PACE in the Community Program of Allinclusive Care for the Elderly

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PACE in the Community Program of All-inclusive
Care for the Elderly

• Presented by Mark Bailey CEO
• Via Christi HOPE
• CHA 2007

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Future Aging Trends

• We now have the largest number of older
  adults living in human history. As the worldwide
  age wave increases over the coming decade, our
  notions of how we define and perceive old,
  health and home will change
  profoundlyTodays providers are called upon to
  generate an innovative future that enables them
  to offer consumers the services they require, in
  a place they call home.
• Larry Minnix
• CEO, AAHSA

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PACE Presentation Outline

• PACE Sponsorship Via Christi Health System
• What is PACE
• PACE Participant Profile
• PACE Center
• PACE Delivery Model
• Adult Day Health Center
• Interdisciplinary Team
• Interdisciplinary Services
• PACE Balancing Act
• PACE Challenges
• PACE Works in the Community
• Does PACE fit in your Ministry

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PACE Sponsorship

• Via Christi Health System of Kansas and Oklahoma
• Operates Acute Care, Senior Care, Retail and
  Outpatient, and Insurance
• Sisters of the Sorrowful Mother Broken Arrow,
  Oklahoma
• Sisters of the St Joseph Wichita, Kansas
• Via Christi Senior Services
• Operates 13 Senior Programs CCRC, Assisted
  Living, Independent Living, low income HUD
• Via Christi HOPE opened 7/2002

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What is PACE

• PACE is a model of care built on the foundation
  that seniors with complex health care needs
  should be able to live in a least restrictive
  environment for as long as possible.
• PACE participants must be
• 55 years age and older
• Certified to need nursing home care by a state
  agency
• Able to live in the community at time of
  enrollment
• Live in the catchment area
• Agree to receive services from the PACE network
  of providers
• http//www.cms.hhs.gov/pace/

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What is PACE (contd)

• PACE is a fully capitated managed care program
• Receives Medicaid, Medicare, Part D and private
  pay
• PACE providers have flexibility to deliver care
  and services to meet the individual needs of each
  participant
• PACE is at full financial risk for all
  participant care
• PACE is the actual provider, the decision maker
  and the payment vehicle to coordinate care to
  participants in the community
• PACE utilizes an interdisciplinary team approach
  of both employed and contracted professionals to
  deliver comprehensive community based services

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PACE Participant Profile

• 9 out of 10 PACE participants live in the
  community
• Community settings may include participants own
  home, living with family, supportive housing, or
  assisted living
• PACE programs deliver services in the
  participants home and provide transportation to
  needed services and activities
• The PACE Center is located in and is a part of
  the community
• Some participants may ultimately reside in a
  long-term care nursing residence, 7-10

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PACE Participant Profile (contd)

• PACE participants are similar to nursing home
  residents, based on their clinical eligibility
  for enrollment
• The average PACE participant is 80 years old 74
  are 75 and 33 are 85 or older
• Most participants are female 75
• Average PACE participant has 8 medical
  conditions many are chronic, including diabetes,
  dementia, COPD, coronary artery disease and
  cerebrovascular disease
• PACE providers must cover nursing home/respite
  care for their participants when necessary
• This is determined when the participant can no
  longer live safely at home

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PACE Participant Profile (contd)

• There has been an increased enrollment of
  Physically Disabled persons (55-64) in the
  program may be in for 20 years
• The mean length of enrollment is about 3 years
  for those who die while enrolled in the program
• The mean length of enrollment is just over a year
  for those who disenroll for all reason other than
  death
• 6 disenroll for all reason other than death
• Move out of catchment area
• Physical and medical conditions improve
• Dont meet state nursing home eligibility
  criteria

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PACE Center
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PACE Center (contd)

• Full Service Physician Clinic
• Interdisciplinary Team Home Base
• Therapy Services
• Social and Recreational Activities
• Personal Care/Bathing/Laundry
• Medical and Behavioral Based Monitoring
• Transportation
• Access to Community Supports and Services

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PACE Delivery Model
Participant and Family
PACE Interdisciplinary Team
Primary Care Physicians
Transportation
Home Care Services
Outpatient Services
Inpatient Hospitalization
Prescriptions and OTC Meds
Specialty Physician
Rehab and Equipment
ADHC
Respite Care
Assisted Living
Nursing Home
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Adult Day Health Center
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Interdisciplinary Team

• Social Work
• Dietician
• Transportation
• Personal Care Workers
• Pastoral Care
• Pharmacist
• Contracted Services

• Clinic
• MD and NP
• Nursing
• Day Center
• RN, Home Care Coordinator
• Therapies
• Physical Therapist
• Occupational Therapist
• Speech Therapist
• Recreational Therapist

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Interdisciplinary Team (contd)
Nutrition
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Interdisciplinary Team Services

• Audiologist/Dental/Optometry/Podiatry
• Counseling/Psychologist
• DME/O2
• Safety and Home Inspection/Life Line
• Home Modifications
• Homemaker/Home Health
• Supportive Housing
• Lab/X-ray
• Transportation

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PACE Balancing Act
Use Dollars Sparingly
Emergency Room Hospital Nursing Home
Use Dollars Generously
PACE Team Home Health Day Center Respite
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PACE Challenges

• Understanding the PACE model
• Educating the Community to the benefits of PACE
• Educating the Medical Community
• Establishing the Referral Network
• Sponsoring Organization and State have to agree
  to implement PACE
• Start-up Capital
• Timeframe of Implementation
• Monitoring and Controlling Services Utilization
• Development of a Formulary PT D
• The Unknown

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PACE works in the Community

• Coordinated and complete health care for the
  elderly
• Ongoing preventative health care
• Participant health needs are continuously
  monitored
• Caregiver and family members receive support
• Participants and family needs are met
• Stay in their community rather than a nursing
  home
• Saves the state and CMS money
• Interdisciplinary team manages care
• Seniors want to remain independent and connected
  to their families and friends
• One Stop Shop

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Does PACE fit in your Ministry

• Could PACE fill an unmet need in the community to
  serve the frail elderly?
• Is PACE a good fit with your current mission and
  strategic direction?
• Are there synergies that you can be leveraged
  between acute care services and long term care
  providers?
• Do you have the staff to make it happen?
• If you dont do it..who will?

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Contact Information
Mark Bailey CEO Via Christi HOPE 2622 W.
Central Wichita, KS 67203 316-946-5202 mark_bailey
_at_via-christi.org National PACE Association http//
www.npaonline.org