Building Blocks to Innovation through PACE November 2018 Samira K. Beckwith, LCSW, FACHE, LHD President and CEO, Healthcare, samira.beckwith@hopehcs.org and Dorothy Ginsberg Senior PACE Consultant, Capstone Performance Systems, dginsberg@cpstn.com Learning Objectives At the conclusion of the presentation, participants will be able to: Identify PACE basics Develop a beginning knowledge of PACE operations Discuss productive opportunities for expanding services Recognize how to add value by developing collaborative relationships Understand the risk models that apply for both Hospice and PACE 1
Healthcare Palliative Care Kids Care Parkinson Program PACE Patients and Families Connections Healing Hearts Hospice Visiting Nurses 2
Why Diversify? Help meet community needs Increased community awareness Stability of multiple revenue streams Greater staff opportunities Shared allocation of administrative expenses Increased donations Why PACE? Gaps and Barriers in Health Care Creating Unmet Community Needs: Difficulty predicting prognosis Hospice referrals are often late Discharge of patients who no longer deemed terminal Unmet needs for individuals dealing with advanced illness Lack of advance planning Fragmentation of care Lack of coordination Lack of knowledge of available community resources. Suffering levels of individuals and caregivers resulting in ER visits, hospitalizations, and nursing home placement. 3
Hospice/PACE Similarities Both are Managed Care models Both utilize an interdisciplinary approach to care Both rely on contractual arrangements for some components of care Both provide care and support to the caregivers Both strive to keep people in their own homes 4
Health Center Comprehensive community based long term care Health plan and Health provider Care management model Type of accountable care Focus on individuals/caregivers to meet their goals of care Coordinated care PACE is.. 5
PACE Model Overview All inclusive care plan: 24/7; 365 days a year Integrates preventive, primary, acute, rehab, longterm care, and end of life care Offers flexibility in the ability to meet individual and caregiver needs All Medicare and Medicaid services, plus No benefit limitations/co pay/deductible for dually eligible Services delivered in most appropriate setting PACE is a Part D provider PACE is both a provider of care and the insurer PACE Eligibility 55 years of age or older Lives in a designated PACE service area Certified as meeting state s nursing home level of care (clinically eligible) Able to live safely in the community at the time of enrollment with the support of PACE services Enrollment in the PACE program is voluntary. If an individual meets the eligibility requirements and elects PACE, enrollment continues as long as desired by the individual, regardless of change in health status, until death, or voluntary/ involuntary disenrollment. 6
PACE Population 80 years old 74% are 75 or older; more than 33% are 85 and older Female (75% of participants are female) Has 7.9 medical conditions (many of which are chronic conditions including diabetes, dementia, coronary artery disease and cerebrovascular disease. The majority of participants wish to stay in their home through end of life. Many families look to PACE to help keep their loved ones at home through end of life. Goal of PACE From Centers for Medicare and Medicaid Services (CMS): The purpose of a PACE program is to provide prepaid, capitated, comprehensive health care services that are designed to: Enhance the quality of life and autonomy for frail, older adults; Maximize dignity of and respect for older adults; Enable frail, older adults to live in their homes and in the community as long as medically and socially feasible; and Preserve and support the older adult s family unit. 7
The PACE Model History Began with On Lok in San Francisco s Chinatown Neighborhood alternative to nursing home placement and in 1979 On Lok receives a four year grant from the Dept. of HHS to developing a consolidated model of delivering care to persons with long term care needs. In 1986 Federal legislation extends On Lok s new financing system and allows 10 additional organizations to replicate On Lok s service delivery and funding model in other parts of the country. In 1990 The first Programs of All inclusive Care for the Elderly (PACE) receive Medicare and Medicaid waivers to operate the program. In 1996 21 PACE programs are operational in 15 states. In 1997 PACE received Permanent Provider status under Medicare and Medicaid (Balanced Budget Act). Currently 24 PACE programs operating 255 PACE centers in 31 states and serving over 45,000 participants. Nursing Home The PACE Model Integrated, Team Managed Care Home Care Hospital Primary Care Lab / X-ray Medications / DME Specialists Day Health Nursing Social service OT / PT Speech Nutrition Recreation Personal care Pharmacy Transportation 8
CMS Required IDT Members Participant/Caregiver Primary Care MD PACE Center Manager Nurse Social Workers OT/PT/RT Therapies Home Care Coordinator Pharmacist Dietitian Transportation Manager Personal Care Attendant and Other as Appropriate Monthly Utilization PACE Center attendance 9 days Personal care at the Center 7 times Escorted trips 2 Medications 6 Personal care at home 25 hours pm Program related housing 3 days Hospital inpatient Less than a quarter of a day Nursing home 3.2 days 9
Why it Works The PACE model ensures that the financial incentives of the provider and the quality of life incentives of the PACE enrollee are aligned. From a financial perspective success relies on use of lower cost preventive care to avoid higher cost inpatient hospital or nursing home care. Overall start up cost???? Personnel resources to research and develop plan for program Complete application Policy/procedure development Building or remodeling for PACE Center Hire and train staff The Cost Equipment and furnishing purchases 10
PACE/Hospice Shared Expenses Shared administrative salaries On call services Shared physician/nurse practitioner Shared administrative expenses i.e. telecommunication, information systems The Process Educate Key Leadership and Board Community assessment Verify state support of PACE Work with State legislature, if needed Complete Application Submit to CMS Request for Additional Information from CMS Complete all State licensing requirements Secure contracts State readiness review CMS Approval Inter Agreement with CMS and your state agencies 11
Keys to Success State support Leaders that the community trusts Care Management PACE as service the hard to serve Build public awareness PACE as a referral hub Hospice and PACE Models are Aligned Manage chronic, debilitating and life threatening diseases. Provide holistic approach to care. Individualized care plan to meet wishes, preferences and needs of the individual. Provides Palliative and End of Life Care. Includes family as part of the team. Works with a capitated budget. 12
Lessons Learned Applying core hospice competencies allows access to patients further upstream in the continuum. Allows opportunity to serve community in new ways. Fulfills unmet needs within the community and improves quality of life. Prevents or delays institutional admissions. PACE is a natural fit with what we know and do in hospice. Hospice providers already have the foundation needed to develop a PACE program. Opportunities for Collaboration between Hospice and PACE Contract with hospice utilizing full team Contract for pain and symptom consults PACE team becomes part of the hospice IDT Education Counseling services anticipatory grief Bereavement 13
You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die. Dame Sicely Saunders, Founder of the Modern Hospice Movement Hospice and PACE Together = HOS PACE 14