-based care providers of all types can get involved.


“I think the concept has a lot of potential, but will inevitably need incremental enhancement,” Bud Langham, the EVP of clinical excellence and strategy at Enhabit Inc. (NYSE: EHAB), told Home Health Care News in an email. “The dementia population is uniquely challenging with highly complex and highly variable needs. It will require a variety of partnerships and radical care coordination to be successful. It is undoubtedly a wonderful opportunity for home health and hospice programs to demonstrate their value.”

Provider participation

Providers can voluntarily opt into the GUIDE Model. CMS is accepting non-binding letters of interest from parties through the middle of September.

After that, more details are expected to come out in the fall, as well as a request for applications.


The Providers HHCN connected with said they are optimistic about the possibilities.

“It’s very aligned with our philosophy longitudinally,” Matt Kinne, VP of growth at Lifespark, told HHCN in an email. “A large percentage of who we serve in our business lines are seniors with dementia. The additional opportunities for them to be supported — along with their family caregivers who are non-professionals — with this model would be great. We were also pleased to see the financial investment being made in serving these seniors. It’s critical and we’re happy to see CMS take this important step.”

Minnesota-based Lifespark is a senior care provider that offers both in-home care and senior living services.

Lifespark is eagerly awaiting the RFA process in the fall, Kinne said. The company anticipates taking on a “lead convener role” within the model.

“It can be a nice adjunct to a Medicare ACO,” Kinne said. “This starts to build the chassis for home health and hospice business to fill the gaps that too often exist between episodes. Home health and hospice traditionally get left out of the value-based conversations because most exist within the fragmented FFS payment structure. When we discharge seniors from a home health stay, there are significant gaps where a model like this could fill as an extension and provide value.”

Providers have also connected the dots between the GUIDE model and CMS’ mandate to move more toward value-based care by 2030.

“Providers — or ‘payviders’ — who already have strong provider and health system relationships will be better positioned to drive this GUIDE model successfully into the community,” Kinne said.

Enhabit’s Langham is making similar considerations.

“We are actively considering engaging with the new model and exploring options to engage,” Langham said. “We have a strong depth and breadth of knowledge caring for this population, along with many years of clinical experience. We would most likely engage as a ‘partner organization’ collaborating with Part B-enrolled providers, but we are looking at our options.”

The Dallas-based Enhabit is one of the largest independent providers of home health and hospice care in the country. Its footprint includes 255 home health locations and 108 hospice locations across 34 states.

The GUIDE model offers providers a way to build on holistic care strategies.

“In order to keep these individuals safe and functioning at their best level possible, care teams must implement a holistic care plan that addresses their specific dementia type, comorbidities, body structure, function impairments and functional limitations — as well as environmental factors,” he said. “When you consider the size of this population, the estimated increase in the population and the amount of dementia health care-related CMS spending, [the GUIDE model] should create opportunities for post-acute providers to benefit as they help move higher-cost facility care to the lowest-cost setting.”

DispatchHealth, the Denver-based in-home medical and urgent care startup, has cared for almost one million patients.

On the way to one million, the company has had extensive experience in treating memory disorder patients at home.

“At long last, CMS is validating the role of caregivers and demonstrating deeper consideration for the value of higher complexity care in the home,” Dispatch Health’s Chief Nursing Officer Erin Denholm told HHCN in an email. “In the face of an ever-growing senior population and the magnitude of conditions like dementia and Alzheimer’s, this type of bundle program will elevate the overall wellness of our senior population and offer much-deserved recognition for unpaid caregivers.”

DispatchHealth is also interested in engaging with the new model, but Denholm said the company is still exploring what that may look like.

“With a partner entity specializing in caregiver support, DispatchHealth could serve this population’s medical and nursing needs,” she said. “We know how to deliver safe, high-quality care in the comfort of our patients’ homes. With the ability to treat high-acuity to low-acuity patients, DispatchHealth can provide a wide range of patient-centric care.”

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