Enhancing Dementia Care: Practical, Affordable Solutions
Presented by UCLA
Thursday, April 17, 2025, 2:30 PM – 3:30 PM EST
Speakers: David B. Reuben, MD (UCLA ADC Program)
Leslie Evertson, DNP (UCLA ADC Program)
David Bass, PhD (BPC)
Gary Epstein-Lubow, MD (NDCC)
Lynn Spragens, MBA (Spragens & Associates, LLC)
As the number of individuals living with Alzheimer’s disease and related dementias continues to rise, all physician groups that provide care for older persons will need to be able to provide the necessary care for these patients and support their caregivers. The clinical manifestations of dementia are devastating, including progressive cognitive impairment, behavioral changes, functional decline, immobility and falls, and swallowing problems. These sequelae often lead to caregiver burden, emotional stress, and negative impacts on health indicators and outcomes. Over half of family caregivers rate the emotional stress of dementia care as high or very high, and 30 to 40 percent develop depression.
In response, six evidence-based dementia care programs have been developed to meet the needs of persons living with dementia and their caregivers, including providing care coordination and caregiver support. Some are based within health care systems and reach out to community-based organizations to provide additional services, whereas others are based in community-based organizations and coordinate social services with care provided by health care systems. These models have been demonstrated to improve the quality of dementia care and reduce the costs of care, and avoid long-term nursing home placement. With support from The John A. Hartford Foundation, these evidence-based models are being disseminated to healthcare organizations nationally.
On July 31, 2023, the CMS Innovation Center announced the Guiding an Improved Dementia Experience (GUIDE) Model to test an alternative payment model for dementia care for Medicare Part B providers (henceforth referred to as “participants”). The GUIDE Model has enrolled 390 participants, including 96 “Established-track Programs” of comprehensive dementia care that began in July 2024 and 294 “New-track Programs” that have a “Pre-Implementation” period that started July 2024, with the expectation that their first performance year will begin in July 2025. The GUIDE Model provides a per-beneficiary-per-month payment to enrolled participants and additional payment for respite care of up to $2,500 per year for those with moderate or severe dementia. This innovative initiative is the first time the CMS has recognized the full scope of dementia care needs, including community services and caregiver support. Nevertheless, the vast majority of people in the US with Alzheimer’s and other dementias will not be cared for by GUIDE participants, in large part because over half are enrolled in Medicare Advantage plans, and many are enrolled in Program of All-inclusive Care for the Elderly (PACE) and hospice, all of whom are ineligible for GUIDE because they are already in an inclusive payment system. Moreover, many Medicare fee-for-service Part B providers did not apply for GUIDE or were not accepted.
This session will introduce APG organizations to the six evidence-based models of dementia care, including caregiver support, and discuss how to manage this growing number of patients effectively and efficiently to maximize clinical outcomes and minimize costs. The intent is to engage physician groups in implementing comprehensive dementia care into their practices by adopting or adapting evidence-based models or co-creating new models that draw upon established elements. The ultimate goal is to help physician groups achieve their quality and financial goals for patients with dementia.
The session will include five speakers who will provide background on the challenges of providing care for dementia patients, the six evidence-based models, caregiver support programs that can be implemented with any dementia care model, and the business case for comprehensive dementia care. There will also be ample time for discussion.
