pace: a foundation for serving people with intellectual disabilities? peter fitzgerald national pace...
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The PACE Model: Who Does It Serve? 55 years of age or older Living in a PACE service area Certified as needing nursing home level of care Able to live safely in the community with the services of the PACE program at the time of enrollmentTRANSCRIPT
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PACE: A Foundation for PACE: A Foundation for Serving People with Serving People with
Intellectual Disabilities?Intellectual Disabilities?
Peter FitzgeraldNational PACE AssociationAlexandria, [email protected]
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What is PACE?What is PACE?PProgram of rogram of AAll-Inclusive ll-Inclusive CCare for the are for the EElderlylderly
An integrated system of care for the frail elderly that is:
• Community-based
• Comprehensive
• Capitated
• Coordinated
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The PACE Model: Who Does It Serve?
• 55 years of age or older
• Living in a PACE service area
• Certified as needing nursing home level of care
• Able to live safely in the community with the services of the PACE program at the time of enrollment
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PACE Demographics
• Average age at enrollment: 78• 75 percent of enrollees are women• Average length in the program 2.5 years• Most common reason for disenrollment:
death
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Milestones in the PACE Model History
On Lok Waivers/Full Risk
1983
On Lok OngoingWaivers
1985
First Center – On Lok
1973 1978
On Lok Demo. Project
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First Demonstration
Sites Operational
1986
Legislation Authorizing PACE
Demonstration
1990 1997
Congress AuthorizesPermanent
Provider Status
Balanced Budget Act of 1997, H.R. 2015
Washington, D.C.
(Nov) 1999
Publication of Interim Final PACE Regulation
First Program Achieves
Permanent PACE Provider
Status
(Nov) 2001
Milestones in the PACE Model History
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Final PACE Rule
(Oct) 2002
Publication of 2nd Interim Final PACE Regulation
enhancing opportunities for program flexibility
November 2006
Milestones in the PACE Model History
PACE required to be a Part D Plan
2005
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The PACE Model Philosophy
Honors what elders want • To stay in familiar surroundings
• To maintain autonomy
• To maintain a maximum level of physical, social, and cognitive function
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PACE Services Provided•nursing•physical therapy,•occupational therapy •recreational therapy•meals•nutritional counseling •social work•medical care•home health care
•personal care •prescription drugs •social services •audiology•dentistry•optometry •podiatry •speech therapy •respite care
Hospital and nursing home care when necessary
&All medically necessary care and services
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Locations of Care
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PACE Provides Transportation
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Integrated Service Delivery and Team Managed Care
Interdisciplinary TeamsParticipant and Family
Home CarePharmacy
Nutrition
OT/PT
Primary Care
Transportation
Personal Care
Activities
Social Social WorkWork
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Integrated, Team Managed CareIntegrated, Team Managed Care
• An interdisciplinary team of professionals with a direct care relationship to the participant
• Team managed care vs. individual case manager• Continuous process of assessment, treatment planning,
service provision and monitoring• Focus on prevention• Aligned quality and payment incentives
–More of the right care means– Less high cost care– Look at long term needs, vs. short-term savings– No cost shifting
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PACE is Small in Scale
Each PACE center and IDT can serve up to about 200 enrollees.
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Capitated, Pooled Financing• Medicare capitation rate adjusted for the
diagnoses and frailty of the PACE enrollees
• Integration of Medicare, Medicaid and private pay payments
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Source of Service RevenueFor Dual Eligible individuals
• 2010 Mean Medicare PMPM Rate: $2063
• 2010 Median Medicaid PMPM Rate: $3258
• PACE also the Part D prescription drug plan for Medicare beneficiaries
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• 172 PACE centers, operated by 80 organizations, in 28 states, serving 23,000+
• Between 2005-2010, number doubled • Enrollment grew 20% in 2008, 13% in
2009• 15 new programs in development
“pipeline”
Status of PACE Development (as of October 2011)
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National Census Growth 1996 – 2010
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PACE Programs Around the U.S.
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PACE Core Competencies Provider-based model Serves a nursing home eligible population in
the community (90% +) Good care outcomes, high enrollee
satisfaction and low disenrollment rates Because PACE is still unfamiliar, a well
known, trusted provider has an advantage
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• Begin to think in terms of People vs. Sentinel Events..
• Abandon the assumption that more is better.
• Understand that not all aspects of care are clinically based, some require simple creativity.
• Embrace the importance of a consistent care delivery system over time.
Challenge for ProvidersChallenge for Providers
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Benefits for StakeholdersProviders: Flexibility to provide the right care and services for each individual.Gov’t Payors: Predictable, lower costs. Shifts financial risk to providers.Family Caregivers: A model of care that supports their efforts.Participant: A model of care focused around their goal to live independently, in the community.
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Serving People with Intellectual Disabilities
• Foundation to Build on– Experience managing complex needs– Provider-sponsored– Direct relationship with individual– Recognition of medical AND social dimensions of
care– Care in the home, and in other settings– Some experience with consumer directed care
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Challenges and Questions• Does PACE provide the range of services needed
by individuals with intellectual disabilities? If not what additional services and supports are needed?
• What core competencies are needed by PACE staff serving individuals with ID?
• Would an ID only PACE Organization be necessary?
• How should PACE be integrated with community living options and services?
• Appropriate cost-basis and rate setting?