Rush University System for Health was recently selected by the Centers for Medicare & Medicaid Services to participate in a new Medicare alternative payment model — Guiding an Improved Dementia Experience — designed to support people living with dementia and their caregivers.
Rush is one of almost 400 participants building dementia care programs across the country, with the goal of increasing care coordination and improving access to services and supports.
“With our continued commitment to providing the best care for our patients, this program will deliver responsive and effective care to those who need it most,” said Elizabeth Davis, MD, associate chief medical officer, Community Health Equity, and associate professor in the Department of Internal Medicine at Rush. “Each patient with dementia has unique, often complex needs, and we have comprehensive services at Rush to meet those needs, not just for patients but also for their caregivers."
"This Medicare program is a step forward in financially supporting the organizations that excel in providing comprehensive care for this patient population.”
The GUIDE payment model will test a new approach for key supportive services furnished to people living with dementia, including comprehensive, person-centered assessments and care plans, care coordination, 24/7 access to an interdisciplinary care team member or help line, and certain respite services to support caregivers.
People with dementia and their caregivers will have the assistance and support of a care navigator to help them access clinical and non-clinical services such as meals and transportation.
“This model will help to fund critical wrap-around services,” said Walter Rosenberg, MSW, MHSM, LCSW, director of Social Work and Community Health, and director of growth and impact, Center for Health and Social Care Integration at Rush.
Hospitals and other providers currently are paid by CMS based on a fee-for-service structure that does not cover the costs, forcing most practices to leave their patients without these supports, he added.
“Many patients are unable to leave their home because of their medical needs and frailty. In many cases, their caregivers live at home with them and require a great deal of services themselves. GUIDE will cover essential social work and community health worker services, which will provide intensive care management, community resource connection, respite care, and caregiver support,” Rosenberg said.
Participation in the GUIDE Model will help people living with dementia and their caregivers have access to education and support, such as training programs on best practices for caring for a loved one living with dementia. The GUIDE Model also provides respite services for certain people, enabling caregivers to take temporary breaks from their caregiving responsibilities. Respite is being tested under the GUIDE Model to assess its effect on helping caregivers continue to care for their loved ones at home, preventing or delaying the need for facility care.
Rush has been a national leader in developing intensive evidence-based care management services:
- The Center for Health and Social Care Integration trains on the Bridge and AIMS models. The Ambulatory Integration of the Medical and Social model embeds a master’s prepared social worker into primary and specialty care teams.
- The Caring for Caregivers program incorporates the Center for Health and Social Care Integration model and provides additional services focused specifically on caregivers needs.
- Rush@Home incorporates both of these care models in its home-based primary care program.
