Evaluation of the Guiding an Improved Dementia Experience (GUIDE) Model

The Centers for Medicare & Medicaid Services (CMS) selected Mathematica to evaluate how the GUIDE Model was implemented and how it affected Medicare fee-for-service beneficiaries with dementia and their caregivers. 

Launched in July 2024, the GUIDE Model is an eight-year national voluntary model that 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. GUIDE aims to achieve these goals through Medicare payments for a comprehensive package of care coordination and care management, caregiver education and support, and respite services.

To understand the success of GUIDE, Mathematica is applying its extensive experience conducting high-quality, complex evaluations on Medicare beneficiaries, including dually eligible beneficiaries, who have high healthcare needs. The Mathematica team also brings decades of lived and clinical experience on caring for people with dementia and supporting their caregivers, which we apply to all aspects of the evaluation.

Mathematica is conducting a mixed-methods evaluation using Medicare and Medicaid administrative data on fee-for-service beneficiaries, including dually eligible beneficiaries, combined with data we collect from surveys and interviews with healthcare providers, individuals with dementia, and their caregivers. 

The key goals of the evaluation are to: 

• Assess whether GUIDE improves Medicare beneficiaries’ quality of care and quality of life; reduces caregiver strain and burden; delays long-term nursing home stays; and reduces (or does not increase) the costs of Medicare expenditures
• Identify GUIDE model components and other contextual factors associated with impacts and how effects differ across types of participants and beneficiaries
• Assess GUIDE implementation, barriers and facilitators to change, provider transformation, and decisions of organizations and beneficiaries to participate in the model

Mathematica will provide CMS with insight into what worked, why, and for whom, as well as how best to scale the model, if successful. Lessons from the evaluation can provide important insights to the broader health community working to improve the lives of people with dementia and their loved ones.