PACE: A Foundation for PACE: A Foundation for Serving People with Serving People with

Intellectual Disabilities?Intellectual Disabilities?

Peter FitzgeraldNational PACE AssociationAlexandria, VAPeterf@NPAonline.org

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

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

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

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

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

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

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

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

Locations of Care

PACE Provides Transportation

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

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

PACE is Small in Scale

Each PACE center and IDT can serve up to about 200 enrollees.

Capitated, Pooled Financing• Medicare capitation rate adjusted for the

diagnoses and frailty of the PACE enrollees

• Integration of Medicare, Medicaid and private pay payments

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

• 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)

National Census Growth 1996 – 2010

PACE Programs Around the U.S.

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

• 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

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.

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

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?