For those of you who are not familiar with the PACE alternative of care, you will find this model very interesting. PACE is one of the alternative models of care that is funded by Medicare and take a unique financial approach. As you will learn in the interview with Shawn Bloom, president and CEO of the National PACE Association, PACE programs are financially motivated to following preventative paths of cafe – a unique occurrence in health care today. This incentive forces PACE Centers to take more of a 360-degree view of care than many care models available.
Shawn’s Description of the PACE Model
Programs of All-inclusive Care for the Elderly (PACE) are innovative because they provide continuous care and services offering individuals eligible for nursing home care the option of continuing to live in the community. Because these health care costs are traditionally paid for through the Medicare and Medicaid programs and out of people’s pockets, access to a comprehensive system of care that encompasses preventive, primary, acute and long term care is usually not possible. One key to the PACE model is the combining of dollars from different funding streams in order to deliver a comprehensive set of services focused on the health and well-being of the individual.
Because PACE delivers care differently from traditional long term care providers, it can be difficult to understand how all the elements of the program work together. For example, the public may be mostly aware of the PACE program’s vans that provide transportation to PACE participants. Policy makers may view PACE as a program that integrates Medicare and long term care funding in a way that saves taxpayer dollars while providing more effective care. PACE participants and their family members might see the PACE center that they attend as the central part of the program. But it is the combination of the different components of the PACE model, including the work of the interdisciplinary team, that results in care and services that are tailored to the individual needs of each PACE participant.
What is PACE?
The ability to coordinate the care of each participant enrolled in PACE is key to the model. PACE programs coordinate and provide all needed preventive, primary, acute and long term care services so that their participants can continue living in the community. To understand how PACE works, it is important to learn about the components of PACE that enable it to respond to the unique needs of each participant enrolled in the program.
Interdisciplinary Teams: Teams comprised of physicians, nurse practitioners, nurses, social workers, therapists, van drivers, aides and others — meet regularly to exchange information and solve problems as the conditions and needs of PACE participants change. Through interdisciplinary teams, the viewpoints of different disciplines are brought together, and information gained through interaction with the PACE participants over time and in different settings is shared. This approach empowers those involved and allows more information to be available at the critical points when decisions are being made.
Capitated Payment Arrangements: PACE receives a monthly capitated payment (i.e., a lump sum from Medicare combined with Medicaid or a participant’s private pay resources that is used to pay for a variety of comprehensive services) and is responsible for the care their participants need. As such, the financial interests of the PACE program and the care needs of the persons they serve are aligned in a unique way. Regardless of whether needed services would be reimbursed under traditional fee-for-service Medicare and Medicaid, PACE provides a comprehensive set of preventive, primary, acute and long term care services that are specifically tailored to the needs of each PACE participant to help them avoid hospital or nursing home placement to the greatest extent possible. The program is designed to closely monitor participants for even subtle changes in needs, which if left unattended could lead to costly acute care episodes.
For example, a Medicare beneficiary shows up at the emergency room every month to be treated for skin infections caused by flea bites. The traditional, fragmented care delivery system would have trouble addressing the root cause of her condition and might just keep treating the patient’s flea bites. For a PACE enrollee, the team, with input from social workers, home health aides and drivers who have been in her home, may decide to fumigate her home and provide a flea dip for her pet. This flexibility can produce more cost effective solutions and a higher quality of life than prescribing costly medications or continually hospitalizing an individual.
PACE Centers: PACE participants regularly attend the PACE center on an average of three days per week. This center includes a health clinic with an on-site physician and nurse practitioner, physical and occupational therapy facilities, and at least one common room for social and recreational activities. Unlike fee-for-service Medicare and Medicaid programs, PACE has the flexibility to provide services such as occupational and physical therapies even when the goal is to maintain or slow the decline of an ability — not to cause measurable improvement. Because PACE participants have regular contact with primary care professionals who know them well, slight changes in their health status or mood can be immediately addressed.
Transportation: Transportation for PACE participants is another covered benefit. Transportation is critical to the implementation of the care plan. It is a key way in which PACE supports families who are providing care for their loved ones. Transportation is provided not only to and from the day center, but also to other appointments. Providing transportation also places a driver, who has been trained to observe cues, in the home of the PACE participant. Drivers can then report these cues that may signal a change in health status or other changes that should be monitored.
About Shawn Bloom
Shawn Bloom is the President and CEO of the National PACE Association (NPA), an organization that represents 71 operating PACE sites and approximately 40 additional health care organizations in various stages of PACE site development. Since joining NPA in (1999), the number of PACE locations has grown to serve over 17,000 participants around the Nation. Shawn has served as the Principal Investigator for many PACE-related grant supported efforts and his leadership has played an instrumental role in not only the growth of PACE, but health care policy reform in general. Shawn frequently speaks on behalf of PACE and health care policy topics at aging forums and numerous federal, state and local provider conferences. With over 25 years in the elder and health care industries, Shawn is a well-known expert with National and local media and frequently is called to testify before state and federal policymakers.
Prior to assuming the role of President and CEO with NPA, Shawn spent 5 years as the Executive Director of the Missouri Association of Homes for the Aging (MoAHA), which represented over 100 not-for-profit long-term health care and housing facilities in the state of Missouri. Shawn previously worked in the Policy and Governmental Affairs Division of the American Association of Homes and Services for the Aging (AAHSA), a Washington, D.C.-based trade association that represents approximately 6000 providers of long-term health and housing services for the aging.
Shawn received his B.S. in biochemistry and gerontology from Kansas State University and completed his M.S. coursework in long term care at the University of North Texas, Center for Studies in Aging. Shawn began his career in the elder and health care industries early in life, working as a nursing home Certified Nurse Aide in high school and college.