program for all-inclusive care for the elderly: an important addition to your ccrc webinar:...
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Program for All-Inclusive Carefor the Elderly:
An Important Addition to Your CCRCWebinar: 266130329November 2, 2011
TIME TOPIC
3:00p-3:10p Welcome-Overview of SessionSpeaker IntroductionsLarry Minnix, President/CEO, LeadingAgeShawn Bloom, President/CEO, NPA
3:10p-3:25p PACE 101: Shawn Bloom, President/CEO, NPA
3:25p-3:35p Integrated Medical Delivery: Cheryl Phillips, MDSenior VP, Advocacy, LeadingAge
3:35p-3:50p PACE and CCRCs: Dan GrayPresident, Continuum Development Services
3:50p-4:00p Case Study-Presbyterian Senior LivingSteve Proctor, CEO
4:00p-4:10p Case Study-Presbyterian Villages of MichiganRoger Myers, President/CEO
4:10p-4:30p Questions/Answers
Agenda
PACE 101
Presented by:
Shawn Bloom, President/CEO
National PACE Associationwww.npaonline.org
Program of All-inclusive Care Program of All-inclusive Care for the Elderly (PACE)for the Elderly (PACE)
www.NPAonline.org
Overview
Presentation Outline
PACE Overview and Brief History PACE Experience with Dual Eligibles Questions/Comments
The The PProgram of rogram of AAll-inclusive ll-inclusive CCare for the are for the EElderlylderly
Is an integrated system of care for the frail elderly that is:
• Community-based
• Coordinated
• Comprehensive
• Capitated
Who Does PACE Serve?
Adults 55 years of age or older and who are:
• Living in a PACE organization’s service area
• State-certified as eligible for nursing home level of care
• Able to live safely in the community with the services of the PACE program at the time of enrollment
PACE is Community-Based
PACE provides innovative, person-centered care for older adults that allows them to stay in their homes and communities and out of nursing homes
“PACE’s help in being able to keep mom at home has enabled us to keep our family together.”
Family Member of a PACE Participant
Employs interdisciplinary teams to deliver and coordinate care across care settings• Doctors, nurses, therapists, social workers,
dieticians, personal care aides, and other providers
• Day centers, clinics, occupational and physical therapy facilities
• Individuals’ homes
• Hospitals and nursing homes, if necessary
PACE Provides Coordinated, Comprehensive Care
PACE Provides Coordinated and Comprehensive Care
Bundles Medicare and Medicaid payments to provide full range of health care services Medical care, social services, and
other long-term services and supports
Capitated, Pooled Financing
Integration of Medicare, Medicaid and private pay payments by PACE providers
Medicare A/B capitation payments risk- and frailty- adjusted for PACE participants
Medicare Part D payments based on bid amounts
Medicaid capitated payment amounts based on states’ expenditures for long-term care populations
Sources of Service Revenue PACE Programs receive approximately
$5,349 PMPM in 2011: 60% of their revenue from Medicaid 40% from Medicare
(A small percentage of program revenue comes from private sources or enrollees paying privately)
2011 Mean Medicare PMPM Rate: $2,018 2011 Mean Medicaid PMPM Rate: $3,331
PACE Programs are Medicare D providers
PACE Organizations Provide:
All Medicare and Medicaid covered–services and more
• medical care• nursing• physical therapy• occupational therapy • recreational therapy• meals• nutritional counseling • social work• home health care• hospital care
• personal care • prescription drugs • social services • audiology• dentistry• optometry • podiatry • speech therapy • respite care• SNF/NH care
PACE History and Evolution 1983 – On Lok demonstration
1986 – PACE replication demonstration
1997 – Congress established PACE as permanent Medicare provider and Medicaid state option (Balanced Budget Act)
Distinct statutory and regulatory designation as a provider-based entity
Sections 1894 and 1934, Social Security Act Title 42, Part 460, Code of Federal Regulations
PACE Core Competencies Operates as a provider-based model Serves exclusively a nursing home eligible
population Produces good outcomes:
Participants more likely to have advance care directives and die at home
PACE participants, caregivers, and employees report high satisfaction with the program
PACE participants have reduced hospitalizations and permanent residency in nursing homes
Integrated, Interdisciplinary Team Care
Hands-on interdisciplinary team approach to care management vs. individual case management
Continuous process of assessment, treatment planning, service provision, and monitoring
Focus on prevention, primary, secondary, and tertiary care
PACE is:Fully-Accountable for the Cost and Quality of
Care Provided How can we move from successfully treating
individual diseases, to successfully caring for individuals? Can we do it for less?
Proven track record in preserving wellness and promoting quality care
Integrated and fixed-rate financing system reduces the cost of care compared to nursing home care substantially
A recent HHS report found PACE generates better health outcomes
A long history serving dual eligibles, where one size does not fit all
90 percent of PACE participants are dual eligibles (Medicare & Medicaid eligible)
Dual eligibles have multiple, complex conditions and benefit from the PACE model of comprehensive, individualized care
PACE has:
PACE has a long history and unique approach 30+ year track record Direct, hands-on provider Accepts full financial risk for participants’ cost and
health care Exclusively serves a subset of the dual eligible
population – frail, older adults
PACE is Distinct
Status of PACE (as of 10/11)
Currently there are 166 PACE centers, operated by 81 sponsoring organizations in 29 states
Over 23,000 PACE participants One-fifth of PACE organizations indicate that
they are approaching enrollment cap imposed by their states
Over one-half of PACE organizations plan to expand with the development of one or more centers in 2011
PACE Responds to Tough Health Care Challenges
For Consumers—Participants/Caregivers: Comprehensive, preferred method of care Stay in the community as long as possible One-stop shopping
For Providers: Freedom from traditional FFS restrictions Focus on the entire range of needs of individual
For Payers: Value and predictable expenditures Comprehensive service package
New Opportunities for PACE Number of PACE organizations doubled in last 5
years to 76:
• Rural PACE grants – 13 rural programs
• More diversity among interested sponsors (e.g., hospices)
• State interest in PACE expansion
PACE/Veterans Administration Start-up Program
New demonstrations being developed to
• Expand current PACE program and offer the model to different populations that would benefit from its services
Recent History
Looking Ahead
Integrated Medical Delivery
Presented by:
Cheryl Phillips, MD
Senior Vice President, Advocacy
LeadingAgewww.LeadingAge.org
How is PACE Clinical Care Delivered?
The center of care delivery is the interdisciplinary team (IDT)
Care plans are created with (not just for) the individual and family and includes social, cultural, functional aspects of care – in addition to the medical needs
Most of the services are coordinated through the adult day center – thus social care is integrated directly with medical care
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What Does the IDT Look Like?
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Interdisciplinary teams assess need, deliver & manage care across settings:
Primary Care
Transportation
Home Care
Nursing
OT/PT
Speech
Nutrition
Recreation
Social Services
Settings/Services
• Adult Day Health Care
• Personal Care
• Home Care
• Nursing Home
• Hospital
• Medical Specialists
• Pharmacy
• Lab/X-ray Medications/DME
Care Management = Care Coordination
Interdisciplinary Team (IDT) Care Planning• Integrates skilled assessment and evaluation findings and
regular assessments by PACE IDT members (physician, nurse, rehab therapists, social worker, dietary, recreation and home care staff) into new or revised person-centered care plan.
Frequent Monitoring• Regular attendance at day center combine with home care
according to individualized care plan
• Input from professionals and paraprofessionals
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Care Management = Care Coordination
Collaborative Care Planning with Participants and Family Members• Insures and improves quality of care
• Maintains participant autonomy
• Comprehensive medical record integrates person-centered goals across the team
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Medical Management
The goal is to maximize medical management in the outpatientsetting and integrate social and functional support needs with IDT
Primary care team on-site: MD, NP, RN
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Medical Management Full-service clinic for urgent care and
management of chronic conditions• IV and Respiratory therapy• Wound care management• Frequent visits for management of chronic disease• Daily clinic care and observation can often prevent
hospitalizations• 24 hour call system with on-call physicians and
nurses linking to IDT• Effective person-centered and team-based delivery
of end-of-life care
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CCRCs Have Much of the Clinical Structure
Many already have on-site clinics and nursing staff
Culture of wellness and prevention is central to CCRC model
Care Coordination is already a skill set – coordinating information and person-specific goals across settings of care
CCRC staff understand the intersection of clinical conditions with function and the goal to maintain independence for as long as possible
Synergies of PACE and the CCRC
Presented by:
Dan Gray, President
Continuum Development Serviceswww.consulting-cds.com
CCRC Challenges
Chronic downturn in the economy
Continuing housing crisis
Upcoming 11% reduction in Medicare Part A reimbursement for skilled nursing
States slashing Medicaid payments
Plummeting investment income and value
Shrinking charitable contributions
Broadening Your Market
CCRCs and The Future
Mission—reach out to older adults who cannot afford to be in a CCRC or wish to remain in their own home
Market—broadens the market from 2% served to the possibility of serving all seniors
Business—diversify into revenue not capital intensive services
CCRCs and The Future
Many CCRCs have strategically developed home- and community-based services for the broader community Mission: develop a broad array of
services for older adults regardless of economic or functional status
Economic StatusAdequate Inadequate Impoverished
Functional StatusIndependent
Retirement CommunitiesLife Care at Home
Rental Retirement Communities, Middle and low income Tax-credit financed housing
Affordable Housing
Needs Assistance
Home CareAdult Day CareAssisted Living
Home CareAdult Day CareAssisted Living
Home CareAdult Day Care
Frail
Private Pay PACEHome CareNursing Home
Spend Down into PACEHome CareNursing Home-Spend Down
PACEHome CareNursing Home
Continuum of Care
Synergies
Housing with Services Care Management across the
Continuum Social Accountability/Medicaid Capital to Fund PACE Start-up The Future of Senior Living and PACE Common Not-for-Profit and Faith-
Based Traditions
Housing With Services
Great place to market PACE—up to 20% may be nursing home eligible
Let costly place to provide services Transportation, which can be costly, can be
avoided CCRCs are experienced developers and operators of
housing with services—a valuable component of PACE
Care Management Across the Continuum
Several CCRCs are adding Chief Medical Directors to integrate services across continuum
In PACE, Medical Directors and Nurse Practitioners are integral to the model PACE is a platform for improving care
management and developing a comprehensive service continuum
Social Accountability/Medicaid
Increasing need to document social accountability efforts—tax issue
Opportunity to serve Medicaid population combined with Medicare—more profitable than serving Medicaid only population PACE allows CCRCs to expand their mission
to the economically disadvantaged while being good stewards of the organization’s resources
Capital to Fund PACE
Reasonable estimate is $15k per participant slot--$4.5m to develop a 300-participant program
Financing opportunities include short-term bank loans, internal loans refinanced into long-term debt after stabilization Many CCRCs have the liquidity and the
mission imperative to make a strategic investment in PACE
Future of Senior Living and PACE
CCRCs having PACE in their continuum will be the leaders in these innovations and in ACOs
Not-For-Profit and Faith-Based Traditions
Senior living organizations have led innovations in caring for the frail elderly for past 100 years
Restraint-free environments Small households Greenhouses® Culture change Assisted living PACE
CCRCs and PACE
CCRCs should become the leading provider of PACE in the future
Presbyterian Senior Living
Presented by:
Steve Proctor
President/CEO
Presbyterian Senior Livingwww.presbyterianseniorliving.org
Presbyterian Senior Living
9th largest senior care provider on Zeigler 100 24 locations in Pennsylvania, Maryland,
Delaware and SE Ohio Upscale CCRCs to affordable housing, skilled
nursing, personal care, and assisted living Historic commitment to serving low to moderate
income seniors throughout the continuum Approach to social responsibility – we earn
money from upscale operations to fund services to those in need
Strategic Focus—Long-Term Care Continuum
Offer a continuum of care to persons in a wide range of financial circumstances
The continuum should be flexible, cohesive, quality driven
Elements of the continuum provided directly by PSL or in partnership with others
PACE is an extension of our affordable housing and services strategy which enables PSL to offer a full range of services to those with limited resources
PACE in Pennsylvania
Called Living Independently for Seniors (LIFE)
County by county franchise Commitment to expansion has faded
with leadership changes within state government
PACE in the Lehigh Valley
Separate location from other operations (2 CCRCs, 1 free standing AL with specialty dementia product, and adult day program with a 20-year history)
Opened in February 2009, first enrollment May 2009
Slower than expected start up due to resistance from AAA
Current census is 58 Program benefits from the synergy of a wider
continuum
PACE in Lancaster
Market saturation–county has 18 retirement communities
New location opening in December 2011 Located next to 1500 member church with
extraordinary physical plant available to retirement community
PACE in Lancaster
Campus will serve 200 senior families with AL, market rate rental, tax credit housing – no skilled nursing component
Relationship with Albright Senior Services—PACE provider
Strong response—considered model for the future
Presbyterian Villages of Michigan
Presented by:
Roger Myers
President/CEO
Presbyterian Villages of Michiganwww.pvm.org
PVM Locations
PACE Eligibles
Program Outcomes
Program Outcomes
Program Outcomes
Program Outcomes
East Jefferson Project Area
East Jefferson Building Design
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East Jefferson Building Design
East Jefferson Condo Structure
East Jefferson Organizational Chart
Questions
LeadingAgewww.LeadingAge.org
National PACE Associationwww.npaonline.org