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PACE providers shift services to the home in a national long-term care review

The COVID-19 pandemic has revealed an urgent need to rethink where and how Americans age, most care professionals agree.

Investing in the lives of older people in small homes and “wallless nursing homes” are one of the few innovative ideas that have emerged over the past year. Alternatively, stakeholders in some aging services simply requested a significant redirect of government funding from the facility to home care. This is supported by a new proposal by President Joe Biden. “American work plan.”

But there is another way to rethink long-term care in the United States that is not well talked about. It is a Comprehensive Long-term Care Program (PACE) for the elderly.

Dr. Rob Schreiber, vice president and medical director of Fallon, said: Health’s Summit ElderCare told Home Health Care News. “Especially for those who are qualified as nursing homes and want to stay alive in the community.”

As of March 30, there are at least 138 PACE organizations operating 272 PACE centers in 30 states, serving a total of approximately 55,000 participants, according to the National PACE Association. ..

Dr. Schreiber is helping to run Summit Elder Care, one of the group’s largest programs. Launched in 1995 as a subsidiary of Worcester, Massachusetts-based health insurance Fallon, the summit cares for approximately 1,200 PACE participants at five sites in Bay and one location in Buffalo, NY. ..

“PACE has been around for almost 50 years,” says Schreiber. “It’s still here and is one of the only validated care models that have actually been shown to improve quality, reduce costs, improve quality of life and increase people-centric satisfaction. Check all the boxes. “

Not all PACE operations are the same, but in most cases it works by combining center-based services with comprehensive home care. For example, the summit coordinates services from social workers, nurses, rehabilitation specialties, and eight other disciplines.

“The key to PACE is the interdisciplinary team,” Schreiber explained.

Move towards home

In its design, PACE was originally created as a way for people to live healthy from their homes and long-term care facilities. This will reduce the cost of the US healthcare system. To qualify for PACE, you must be a physician-certified individual, 55 years of age or older, in need of nursing home-level care.

Payers for PACE include Medicare and Medicaid, and Medicare Advantage.

As Schreiber pointed out, the model itself has been around for decades. However, the spotlight has been on nursing homes that have continued to recover after the deadly COVID-19 outbreak that lasted for months in 2020 and early 2021, and have not received any further attention.

According to Schreiber, the summit actually set up a field SNF to avoid participants going to a skilled nursing facility (SNF).

“I knew that some people were COVID positive but didn’t want to go to a hospital or a skilled nursing facility,” he said. “Maybe it wasn’t part of their goal, or they didn’t want to go to a nursing home because they weren’t seen by their families. They needed an alternative, so they went to Worcester’s latest summit site. We have developed a temporary COVID-19 clinic. “

In many respects, the ability to turn on a dime and activate an emergency use SNF reflects one of the greatest strengths of the PACE model, flexibility. The PACE organization houses so many different services under one roof that it can be quickly pivoted as needed, added to one offering and deducted from another.

That’s what CHA PACE did to provide the best service to the community in the event of a public health emergency, its secretary-general Jed Geyerhahn told HHCN.

First, the Cambridge, Massachusetts-based CHA, part of the Cambridge Health Alliance, a hospital-based healthcare system, has closed its physical center and is already devoted to robust home care capabilities.

“We have always been a home care-based PACE program,” says Geyerhahn. “Most PACE programs are very center-based and most or a significant portion of the participants attend the center. However, space is invaluable here in Cambridge and its metropolitan areas. We have always provided a lot of home care, as we have never had a lot of that central space. “

Founded in 1996, CHAPACE serves more than 465 participants. About 40% of that growth has been achieved in the last five years alone.

“We didn’t have to get used to the idea of ​​providing care to people in the community because they were already doing it,” Geyerhahn said. “And likewise [our staff members] All were equipped with laptops and phones, as they were already primarily providing care in the community. “

The future of PACE

In the light of the success of the model in the midst of a pandemic, PACE is in a position to attract participants as more older people and their families are trying to avoid traditional nursing homes.

Overall, PACE-enrolled participants were at one-third the risk of nursing home residents by being infected with COVID-19, National PACE Association statistics suggest.

However, PACE is also set up as an alternative to home care that can be costly if home care and long-term care services are needed 24/7. This is especially true as the organization follows the CHA playbook by rebalancing the PACE model for home care.

The Summit ElderCare left the center open for a small number of participants who could not go without an intensive level of care, but invested more resources in home care.

“We knew that in March, when the outbreak began, a lot of care had to be done at home,” Schreiber said. “Overnight-and I think this happened in almost every PACE organization in the country-we had to move from a site-based care model to a home-based care model.”

He added that “switching on” became possible with the help of technology.

“Telehealth has literally become a model for visits overnight,” Schreiber said. “Thankfully, many of our providers and teams had iPhones, so we did a lot of Face Timing, but from a telemedicine perspective, we could also use other types of modality. I was able to do it. “

PACE isn’t always supported at the federal level, but it’s starting to change. In fact, a recently released budget report from the House Expenditure Commission obtained by HHCN identifies PACE as a key priority.

“The committee [PACE] By allowing these highly medically complex Medicare or Medicaid beneficiaries to live at home rather than in long-term care facilities, in the lives of more than 52,000 participants. ” Report states.. “The Commission urges the CMS to expedite PACE-specific pilots approved by the PACE Innovation Act of 2015, specifically innovative and comprehensive by the beneficiaries of the new Medicare or Medicaid. Test the integrated, fully risky PACE model. “

Commercial model

The PACE model has historically been non-profit, as federal regulations on commercial PACE providers existed until 2015. With the barriers to entry lifted, more and more commercial businesses are beginning to emerge.

Currently, there are a total of five commercial PACE providers nationwide. Financial documents reveal.. Denver-based InnovAge (Nasdaq: INNV) is the largest PACE organization in operation and leads the group.

Officially launched in early March, Innov Age has approximately 1,900 employees. It serves 6,600 seniors in Colorado, New Mexico, California, Pennsylvania and Virginia.

“I think the IPO is noteworthy in several ways.” InnovAge CEO Maureen Hewitt told HHCN earlier.. “One is to increase capital, and the second part is related to consciousness. That is, the program has been around for years and now PACE replaces the patient’s nursing home care. It’s time to become a general term for things. I think this really helps. “

According to the company, the InnovAge is twice the size of its closest PACE-focused competitor and more than 30 times the size of a regular PACE operator.

Like its peers, InnovAge strives to improve the health of its participants and reduce medical costs by leveraging its extensive network of services. Its interdisciplinary care team includes primary care providers, home care coordinators, personal care attendants, drivers, nutritionists and more.

InnovAge’s referrals are similarly broad, with participants coming from hospitals, nursing homes and long-term care facilities, as well as the entire community.

“Given what PACE does and what it offers, we are a powerful alternative to nursing home care,” says Hewitt.

From 2016 to 2020, InnovAge increased the number of participants from 3,100 to 6,400. Over the same period, the company’s revenue increased from $ 233 million to $ 567 million.

As Innovage continues to gain momentum, more profit programs may seek to set up shops, supported by the interests of payers and private-equity funds.

Nonprofits like the Summit are also in a good position for future growth.

“From [1995] So far, we have grown significantly, “Shriver said. “Our goal is to continue to grow fairly aggressively over the next few years.”

PACE providers shift services to the home in a national long-term care review

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