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CMS GUIDE Model: Lessons Learned by an Established Track Program at End of Year One
Mongelli J, Tangredi K, Gieniusz M, Nouryan C, Ulbricht C, Carroll M, Carney M, Burns E. Innovation in Aging, 2025-12-31
Topic: Risk, prevention and care in population studies
This paper reports first-year, real-world results from one of the 96 'Established Track' organizations in the CMS GUIDE dementia care model, which launched nationally on July 1, 2024. It shows what enrollment, respite use, and disenrollment actually looked like for one program in year one — an early, ground-level look at how the new Medicare dementia-care payment model is playing out in practice.
Key findings
- 158 beneficiary-caregiver pairs were enrolled in year one; average beneficiary age was 79
- Caregivers were 53% adult children, 35% spouses, and 10% other relationships
- Patient complexity was distributed 19% low, 73% moderate, 8% high
- Over 35% of eligible beneficiaries used GUIDE respite services
- About 9% of enrollees disenrolled, and 64% of those disenrollments were due to death or hospice transition
Why it matters
This paper reports first-year real-world results from one of the 96 Established Track organizations in the CMS GUIDE dementia care model, including enrollment, respite use, and disenrollment. It is an early, ground-level look at how the new Medicare dementia-care payment model is playing out in practice, not a test of whether the model improves outcomes.
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Study details
- Study designcohort
- Participants158
- Effect size35%+ of eligible beneficiaries used GUIDE respite services; ~9% disenrollment rate, 64% of those due to death/hospice
- Evidence strengthEarly
Limitations
Single-site, single-organization report from only 1 of 96 Established Track programs in year one, and published as a conference abstract (GSA Annual Scientific Meeting) rather than a full peer-reviewed journal article; not generalizable to the national program.
How this study scored 60/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded and indexed in PubMed because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, still being cited, senior author's track record, institution's track record, multi-centre collaboration and free to read, so those were left out: it earned 37 of the 62 points we could judge it on, which is 60 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Innovation in Aging) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 2 / 5 | Rated “early” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 158 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 0 / 2 | No PubMed ID and no DOI — scores zero (not stated in the record — scored 0) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 37 / 62 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 37 of the 62 points we could judge it on is 60 out of 100. |
| Total | 60 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. This record has no DOI, so the citation leaves it out. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Mongelli, J., Tangredi, K., Gieniusz, M., Nouryan, C., Ulbricht, C., Carroll, M., et al. (2025). CMS GUIDE Model: Lessons Learned by an Established Track Program at End of Year One. Innovation in Aging.
Vancouver
Mongelli J, Tangredi K, Gieniusz M, Nouryan C, Ulbricht C, Carroll M, et al. CMS GUIDE Model: Lessons Learned by an Established Track Program at End of Year One. Innovation in Aging. 2025.
BibTeX
@article{mongelli2025-784513c0,
author = {Mongelli, J. and Tangredi, K. and Gieniusz, M. and Nouryan, C. and Ulbricht, C. and Carroll, M. and Carney, M. and Burns, E.},
title = {{CMS GUIDE Model: Lessons Learned by an Established Track Program at End of Year One}},
journal = {Innovation in Aging},
year = {2025}
}
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