Programs of

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Programs of All-inclusive Care for the Elderly
Peter Fitzgerald National PACE Association Sep
tember 7, 2006
Richmond, Virginia

www.NPAonline.org
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What is PACE?

• An integrated provider of care for the frail
  elderly that is
  
• Community-based
• Comprehensive
• Capitated
• Coordinated

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The PACE ModelWho Does It Serve?

• 55 years of age or older
• Living in the PACE providers service area
• Certified as needing nursing home care
• Able to live safely in the community at the time
  of enrollment

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PACE History A New Way of Caring for Seniors

• Chinese-American community in San Francisco
  develops interdisciplinary team and adult day
  center model, On Lok meaning Peaceful, Happy
  Abode, to keep elderly in the community (1973)
• Integrates provision of primary and specialist
  care into services to improve outcomes requires
  state waiver for capitation to achieve needed
  flexibility (1978)
• Integrates inpatient care requires federal
  waiver for capitation to achieve needed
  flexibility (1983 initial, and ongoing, 1985)

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PACE History Replication

• Federal legislation authorizes PACE demonstration
  (1986)
  
• 10 demonstration sites in 8 states become
  operational (1990)
  
• California (2 sites), Colorado, Massachusetts,
  New York (2 sites), Oregon, South Carolina,
  Texas, Wisconsin
  
• Demonstration evaluation finds Medicaid cost
  savings and quality improvement (2000)

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PACE Permanent Provider Status

• PACE becomes a permanent Medicare provider and
  state option for Medicaid (1997)
  
• Flexibility regulations support adaptation of
  model to meet local needs (2002)
  
• Federal rural PACE pilot program (2006)

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PACE Today Growth and Expansion

• Thirty-five organizations are operating under
  dual capitation
  
• Five sites are delivering services under Medicaid
  only capitation
  
• Operates in 19 states,
• Approximately twenty-five entities are actively
  moving forward with PACE planning and development.

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Census Growth 1996 2004
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Growth in PACE Comes from Providers
Each PACE center and IDT typically serves about
150 enrollees.
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Keys to PACE Model

• Focus on the individual participant
• Interdisciplinary team members
• Role of care management and integration kept
  close to care delivery
  
• Comprehensive and flexible care
• Caregiver support
• Aligned quality and financial incentives

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Focus on the Participant

• Honor what frail elderly want
• To stay in familiar surroundings
• To maintain autonomy
• To maintain a maximum level of physical, social,
  and cognitive function
  
• To be known holistically

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Integrated Team Care
Comprehensive Shared Information Shared
Decision-making
Participant
Pharmacy
Home Care
Social Worker
Activities
Nutrition
Primary Care
Nursing
Personal Care
Transportation
OT/PT
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PACE is Information Rich

• In the morning
• Participant is assisted with dressing and
  breakfast by PACE personal care assistant
  
• Participant transported by PACE driver to see
  specialist
  
• In the afternoon
• Participant joins social activity at PACE Center
  led by Center staff
  
• Nurse Practitioner speaks with specialist
• Participant sees Nurse Practitioner at the PACE
  Center to review specialists recommendations,
  review care plan
  
• Social worker speaks with family caregiver
  regarding specialist care recommendations, care
  plan
  
• In the evening
• Participant transported by PACE driver home
• Home health nurse visits Participant at home to
  check health status, review care plan
  

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Example Transportation
The eyes and ears of transportation drivers
contribute to the PACE interdisciplinary teams
understanding of the Participant
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Comprehensive and Flexible Care
nursing physical therapy, occupational therapy
Recreational therapy meals nutritional
counseling social work Medical care Home healt
h care
personal care prescription drugs Social servic
es audiology dentistry optometry podiatry
speech therapy
Respite care
Hospital and nursing home care when necessary
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Example PT OT
PACE PT and OT services go beyond rehabilitation
to maintain functioning
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Caregiver Support

• Home health care and personal care assistance
  reduces strain on caregivers
  
• Ongoing contact and communication with family
  members and friends
  
• Caregiver support groups
• Respite care

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Aligned Quality and Financial Incentives

• Full risk and responsibility for care, regardless
  of setting or need
  
• Substituting increased primary care,
  rehabilitation and home and community based
  services for inpatient care results in
  
• Better outcomes, less need for inpatient care
• Greater ability to live at home

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Sources of Service Revenue

• PACE Programs receive approximately
• 2/3 of their revenue from Medicaid
• 1/3 from Medicare
• (A small percentage of program revenue comes
  from private sources or enrollees paying
  privately)
  
• 2005 Mean Medicare PMPM Rate 1,809
• 2005 Mean Medicaid PMPM Rate 3,073

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States Role in PACE Development/Implementation

• Provider selection
• Positioning PACE among other long-term care
  options
  
• Licensure/certification requirements
• Medicaid capitation rate-setting
• Eligibility requirements/certification
• Enrollment/disenrollment

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States Role, continued

• Approval/submission of PACE provider application
• State readiness review
• State contract
• State plan amendment
• 3-way PACE program agreement
• Ongoing oversight/monitoring

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PACE in Virginia

• 1 pre-PACE (Medicaid capitation only) program
  Sentara
  
• Full capitation application into state
• Statewide working group of developing programs
  across state six in active development
  
• State funds for start-up and development
  authorized, applications were due September 1
  
• For rural providers, applications to the federal
  rural PACE pilot program
  
• Will be awarded no later than September 30, 2006

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PACEs As a Partner for Integrating LTC

• Proven results
• Keep frail elders in their homes
• High Quality and Satisfaction
• High Staff Satisfaction
• Cost effectiveness
• Designed as a fully integrated, flexible model
  for providers
  
• Predictable, capitated payments

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Contact Information

• Peter Fitzgerald
• National PACE Association
• Alexandria, VA
• peterf_at_npaonline.org
• [phone]