Emory Integrated Memory Care Tests Medicare Dementia Care Model

Emory Integrated Memory Care in Atlanta is one of nearly 400 participants to participate in a new Medicare alternative payment model as part of a testing process. Selected by the Centers for Medicare & Medicaid Services (CMS), Emory Integrated Memory Care is the only 2024 Georgia practice to test the new Guiding an Improved Dementia Experience (GUIDE) Model approach to how Medicare pays for the care of individuals living with dementia.

Exploring the GUIDE Model

Carolyn Clevenger, DNP, GNP-BC, AGPCNP-BC, FAANP, FGSA, FAAN, founder and director of Emory Integrated Memory Care

According to CMS, “the GUIDE Model focuses on comprehensive, coordinated dementia care and aims to improve quality of life for people with dementia, reduce strain on their unpaid caregivers, and enable people with dementia to remain in their homes and communities.” The model will set care standards, such as 24/7 access to a support line, and caregiver training, education, and support services.

Emory Integrated Memory Care (IMC) is the basis for the GUIDE Model, and directly influenced the creation of the alternative payment model. Carolyn Clevenger, DNP, GNP-BC, AGPCNP-BC, FAANP, FGSA, FAAN, founder and director of Emory Integrated Memory Care, founded the practice in 2015 and developed the model in partnership with family caregivers.

“I was looking at models of care and felt like they weren’t serving the needs of people with dementia,” Clevenger explains. “I was working with the emergency department, hospital, and the neurology team where people would get their diagnosis.” In particular, Clevenger spoke with families who would bring a loved one to the clinic to be told their loved one has Alzheimer’s and the physician would see them again in a year, or they were told to go back to their primary care physician.

The IMC model takes a comprehensive approach to dementia care. “I call it all-inclusive dementia care,” says Clevenger. “They can get primary care and dementia specialty care and support for their caregiver all in one practice.”

IMC, the first program of its kind in the nation, delivers primary and dementia care to patients right where they live. Patients receive appointments with a nurse practitioner at a senior living community, as well as weekly sessions with a Dementia Care Assistant who creates one-on-one activities specifically for them. IMC and care partners deliver support, education, and counseling, and patients receive care coordination and navigation.

The IMC Clinic is a primary care practice that offers services like preventive care, acute issue treatment, support for managing behaviors related to dementia, planning for future needs and decisions, and an after-hours line for patients with urgent issues.

“We not only deliver good care, we measure it,” Clevenger explains. “We measure how well we can keep people out of the emergency department and hospital, and we’ve cut hospitalization rates in half.” IMC helps reduce caregiver distress measurably within six months, as well as reduce psychiatric symptoms while also deprescribing antipsychotics and high-risk drugs. “When we compare how frequently we deprescribe that drug by 12 months, we’re 70% more likely to remove that drug,” she says.

In 2022, IMC was part of the Alliance to Improve Dementia Care group, which produced the Scaling Comprehensive Dementia Care Models report. All of the participants have a slightly different model of care, but all have published on their outcomes. All participants agreed on eight core elements, such as caregiver supports and services, ongoing monitoring, careful review of medications, and coordinating care. Those eight core elements became the eight core elements of GUIDE, plus a ninth element – respite – which was added.

The GUIDE Model incorporates:

• A standardized approach to dementia care, including staffing consideration and services for those with dementia and their unpaid caregivers.
• A monthly per-beneficiary payment to support collaborative care.
• Requiring participants to provide caregiver training and support services, including a 24/7 support line.
• Respite services that can deliver 24-hour care to give the unpaid caregiver temporary breaks.
• Screening for health-related social needs to connect them to local organizations.

Testing the GUIDE Model

“The goals for GUIDE are that this improves quality of life and reduces burden for their caregivers,” explains Clevenger. “We found that to be true certainly at IMC.” She notes that families often tell IMC what it means to them to be able to bring their loved one to a practice that understands the context of dementia. The fact that the practice can talk to these families not only about healthcare-related decisions, but also about their social life, including housing and driving and food access, is particularly meaningful. Having a dementia-proficient clinician and a care navigator helps families feel like they have someone to call on.

GUIDE sites don’t have to have a primary care operation, but Clevenger notes that the fact that IMC has been a primary care practice during its entire operation is a significant benefit, since IMC is now familiar with making sure they meet the GUIDE standards. “We’re an age-friendly health system, so the fact that we have some experience with a couple of different national recognition programs and that we’ve been tracking our population really closely since 2015 is really unique to us,” she says.

The GUIDE testing project is an eight-year project, which begins now, and the Medicare Innovation Center has a legislated definition of success for the project. “These care models have to either maintain or improve the quality of care delivered,” she says. “Outcomes have to be better. Quality has to maintain or improve, and cost has to maintain or be lowered.” Hospitalization is the biggest driver in the total cost of care, meaning it’s important to keep people out of the hospital and/or delay or avoid nursing home placement. Care models don’t necessarily have to do both, but they have to at least maintain or improve either the quality or the cost. “If [the model] meets those criteria, it goes into the actual benefit permanently without going through legislation,” says Clevenger.

What the GUIDE Model Could Mean for Memory Care

Clevenger has already seen more interest in memory care simply by having the GUIDE Model available. “The first question is, what does good care look like?” she says. “We have the definition of good dementia care; delivering these nine core elements raises the standard for dementia care to a minimum. Immediately, we’ve raised the bar.”

The GUIDE Model also addresses the challenge of delivering quality care in a financially sustainable way. “It’s possible to have a financially viable practice for people with dementia,” she explains. “We know what the service looks like and we have a way it can pay for itself.”

Additionally, the GUIDE Model may lead to increased evaluation for dementia, since Medicare beneficiaries must have a dementia diagnosis in order to be eligible for the GUIDE benefit. “Half of people living with [dementia] symptoms don’t get a diagnosis,” says Clevenger. “Now, we have a very clear reason for why your primary care should be doing this evaluation and talking with you. I think we’ll start to see better recognition.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.