This article first appeared in NACHC’s Care Teams Digest, a bimonthly newsletter designed for health center care teams.
According to the 2022 Uniform Data System (UDS), the senior population in Community Health Centers has grown significantly, increasing by more than one million patients in the last five years. Caring for older patients is a challenge for many health centers. Successful care strategies to address this population’s complex needs is where the innovative PACE (Program for All Inclusive Care for the Elderly) comes in.
“We wanted to make sure that our seniors would have access to health care in their community so they can continue living at home rather than go into a nursing home,” says Brian Toomey, CEO, Piedmont Health, Chapel Hill, NC, one of the early adopter health centers offering PACE. “At our core, we believe in providing the right care, at the right time, at the right place, done right. This is our “WHY” for creating, investing in, and growing our PACE organization,” adds Toomey. This is what drives their health center to dedicate time and resources to PACE.
What is PACE?
The Program for All Inclusive Care for the Elderly (PACE) is a comprehensive package of services that helps low-income adults aged 55 and older who need nursing home care, so they can successfully remain in their homes for as long as possible. This national program that considers services for all aspects of a PACE participant’s health care. For example, it incorporates high-quality preventive, primary, acute, and long-term care as well as social services such as medical transportation, meal delivery, and the implementation of safety measures at home.
For each PACE participant, an interdisciplinary team (IDT) develops an individualized care plan that is monitored and reviewed regularly. As medical, cognitive, behavioral, or other care needs change, participants and caregivers work with their PACE IDT to address those changes—all with the goal of enabling the participant to live independently in their home and community for as long as possible.
Health centers operating PACE serve as both the health plan and the provider of services. A capitated Medicare and Medicaid rate is provided for each participant (most participants are already Medicare and Medicaid recipients). This gives a health center the opportunity to build capacity for care coordination services and risk management for a full senior population rather than limit services to those reimbursable for only fee-for-service plans. Health services can include those offered at the health center and by contracted partners like hospitals, medical specialists, etc.
Becoming a PACE Organization—Opportunities and Challenges
“We have always cared for and loved these patients long before they were eligible for both Medicare and Medicaid benefits. Other health systems wanted them as patients,” says Vernita Todd, Vice President & Chief Strategy Officer, San Ysidro Health, whose San Diego PACE serves an average of 2,622 participants each month across four sites. “While we recognized we had a pipeline of patients who could be eligible for PACE, we also knew that we were a trusted health partner to many of them. We wanted to make a commitment to them to continue to provide care as they age and their care needs became more complex.” Toomey and Todd whose health centers have been PACE organizations for more than ten years believe that PACE offer health centers several unique opportunities and challenges. They offer the following tips:
- Know your health center’s “WHY” for starting a PACE to keep you focused.
- Understand the difference between how services can be provided with capitation vs. fee for service.
- When operating in a risk-based environment, give careful consideration to providing care for people in the right way, rather than considering how much you get paid for performing the care. Managing how and when services are used is a priority concern in a risk-based environment.
- You must create a system of checks and balances for care plans as you become an insurance provider through PACE. You’ll want to ensure participant care services are not over or underutilized.
- PACE has a ratio-based staffing model. Understand the ratios by category and be prepared to be fully staffed at every level and type of care service from day one.
- Make sure to develop processes and systems for managing many PACE components. Consider scalability with things like meal delivery.
- Try to make systems more automated and less manually-driven when possible.
- PACE can be very profitable. However, it does require an upfront capital investment and operational funds.
Looking to start PACE? Do your research.
- Understand your state’s PACE landscape. Learn your state rules and if PACE is approved. Every state is different.
- Do PACE organizations currently exist in your state? If so, talk to them about possible partnership opportunities, rather than starting one.
- Talk and visit with other health centers that have PACE. Include staff from across your organization – board, leadership, medical, pharmacy, behavioral health, etc.
- Join the National PACE Association for resources and to connect with colleagues.
- Download resources and participate in trainings from PACE@CHC, a program to help health centers develop a better understanding of the PACE model.