Integrated Care Strategies of

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An Introduction to PACE

• Integrated Care Strategies of
• Community Care Organization
• Milwaukee, Wisconsin
• www.cco-cce.org
• Total Longterm Care
• Denver, Colorado
• www.totallongtermcare.org

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PACE Operations
In addition to PACE operations in Denver and
Milwaukee, Total Longterm Care and Community Care
Organization are the sponsoring organizations of
the PACE program Total Community Care in
Albuquerque, New Mexico.
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What in the World is Going on with Long-Term Care?

• In 2003, estimates are that over 3 million people
  received Medicaid-financed long-term care svcs.
  
• 55 were in nursing homes
• A majority were dually-eligible
• Avg. expenditures for Medicare beneficiaries with
  ADL limitation(s) is 4X higher than for Medicare
  beneficiaries with no ADL impairments

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What in the World is Going on with Long-Term Care?

• LTC is inherently unpredictable and costly due to
  the nature of chronic conditions
  
• Consumers use a variety of services that cut
  across multiple delivery sectors and different
  professional/para-professional domains, each with
  a distinct clinical focus and boundaries

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What in the World is Going on with Long-Term Care?

• Multiple funding streams with disparate and
  conflicting regulations leads to unintended
  financial incentives and unintended clinical
  outcomes

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In Fee-for-Service, there is little incentive for
coordination or integration
Institutional Care
Primary Care
In - Home Care
Acute Care
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PACE is
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PACE is
The highly successful model of fully-integrated
acute and long-term care for frail older adults.
It is the only federally qualified provider-type
which fully-integrates all Medicare and Medicaid
services into one seamless service package for
beneficiaries.
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Who Does PACE Serve?

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

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The PACE Model History

• Began with On Lok in San Franciscos Chinatown
  Neighborhood

1973- First Adult Day Health Center
1978- Demonstration Project 1983- Waivers/Full Ri
sk 1990- First Demonstration Sites 1999- CMS Fin
al Interim Regulation 2002- CMS Regulation Addend
um
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In the PACE Model
Beneficiaries receive all of their health and
social services through the PACE provider
organization.
Full interdisciplinary teams, including staff
physicians, provide and coordinate all services
for the enrollee.
No benefit limitations, co-pays or deductibles
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Integrated, Team Coordinated Care
Interdisciplinary Team
Social Services
Home Care
Pharmacy
Clinic/Nursing
Activities
Nutrition
Primary Care
Personal Care
Transportation
OT/PT/Other Therapies
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In the PACE Model
An adult day health center typically becomes the
focal point of service delivery and services are
often provided directly in the day center setting.
The services of the PACE organization follow the
beneficiary across all care settings including
the home, assisted living, hospital, nursing home
and back home again.
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In the PACE Model
Beneficiaries receive the full range of health
and social services they need to maintain their
function and remain living at home.
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In the PACE Model
Medical Specialists
Pharmaceuticals
Labs and X-Ray
Services provided through the PACE organization
include
Transportation
Home Care
Primary Care
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In the PACE Model
Adult Day Care
Therapy Services
Dental
Services provided through the PACE organization
include
Hospital Inpatient
Nursing Home
DME
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In the PACE Model
Outpatient Services
Emergency Room
Optometry
Services provided through the PACE organization
include
Chore Services
Personal Care
Meals
Other Services
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PACE Participants
Average Number of
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Hospitalization Rates
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Hospitalization Rates
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Place of Death in PACE
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Types of PACE Sponsors
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Key Features of PACE
The PACE organization has the ability to provide
services to beneficiaries as they need them and
not according to Fee-for-Service schedules.
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Key Features of PACE
PACE Organizations fully integrate all Medicare
and Medicaid services into one package for
at-risk older adults rather than the fragmented
Fee-for-Service system.
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Key Features of PACE
The principal care management mechanism in PACE
is the interdisciplinary team which directly
provides and coordinates all care for the
individual.
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Key Features of PACE
The PACE Organization pools capitated or fixed
payments, typically from Medicare and Medicaid,
to provide all of the needed services in the PACE
benefit package.
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What is the Wisconsin Partnership Program?

• In 1997, the State of WI sought ways to create a
  flexible adaptation of PACE that could be viable
  in both urban and rural communities and serve
  populations besides frail elders.
• The Partnership Program began under the states
  PACE waiver and fully integrates all Medicare and
  Medicaid services to frail beneficiaries.
  

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The Partnership Model varies from PACE in 4 key
elements

• The participant maintains their relationship with
  a community physician and the provider
  organization subcontracts with that physician for
  services.
• The focal point of service delivery is moved from
  the adult day health center and into the home and
  other care settings (ADHC may be contracted).

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The Partnership Model varies from PACE in 4 key
elements

• The core interdisciplinary team is smaller in
  scale than in PACE.
  
• Some of the organizations serve young physically
  disabled individuals and/or frail elders (policy
  and provider benefit).

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At the time of development

• The PACE demonstration protocols did not allow
  for the flexibility necessary to create this
  adaptation.
  
• Separate waivers (1115 and 222) were
  necessary.
  

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And now

• With minor operational modification the PACE
  Provider Regulation could allow for the programs
  serving frail elders to be considered PACE
  programs.
• The programs serving young physically disabled
  individuals require statutory change or
  amendment.
  

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So, why is this relevant to the development of
Rural PACE?
The Partnership Program has successfully
demonstrated the core concepts under
consideration in developing rural PACE programs.
The experience of Partnership lends credence to
the position that rural PACE models can be
clinically, operational and financially effective.
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State of Iowa Participation in PACE Feasibility

• In 2004, DHS, DEA, DIA and Iowa Finance Authority
  all participated in analyzing PACE development
  
• Solicit provider interest, identify markets of
  development and identify capacity for benefit
  administration
  
• Intra-agency interest in seeing PACE develop
• Providers often initiate PACE development

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Why Develop PACE in Iowa?

• PACE Delivers Quality Care and Satisfaction is
  Extraordinarily High
  
• Participants have lower inpatient rates, lower
  mortality rates, report significantly better
  health status and choose to remain in the program
  until they die.

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Why Develop PACE in Iowa?

• PACE Allows Nursing Home Qualified Iowans to
  Remain Living at Home
  
• Although all participants qualify for NF level of
  care, only 8 actually live in a nursing home.
  When NF is necessary, the provider, not the
  state, pays for this service, even in
  perpetuity.
• Significantly improved outcomes for comparable
  individuals compared to fee-for-service.

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Why Develop PACE in Iowa?

• Cost Savings
• PACE capitation rates reflect 5 savings to the
  state when compared to the fee-for-service
  environment
  
• Cost Predictability
• Cost of care is borne by the PACE program, not
  the state. Costs become predictable for the state

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Why Develop PACE in Iowa?

• PACE complements Iowas initiatives to
  re-balance long-term care
  
• Budget neutrality
• Containing the growth of LTC
• Consolidating of the fragmented LTC system
• Building upon the present LTC system

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Why Develop PACE in Iowa?

• PACE complements Iowas initiatives to
  re-balance long-term care
  
• Maximizing consumer independence
• Developing a system that follows consumers across
  all care settings and creates incentives for the
  delivery of appropriate services regardless of
  care setting

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Questions???
Integrated Care Strategies East
1555 S. Layton Blvd Milwaukee, WI 53215 (414) 90
2-2391
Integrated Care Strategies West
200 E. 9th Avenue Denver, CO 80203 (303) 869-473
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