PACE has shown path to im­proved el­der care

Modern Healthcare - - COMMENT - By Shawn Bloom Shawn Bloom is pres­i­dent and CEO of the Na­tional PACE As­so­ci­a­tion.

As the num­ber of se­niors with longterm ser­vice and sup­port needs continues to grow, Medi­care and Med­i­caid are seek­ing new ways to pro­vide care and ser­vices more ef­fec­tively and ef­fi­ciently. One model, Pro­grams of All-in­clu­sive Care for the El­derly, or PACE, has a suc­cess­ful track record of serv­ing low-in­come, dual-el­i­gi­ble se­niors—the frailest of the frail—since its in­cep­tion more than 25 years ago.

Now with more than 100 pro­grams in 31 states, PACE is look­ing to build on its ex­pe­ri­ence and make a sig­nif­i­cant con­tri­bu­tion to­ward achiev­ing state and federal goals for dual-el­i­gi­bles need­ing longterm sup­port ser­vices. But re­spond­ing to the new needs of state and federal pol­i­cy­mak­ers means up­dat­ing reg­u­la­tions and over­sight to sup­port in­no­va­tive mod­els.

PACE came into ex­is­tence as a way to serve nurs­ing home-el­i­gi­ble elders in the com­mu­nity. The pro­gram’s abil­ity to in­te­grate all med­i­cally nec­es­sary care with ser­vices and so­cial sup­port through a bun­dled, cap­i­tated pay­ment sys­tem is the key to its suc­cess. PACE has demon­strated its abil­ity to con­trol the costs of car­ing for dual-el­i­gi­bles in need of long-term sup­port, while keep­ing them out of nurs­ing homes. More than 90% of PACE en­rollees re­side in a com­mu­nity set­ting.

To­day, PACE or­ga­ni­za­tions, po­ten­tial spon­sors and states in­ter­ested in ex­pand­ing ac­cess are limited by a reg­u­la­tory ap­proach that needs to be up­dated. While federal reg­u­la­tions gov­ern­ing PACE were de­signed to en­sure the suc­cess­ful tran­si­tion of PACE from a demon­stra­tion pro­gram to a per­ma­nent part of Medi­care, they have not kept up with to­day’s in­no­va­tions. Many PACE or­ga­ni­za­tions are ea­ger to ex­pand their ser­vice ar­eas, en­gage com­mu­nity physi­cians and uti­lize al­ter­na­tive-care set­tings, yet cur­rent reg­u­la­tions stymie these ef­forts.

As a re­sult, much of the prom­ise of PACE is be­ing left un­tapped. PACE is best po­si­tioned to help states and the federal govern­ment achieve their goals of bet­ter-in­te­grated, more cost-ef­fec­tive sup­port, in com­par­i­son to Med­i­caid man­aged­care plans. Ac­cord­ing to a re­cent Tru­ven Health An­a­lyt­ics re­port, states that have Med­i­caid man­aged-care plans keep less than half of their nurs­ing home-el­i­gi­ble en­rollees out of nurs­ing homes.

If the goal of care in­no­va­tion for this vul­ner­a­ble pop­u­la­tion is to im­prove re­sults, then we need a federal and state reg­u­la­tory en­vi­ron­ment that can build on and ex­pand the role of PACE through growth, in­no­va­tion and ac­count­abil­ity.

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